Essay

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Week 6 Assignment: EBP Change Process form

ACE Star Model of Knowledge Transformation

Follow Nurse Daniel as your process mentor in the weekly Illustration section of the lesson. Please do not use any of the Nurse Daniel information for your own topic, nursing intervention, or change project. Nurse Daniel serves as an example only to illustrate the change process.

Name:

Star Point 1: Discovery (Identify topic and practice issue)

Identify the topic and the nursing practice issue related to this topic. (This MUST involve a nursing practice issue.)

The topic of my nursing practice issue is reducing surgical infection rate by prohibiting artificial nails among clinical staff members.

Briefly describe your rationale for your topic selection. Include the scope of the issue/problem.

Hospital Acquired Infections (HAIs) are a major concern for all types of healthcare facilities. The Center for Disease Control and Prevention states that on any given day, about one in 31 hospital patients has at least one healthcare-associated infection. (2018). Hand hygiene is the most important method of preventing infections and this is especially true in the perioperative field. Outbreaks of similar infections cultured from the surgical site can be traced back to individuals who wear artificial nails. Infections are a major post-surgical complication and costs the healthcare facility money and can cost a patient their life.

Star Point 2: Summary (Evidence to support need for a change)

Describe the practice problem in your own words and formulate your PICOT question.

Artificial nails are breeding grounds for bacteria, fungus and viruses. Staff at my facility wear these nail enhancements and studies reveal adverse patient outcomes when providing patient care while having nail enhancements. Among surgical staff members, would banning artificial nail enhancements lead to a decrease in surgical site infections in postoperative adult patients over a 3 month period?

List the systematic review chosen from the CCN Library databases. Type the complete APA reference for the systematic review selected.

Winslow, E, Jacobson, A. (2001 October). The case against artificial nails. In Combating Infection. Retrieved from :https://eds-b-ebscohost-com.chamberlainuniversity.idm.oclc.org/eds/detail/detail?vid=1&sid=8cf67705-a24d-462f-87a9-13f8bcb8b5db%40sessionmgr103&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#db=c8h&AN=106889325

List and briefly describe other sources used for data and information. List any other optional scholarly source used as a supplement to the systematic review in APA format.

Hand Hygiene in Healthcare Setting. (2020 January 31). The Center for Disease Control and Prevention. Retrieved from: https://www.cdc.gov/handhygiene/providers/index.html

Marchetti, A., Rossiter R. (2013 December).Economic burden of healthcare-associated infection in US acute care hospitals: societal perspective. J Med Econ;16(12):1399-404. doi: 10.3111/13696998.2013.842922. PMID: 24024988.

Briefly summarize the main findings (in your own words) from the systematic review and the strength of the evidence.

This review was written to inform healthcare professionals about the danger of wearing nail extensions in the workplace. It references different root-cause analysis which revealed that the patients who suffered a postsurgical infection in a specific time period were all traced back to operating room staff whose artificial nails were cultured to the corresponding infection. This is evident of a direct correlation between nail extensions and infections. Also, the review explains that even after performing hand hygiene, more pathogens are cultured from healthcare workers with artificial nails than those without.

Outline one or two evidence-based solutions you will consider for the trial project.

The article referenced the CDC guidelines for all perioperative team members to have short, clean nails free of any enhancements. This evidence based solution helps prevent HAIs by reducing the surface area of the fingernails which harbor a flora of pathogens.

Star Point 3: Translation (Action Plan)

Identify care standards, practice guidelines, or protocols that may be in place to support your intervention planning (These may come from your organization or from the other sources listed in your Summary section in Star Point 2).

Our facility policies on hand hygiene include using an alcohol-based hand rub before donning and after doffing gloves and between patient contact. Team members that work inside the sterile field (surgeons and operating room technicians) must scrub using a Chlorhexidine hand scrub for 5 minutes prior to donning sterile gloves for the surgical procedure. The CDC, "recommended that healthcare providers do not wear artificial fingernails or extensions when having direct contact with patients at high risk (e.g., those in intensive-care units or operating rooms)". (2020). Keep natural nail tips less than ¼ inch long." Avagard nail scrub must be used under the nails.

List your stakeholders (by title and not names; include yourself) and describe their roles and responsibilities in the change process (no more than 5).

Nurses and Operating Room Technicians- These are the most hands-on team members whose' hand hygiene directly impacts patient outcomes. Nurse Managers - Enforce the policies and oversee their compliance. Director of Nursing - Creating new guidelines and policies with respect to state and federal mandates and under the standards of the accreditation organization, Joint Commission. Compliance Manager - Reports to the state Department of Health and the Center for Medicare & Medicaid Services all reportable incidents including post-surgical infection rates.  

What specifically is your nursing role in the change process? Other nursing roles?

As an assistant nurse manager, it is my job to explain the new policy to the staff members. I usually do this during in-service meetings and open the floor for questions and concerns brought up by my team. I also observe to see if the new policy is being embraced by the staff. If not, I must investigate the motivations behind the policy non-compliance. The staff nurses' responsibility is to be the link in the prevention of infection which starts with proper hand hygiene as explained in the new policy. The Director of Nursing has a role to report occurrences and infection rates to outside committees which oversee our facility's accreditation.

List your stakeholders by position titles (charge nurse, pharmacist, etc.).-Why are the members chosen (stakeholders) important to your project?

Staff nurses, operating room technicians, surgeons, nurse managers, director of nursing, compliance manager. These team members are the most important stakeholders in implementing this change. The clinical staff mentioned are the ones that perform all hands-on care. They are the main catalysts in spreading infection in the operating room. Middle management is important in making sure that clinical staff members adhere to the new policy and they are the ones that will report to upper management. In turn, upper management uses this data when compiling their quarterly reports for the Joint Commission and this information will also be used in their annual report to CMS.

What type of cost analysis will be needed prior to a trial? Who needs to be involved with this?

The cost analysis is leaning towards embracing the new policy of banning nail extensions for clinical staff. The cost of not adopting this policy would lead to an increase in infection rates in postoperative patients. According to Marchetti and Rossiter, "HAIs in US acute-care hospitals lead to direct and indirect costs totaling $96-$147 billion annually." (2013). Not only do HAIs burden the facility financially, they can threaten to shut down the center. The Joint Commission is who accredits ambulatory surgery facilities. Adverse patient outcomes such as medication errors, surgical site infections and falls are reasons for Joint Commission to withdraw accreditation. Without this we cannot continue the day to day operations.

Star Point 4: (Implementation)

Describe the process for gaining permission to plan and begin a trial. Is there a specific group, committee, or nurse leader involved?

In order to implement change there must be a need for it. Seeing that some staff members go against policy, this matter needs to be brought to the nurse manager in charge of the unit. Then, she will discuss this matter with the most senior nurse, the Director of Nursing as well as the Medical Director. Ultimately, they are the ones who will deem the policy necessary to implement. Describe the plan for educating the staff about the change process trial and how they will be impacted or asked to participate. In my facility, any changes in policy must be explained to the staff during in-service meetings. This gives the staff that are impacted by the policy a rationale for why this will lead to better patient outcomes as well as giving them an opportunity to voice their concerns over the proposed changes. Staff members who chose to wear nail enhancements will be asked to have them removed and begin working in accordance with policy. Issues with non-compliance with the policy may warrant grounds for termination of employment.   Outline the implementation timeline for the change process (start time/end time, what steps are to occur along the timeline). Week 1 - Compliance Manager must compile a statistical report on all reportable incidents. Rates on infection must be singled out. Nurse Manager and Director of Nursing have a meeting on trial. Week 2- In-service for staff about the need to remove artificial nails.

Week 2 – Week 14- Nurse Manager conducts audits and collects data on reportable incidences and infection rates.

Week 15- Compliance Manager assessed efficacy or failure of initiative

Week 15- Director of Nursing compiles information to be reported to Department of Health

Week 16- Policy is revisited by management and becomes permanent policy or removed.

List the measurable outcomes based on the PICOT. How will these be measured?

The measurable outcomes would be an increase or a decrease in post-surgical infection rates. They will be measured by a patient survey, in which one question asks "Have you had a surgical site infection postoperatively?". To have a baseline for measuring the effectiveness, the Compliance Manager must compile a statistical report based on infection rates which occurred during a period of time when clinical staff members wore nail enhancements

What forms, if any, might be used for recording purposes during the pilot change process. Describe. All reportable incidents must be documented on a Quality Assessment Form which the Compliance Manager keeps a record of. This is the information that must be reported to the Joint Commission and CMS.

What resources are available to staff (include yourself) during the change pilot?

Nurse Managers are available as resources for the staff to voice their concerns about the change. The managers are also there to provide information about the process. Visual resources are a great idea such as CDC posters on hand hygiene.

Will there be meetings of certain stakeholders throughout the trial? If so, who and when will they meet?

The primary meeting of stakeholders is the only meeting necessary due to the small size of the facility.

Star Point 5: (Evaluation)

How will you report the outcomes of the trial?

Outcomes of the trial will be reported to upper management by the middle management (nurse managers). From there, it will trickle down to the staff members where it will be reported to them during another in-service meeting. A good idea would be to present the ongoing evaluation of outcomes in a visual representation such as a frequency chart. This will encourage the staff to adhere to policy because they can visually see that these interventions are making a difference.

What would be the next steps for the use of the change process information?

This information would be used as a basis for hand hygiene protocols in the surgery center. It will provide insight with factual data about the efficacy of our trial. In addition, this information can be used during the pre-employment on boarding process where all newly hired staff must agree to the Dress Code Policy which states that nail enhancements are not permitted.

9.2019 Update. DLP