Nursing Discussion #1
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clabsi_education_curriculum.pptxBrandi Shull, Robin Garrison, Anne Rogers, Tina Raab, Charlene Lucas, and Haley Kaufman Walden University NURS 6321-4: Curriculum Development, Assessment, and Evaluation November 13th, 2016
CLABSI Education Curriculum
Introduce speakers: Brandi Shull, Robin Garrison, Anne Rogers, Tina Raab, Charlene Lucas, and Haley Kaufman. We are all MSN students at Walden University. We are going to discuss a central line-associated bloodstream infection, CLASBSI, program that we designed for Navicent Health after conducting a needs assessment of the hospital and identifying an elevated CLABSI rate.
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Objectives
Summarize Navicent Health as a health care facility.
Describe the proposed CLABSI program.
Identify external and internal factors that impact the CLABSI program.
Evaluate learning theories that influence the CLABSI program.
Explain the curriculum design for the CLABSI program at Navicent Health.
Examine the proposed plan of study.
Identify the Master Plan of Evaluation for the CLABSI program.
Analyze the rationale for the Master Plan of Evaluation.
The objectives for this module include: Summarizing Navicent Health as a health care facility. Describing the proposed program. Identifying external and internal factors that impact the CLABSI program. Evaluating learning theories that influence the CLABSI program. Explaining the curriculum design for the CLABSI program at Navicent Health. Examining the proposed plan of study. Identifying the Master Plan of Evaluation for the CLABSI program. And finally, analyzing the rationale for the Master Plan of Evaluation.
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Navicent Health
Navicent Health Center – Bibb County, Macon, Georgia
Research Based, Urban Health Center
Second largest hospital in Georgia
Level I trauma Center
Over 4000 Employees
Specialty Intensive Care Units – Adult, Pediatric, Neo-natal
Above average CLABSI infection rate
(Navicent Health, 2016)
(Navicent Health, n.d.)
Navicent Health is a large, successful, research-based, urban health center in the Southeast region of Bibb County, Macon Georgia. Navicent Health is the second largest hospital in the state of Georgia and has been recognized for it’s Level I Trauma Center, Magnet status, Det Norske Veritas accreditation and numerous excellence awards. Navicent Health organization employs 4,600 individuals and is licensed for 637 beds throughout many specialty departments including specialty Intensive Care units for adults, pediatrics and Neonates. In the intensive care units there is a higher than national average CLABSI rate.
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Influential External & Internal Factors
External Factors
(Navicent Health, 2015)
(Georgia Department of Public Health, 2016)
Internal Factors
The external factors that may affect developing a curriculum for Navicent is the surrounding community. Navicent is located in Macon-Bib county. The estimated population of Macon–Bibb county is 13,632 in 2015, about 59 % of the population is African-American, 37% were white, with the remainder of the population being Asian, Hawaiian, Hispanic and other races. Approximately 70.2% of individuals in Macon had a high school education or higher with a mean household income $29,205 with 34.1% of the population living in poverty.
Continuing education is an important part of providing the best quality of care for patients. The nursing profession as a whole benefit when each nurse grows as individuals in their knowledge of nursing specialties. When evaluating the potential educational needs for staff nurses, it is beneficial to look at nursing-sensitive indicators. The survey stated that Navicent scored below national benchmark on methicillin-resistant Staphylococcus Aureus (MRSA) blood infections possibly related to central line infection or wound care (Hospital Compare, 2016). Other data indicating central line-associated bloodstream infection, CLABSI, is an appropriate topic for an education program include evidence from the Leapfrog Group indicating a CLABSI standardized infection greater of 1.180 (The Leapfrog Group, 2016).
The internal factors that Navicent Health the development of a curriculum is the profit of the hospital. Navicent Health a non-profit corporation that was incorporated on November 17, 1994. The estimated total gross revenue is $2,513,522,395 for its billed services. However, approximately $1,749,256,395 where not paid by Medicare and Medicaid reimbursement, commercial insurance discounts, charity care provided, and bad debt (Navicent Health, 2015). Therefore, the total operating revenue is $764,266,000. The total operating expenses are equal to $720,872,000, which include salaries and employee benefits, supplies and services, and depreciation (Navicent Health, 2015). According to Navicent Health (2014), they received approximately 46% Medicare, 18% Medicaid, 28% private insurance, and 8% self-pay/ indigent payments. Navicent Health also receives $171,131 in cash contributions from charitable organizations and $2,150,430 in cash grants from Navicent Health Foundation (Navicent Health, 2015).
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Gross revenue= $2,513,522,395
Monies not reimbursed=
$1,749,256,395
Total operating revenue=
$764,266,00
Column1
African-American White Other races 0.59000000000000008 0.37000000000000005 4.0000000000000008E-2
Design of Proposed Program
Five Learning Sessions
Introduction to CLABSI
Pretest & Lecture
CLABSI Insertion Bundle
Lecture & Simulation
CLABSI Maintenance Bundle
Lecture & Simulation
Central Line Dressing Changes
Video & Simulation
Early Removal of Central Lines
Case Scenarios, Video, & Simulation
(Lawrence, 2016)
The CLABSI curriculum consists of five learning sessions developed after reviewing best practice recommendations from the literature, DNV accreditation guidelines, and the Joint Commission guidelines.
The first session is titled, “Introduction to CLABSI.” This session starts with a pre-test that establishes the baseline knowledge of class participants. Next, an instructor reviews topics including the definition of terms related to CLABSI, types of central venous catheters, risk factors for CLABSI, how organisms enter the bloodstream, why CLABSI prevention is important for patient safety, and the outcomes monitored related to CLABSI. This initial session is taught in a classroom setting led by a nurse specialist at the facility.
The second session is titled, “CLABSI Insertion Bundle.” This session includes a lecture and simulation component. The learner can participate in a mock central line insertion, demonstrate competency in completing the insertion bundle checklist, and assess maintenance of the central line insertion bundle throughout a simulated procedure.
The third session is titled, “CLABSI Maintenance Bundle.” This session includes a lecture and simulation component. The session begins with a review of the CLABSI maintenance bundle components. Next, staff members demonstrate the administration of an intravenous medication through a central venous catheter and how to connect maintenance intravenous fluids to the catheter.
The fourth session is titled, “Central Line Dressing Changes.” Central line dressing changes are a part of the CLABSI maintenance bundle and are a hospital competency that staff performs annually (DNV Business Assurance, 2013). The session starts with a video that demonstrates the steps for changing a central line dressing change using sterile technique. Next, the staff practices central line dressing changes on a simulated patient. The staff members are assessed for competency while performing this skill on the manikin.
The fifth session is titled, “Early Removal of Central Lines.” A key component of CLABSI prevention is ensuring central lines are only used when medically indicated (The Joint Commission, 2013). Staff members review the list of acceptable reasons for a patient to have a central venous catheter in place. They are also empowered to advocate for patients and ensure the physician is aware if a patient meets criteria per the hospital policy for central line removal. Case scenarios are reviewed, and staff members describe whether the patient meets criteria for maintaining a central line. The learner also discusses a video depicting the technique for central line removal. Each participant performs this skill on a simulated patient. At the conclusion of this learning session, staff members receive a post-test that contains questions related to the information taught in the preceding four weeks.
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Four Theories Utilized
Multiple Theories may be used:
Situated Learning Theory
Role Modeling
Adult Learning Theory
Assimilation Theory
(Keating, 2015)
(Worlde, n.d)
There are multiple theories that can be used to develop a curriculum. Applying multiple theories allows creativity, diversity, multiple points of view and ingenuity when developing a curriculum. For the CLABSI Project the four theories which can be applies are Situated Learning Theory, Role Modeling, Adult Learning Theory and Assimilation Theory. We will look at each theory individually.
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Situated Learning Theory
Learning in the current
environment
(University of Iowa, n.d.)
Role Modeling
Being an example
Mentoring
Utilizing Case Scenarios
(Billings & Halsted, 2016)
Applicable Theories
(Health Xchange, n.d.)
Situated learning theory focuses on learning which can be applied in the situation where it takes place (Billings & Halsted, 2016). CLABSI training can happen in the Navicent Health ICU department
With role modeling, the nurses at Navicent Health can role model to each other a they learn, incorporating case scenarios where appropriate
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Adult Learning Theory
Incorporates Life
Experiences
Assimilation Theory
Blends old and new meanings
(Billings & Halsted, 2016)
Applicable Theories
(Haines Center, 2016)
(Assimilation Theory, n.d.)
With the Adult Learning Theory nursing can incorporate their own life experiences to the training. Navicent Health nurses can build on the knowledge that they already have
The Assimilation Theory allows old meanings to be incorporated into new meanings. The Navicent Health Team can utilize and continue the aspects of CLABSI infection that have worked in the past
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(Ibn El Haj, Lamrini, & Rias, 2013)
Framework: The Donabedian Model
The framework that can be applied to the CLABSI project is based on the Donabedian Model which focuses on quality care. The Donabedian Model contains three components: structure, process and outcomes.
For the CLABSI project, the framework appears as:
Structure: current leadership, patient population, staff skill mix, supplies and material resources used and available
Process: current CLABSI clinical practice, guidelines, policies, procedures
Outcome: current CLABSI infection rates for specific units and/or caregivers
The framework will also include analyzing data, interpreting results, implementing interventions and assessing the benefits
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Curriculum Design
| Session One: Introduction to CLABSI | Session Two: CLABSI Insertion Bundle | Session Three: CLABSI Maintenance Bundle | Session Four: Central Line Dressing Change | Session Five: Early removal of Central Line |
| Complete Pre-Test | Attend didactic lecture | Attend didactic lecture | Watch video of central line dressing change technique | Attend didactic lecture |
| Attend didactic lecture | Participate in simulated central line insertion scenario. RN acts as the primary care nurse for the simulated patient. Must complete central line insertion bundle checklist per hospital standards to pass. | Demonstrate on a simulated patient how to properly administer an intravenous push medication and how to connect maintenance intravenous fluids to a central line. Must demonstrate competency in these skills to pass. | Demonstrate proper technique for performing a central line dressing change. Must demonstrate competency in these skills to pass. | Correctly decide whether a case scenario patient meets criteria to keep a central line in place per hospital and CDC requirements. |
| Correctly identify any breaches in sterile technique observed during procedure. | Correctly describe dressing change schedule per hospital policy. | Pass Post-Test containing questions from previous four weeks of class. |
The curriculum design depicts the components of the program that the learner must successfully complete prior to finishing the program. In session one, the learner must complete a pre-test and attend a didactic lecture. In session two the learner must attend a didactic lecture and participate in a simulated central line insertion scenario that is video taped. They will complete a central line insertion bundle checklist per hospital standards and identify any breaches they observe in sterile technique. During session three the learner must attend the didactic lecture. They also must demonstrate competency at administering an intravenous push medication and connecting an intravenous infusion to a central line. The fourth lecture requires the learner to watch a video of a central line dressing change. After watching the video, learners will demonstrate competency at performing a central line dressing change and describe the dressing change schedule for central lines per Navicent Health policy. Session five requires the learner to attend a didactic lecture. Following the lecture the learner reviews a case scenario and decides whether the patient meets criteria for central line removal. The learner also must pass a post-test with a minimum passing score of 84. The post-test contains information that is covered in all five weeks of learning.
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Plan of Study
Session 1 - Introduction to CLABSI
Pretest
Risk factors of CLABSI
Point of entry
Effects on patients and hospital
Session 2 - Insertion Bundle
Hand hygiene
Sterile Field
Simulation of central line insertion
(IPICCYOU, 2011)
In session one, the learners will receive a pre-test to determine baseline knowledge of CLASBI prevention and care. They will then be a part of a lecture presenting topics such as the definition of key terms, types of venous catheters, and how organisms may enter the bloodstream. They will give induction of why CLASBI prevention matter and what are the outcomes.
The second session will teach the correct processes related to catheter insertion. They will be a part of a discussion and simulation of a central line insertion.
Picture Source: IPICCYOU. (2011). [photograph]. Retrieved from https://ipiccyou.wordpress.com/category/clabsi/
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Plan of Study
Session 3 - CLABSI Maintenance Bundle
Aseptic vs. clean technique
Disinfection of catheter hubs
Tubing changes
Session 4 - Central Line Dressing Changes
Dressing change schedules
Simulation of dressing change
Documentation
(Lawrence, 2012)
.
The third session will detail the maintenance care required for central lines. This session will discuss the difference between aseptic and clean technique and the proper way to administer medications through this line. In the fourth session, there will be a video showing how to perform dressing changes properly. The learners will demonstrate back to the instructor on a manikin how to properly change a central-line dressing. With feedback, the nurses will have the opportunity to improve their technique.
Picture source: Lawrence, J. (2012). [photograph]. Retrieved from http://www.scoop.it/t/clabsi?page=3
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Plan of Study
Session 5 - Early removal of Central Line
Early removal is key
Case scenarios for removal
Video of Removal
(Zagrean, 2014)
The fifth session will provide instruction on how to correctly remove a central-line. In addition, instruction will be given on when and why a central line would be removed as well as when it needs to stay in place. This would conclude the program; the learners will be given a post-test covering all information provided through the courses.
Picture Source: Zagrean, J. (2014). [photograph]. Retrieved from https://www.youtube.com/watch?v=5gR_SJ99BnE
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Rationale for Evaluation
Why Evaluate?
Quality
Strengths
Weaknesses
Evaluation allows for assessment of strengths, weaknesses, and quality of the education program (Billings & Halstead, 2016). The CLABSI program at Navicent Health is being piloted in the ICU prior to applying it to the entire hospital. Any strengths and weaknesses of the program need to be evaluated carefully to allow the educator to maximize the performance of students and increase the effectiveness of the program (Billings & Halstead, 2016). It is also important to evaluate the quality of the program. The quality of the program is the most important factor for the CLABSI program at Navicent Health.
Pictures are clipart from powerpoint program.
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Quality Assurance Model
Total Quality Management
Continuous Quality Improvement
Model for Evaluation
(Clipart Kid, 2016)
Prior to designing the Master Plan of Evaluation, the nurse educator should choose a model for evaluation or in some cases may choose several (Billings & Halstead, 2016). Evaluation models provide the nurse educator with a plan for evaluation and allow them to select the priority for the evaluation process (Billings & Halstead, 2016). In the case of the CLABSI program, a Quality Assurance Model is selected as the primary model for evaluation (Billings & Halstead, 2016). This model effectively demonstrates the priority of the CLABSI program at Navicent Health. There is an emphasis on quality, and the program must demonstrate a decrease in the CLABSI rate or it is not successful (Billings & Halstead, 2016). Total quality management and continuous quality improvement are two approaches that an organization may use show the evolution of the CLABSI program over time (Billings & Halstead, 2016). It is expected that the program adjust and continuously evolve in order to decrease the CLABSI rate indefinitely. CLABSI rates and processes at the hospital are continuously monitored for areas for improvement. The CLABSI education program must assist the hospital in achieving the goal of decreasing the CLABSI rate.
Picture Source: Clipart Kid. (2016). [picture]. Retrieved from http://www.clipartkid.com/quality-improvement-cliparts/
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Master Plan of Evaluation
| Curriculum Component | Responsible Party | When and How Often | Evaluation Models | Evaluation Strategies |
| Mission, Vision, and Philosophy | Director of Staff Development | At conclusion of pilot, then yearly | Quality Assurance Model | Checklist with hospital mission, vision, and philosophy and the program mission, vision, and philosophy Course facilitator provides summary of student end of course outcomes |
| Individual Courses | Course Facilitator | After each of the five learning sessions | Quality Assurance Model | Course facilitator completes student competency forms after each session Learner and course facilitator review the video-taped simulation session at the end of each course (if simulation used) Learner completes self-reported comfort level with skills taught during each course |
| Teaching Effectiveness | Course Facilitator | After each of the five learning sessions | Quality Assurance Model | Teacher evaluation questionnaires are handed out at the end of each learning session for learners to complete Questionnaire scores are reviewed by course facilitator |
| Overall Purpose/Goal (Reduce CLABSI SIR) | Infection Control | Data collected for year prior to starting program then quarterly | Quality Assurance Model | Calculation of Navicent Health ICU CLABSI SIR rate each quarter Compare quarterly data to baseline SIR data from previous year |
Click pointer.
The Master Plan of Evaluation will evaluate four curriculum components starting with the mission, vision, and philosophy. The mission, vision, and philosophy of the facility depict the overall goal of the hospital (Keating, 2015). It is important to ensure the mission, vision, and philosophy of the education program is congruent with the mission, vision, and phillosophy of the overall facility. The Director of Staff Development is responsible for performing this evaluation and they will use a checklist to evaluate each of the three areas of the program. They also will use a summary of the program outcomes that is given to them by the course facilitator to complete this evaluation. This component is evaluated at the conclusion of the pilot program and then annually. The primary evaluation model used in all four curriculum components is the quality assurance model.
Click pointer.
The second curriculum component is the individual courses. The courses are evaluated by the course facilitator after each teaching session. This allows for formative evaluation. Any strengths or weaknesses in the program can be addressed in order to enhance student learning throughout the program. The curriculum is also evaluated formatively after the completion of the pilot program. Evaluation strategies include competency checklists that are completed by the course facilitator during simulation of skills that are taught in the course. The learner and course facilitator also perform video debriefing after completing simulation events. This allows the learner to objectively see what areas they performed well on and any areas of improvement (Cheng et al, 2014). The learner also has the opportunity to complete a checklist containing a self evaluation. They are instructed to circle the number that corresponds with their level of comfort performing the skills that are taught in the class.
Click pointer.
The third curriculum component is the teaching effectiveness. This area is assessed by the course facilitator after every course. Evaluation strategies include a teaching effectiveness checklist that learners complete at the end of each course. The teaching effectiveness is rated using a scale and averages are calculated for each area of teaching effectiveness.
Click pointer.
The fourth and most important area of curriculum evaluation is the overall goal or purpose of the program. The program’s overall goal is to decrease the CLABSI SIR rate at Navicent Health. Data for the year prior to initiating the program is collected and used as a benchmark for assessment. Data is then collected quarterly after the program’s completion. The data must show a decrease in the CLABSI rate or per the quality assurance model the program is not successful. This data is collected and reported to the hospital by the infection control nurses at the facility.
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Strategies for Master Plan of Evaluation
Benchmarking and Quality Assurance Model
Formative and Summative Evaluation
0.505 SIR
1.204 SIR
Navicent Health
Benchmark
(Comparable Hospitals)
(The Leapfrog Group, 2016)
Benchmarking is a tool that is used in combination with the Quality Assurance Model (Billings & Halstead, 2016). Benchmarking is the process of establishing a standard that can be used to compare evaluation results to (Billings & Halstead, 2016). There are multiple benchmarks for the CLABSI program at Navicent Health. The Leapfrog Group (2016), requires CLABSI rates to be calculated in the form of a standardized infection rate, SIR (The Leapfrog Group, 2016). The SIR rate for the year prior to the CLABSI program can be compared to any future data, and the SIR rate at Navicent Health may be benchmarked against other hospitals that contain similar characteristics to Navicent Health (The Leapfrog Group, 2016).
Formative Evaluation and Summative Evaluation are other concepts that apply to the evaluation process for the CLABSI program at Navicent Health. Formative evaluation is evaluation that takes place while data is collected, and summative evaluation occurs after data collection is complete (Billings & Halstead, 2016).
Formative evaluation allows the course facilitator to make changes as the pilot course progresses to increase program and teaching effectiveness. Summative evaluation is helpful because actual end of program data is available at the conclusion of the course. Formative and Summative evaluation assist the program at achieving continuous quality improvement and total quality management (Billings & Halstead, 2016).
Picture is clipart from ppt program.
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Accreditation
Navicent Health is Accredited by Det Norske Veritas (DNV) with an emphasis on:
Infection Control
Hand Washing
Aseptic Technique
Insertion Bundles
Maintenance Bundles
Early removal of central
lines
DNV Accreditation (n.d.)
Det Norske Veritas (DNV) Business Assurance (2013) recommends that all staff receive training on hand washing, aseptic technique, insertion bundles, maintenance bundles, and early removal of central lines that are not medically indicated. Navicent Health is accredited by the DNV, so all of these standards are incorporated into the learning plan.
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Questions?
(Vannika, 2015)
Image Source: http://www.keepcalm-o-matic.co.uk/p/keep-calm-and-prevent-clabsi/
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References
Assimilation Theory. (n.d.). [Online Image]. Retrieved from http://4.bp.blogspot.com/_51KChdm7spI/S9k2bha-v_I/AAAAAAAAAAs/oFRhO2fIAq0/s1600/Accommodation.png
Billings, D. M., & Halstead, J. A. (2016). Teaching in nursing: A guide for faculty (5th ed.). St. Louis, MO: Elsevier.
Cheng, A., Eppich, W., Grant, V., Sherbino, J., Zendejas, B., & Cook, D. A. (2014). Debriefing for technology-enhanced simulation: a systematic review and meta-analysis. Medical Education in Review, 48(7), 657-666. doi:10.1111/medu.12432
Clipart Kid. (2016). [picture]. Retrieved from http://www.clipartkid.com/quality-improvement-cliparts/
DNV Accreditation. (n.d.) [Online image]. Retrieved from http://www.och.org/wp-content/uploads/2013/04/DNV_Accredited.png
DNV Business Assurance. (2013). Standard, interpretive guidelines, and surveyor guidance for
hospitals. Retrieved from http://www.mz.gov.si/fileadmin/mz.gov.si/pageuploads/kakovost/akreditacije/DNV-DSHC102__Hospital_Standard__Guidelines_and_Guidance__V3_0.pdf
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Georgia Department of Public Health. (2016). Online Analytical Statistical Information System. Retrieved September 12, 2016 from https://oasis.state.ga.us/gis/demographuccluster/bibb county.htm
Haines Center. (2016). [Picture]. Retrieved from http://hainescentre.com/training/adult-learning/
Health Xchange.(n.d.) [Photograph]. Retrieved from http://www.healthxchange.com.sg/News/PublishingImages/role-model.jpg
Ibn El Haj, H., Lamrini, M., & Rais, N. (2013). Quality of Care Between Donabedian Model and ISO9001V2008. International Journal For Quality Research, 7(1), 17.
IPICCYOU. (2011). [photograph]. Retrieved from https://ipiccyou.wordpress.com/category/clabsi/
Keating, S. B. (Ed.). (2015). Curriculum development and evaluation in nursing (3rd ed.). New York, NY: Springer.
Lawrence, J. (2012). [photograph]. Retrieved from http://www.scoop.it/t/clabsi?page=3
Lawrence, J. (2016). [picture]. Retrieved from http://www.scoop.it/t/clabsi?page=3
Navicent Health. (2015). Report to Our Community. Macon: The Fisher Group.
Navicent Health. (2016). About us. Retrieved October 11, 2016 from https://www.navicentheal th.org/about-us.html
References
Navicent Health. (n.d.). [picture]. Retrieved from http://mccgpediatrics.org/wp-content/uploads/2012/08/navicent_health_logo.png
The Joint Commission. (2013). Potential educational delivery methods and reduced
CLABSI rates. Retrieved from https://www.jointcommission.org/assets/1/6/CLABSI _Toolkit_Tool_3-2_Potential_Educational_Delivery_Methods_and_Reduced_CLABSI_Rates.pdf
The Leapfrog Group. (2016, October 31). The medical center, navicent health. Retrieved from http://www.hospitalsafetygrade.org/h/medical-center-of-central-georgia
University of Iowa (n.d.) . [Picture]. Retrieved from https://now.uiowa.edu/sites/now.uiowa.edu/files/styles/640_wide/public/primary-media/nursing-clinical-ed-6-copy-1100.jpg?itok=owT-V60r
Vannika. (2015). [picture]. Retrieved from http://www.keepcalm-o-matic.co.uk/p/keep-calm-and-prevent-clabsi/
Worlde. (n.d.). Learning Theories [Picture]. Retrieved from http://epltt.coe.uga.edu/images/4/4c/IntroWordle.png
Zagrean, J. (2014). [photograph]. Retrieved from https://www.youtube.com/watch?v=5gR_SJ99BnE
References
