NR451 Milestone2 Rubric

Introduction to the plan is nursing focused, with evidence-based problem identification and potential solutions clearly identified.)

An overview of the ACE Star model as a guide for change is given. Scope of the problem is identified. Stakeholders are identified. Team members and their roles and practice area are identified and discussed. State how nurses should use this model as a guide to facilitate change.

Evidence is provided thru basic information that indicates a change is needed. For example, there have been 6 urinary tract infections over the last two months and there were none present the last two years at the same time period. What are some of the evidence-based interventions you discovered in your Evidence Summary that do you plan to use?

Activities to achieve the final steps of change are fully described. What is needed to achieve? How do you translate what information you have gathered into practice? Include measurable outcomes. How do you inform staff? What is your plan of action to pilot the plan? What is the timeline?

Clear, solid summary of the key points, ACE Star model and steps of the change plan are included; ways to sustain the change plan are described.

APA format 6th edition. Grammar, sentence structure, punctuation, and spelling correct. References, citations correct. Paper formatted in APA format. 0-1 errors

Topic: Interventions to improving professional adherence to guidelines for prevention of device related infections

Flodgren G, Conterno LO, Mayhew A, Omar O, Pereira CR, Shepperd S. Interventions to improve professional adherence to guidelines for prevention of device-related infections. Cochrane Database of Systematic Reviews 2013, Issue 3, Art., No.: CD006559. doi:10.1002/14651858.CD006559.pub2.

Hocevar, S. N., Lessa, F. C., Gallagher, L., Conover, C., Gorwitz, R., & Iwamoto, M                (2014).InfectionPrevention Practices in Neonatal Intensive Care Units Reporting to the National                Healthcare Safety Network. Infection Control and Hospital Epidemiology, 35(9), 1126–1132.                http://doi.org/10.1086/677636

Design for Change Proposal Nursing Assignment

The practice issue that I have identified concerning my topic is whether or not the need for intense NICU infection bundles related to decreasing the incidence of ventilator-associated pneumonia, necrotizing fasciitis and CLABSI’s are recommended for the NICU population. The question I have chosen for this topic is as followed:

Will implementing new infection bundles versus not implementing new infection bundles significantly decrease acquired infections in NICU babies?Design for Change Proposal Nursing Assignment 

As a traveling Registered Nurse, I have had the pleasure to work at several different NICU’s around the United States. At the hospital that I am currently working at, a level four nicus in Tacoma, Washington, they have implemented some brand new NICU infection bundles that I have never seen before. The purpose of my capstone will be to see if the newly implanted NICU bundles have an effect on helping to decrease the incidence of infections in the NICU population.Design for Change Proposal Nursing Assignment

_x__ Clinical

_x__ Education

___ Administration

___ Other (List):Design for Change Proposal Nursing Assignment

_x__ Safety/risk management concerns

___ Unsatisfactory patient outcomes

_x__ Wide variations in practice

___ Significant financial concerns

___ Difference between hospital and community practice

__x_ Clinical practice issue is a concern

___ Procedure or process is a time waster

___ Clinical practice issue has no scientific base

__ Other:

Safety Risk Management Concerns:Design for Change Proposal Nursing Assignment

I chose safety and risk management because critically ill infants that are cared for in the neonatal intensive care units are among the most vulnerable patient population in the hospital. NICU babies are at an increased risk for adverse outcomes related to nosocomial infections and unplanned readmission to the hospital. Nosocomial infections can affect nearly 1 in 6 very low birth weight infants (VLBW), which can double the risk of mortality and lengthen the NICU stay. Invasive equipment, such as central lines and ventilators, are a familiar source of nosocomial infection.Design for Change Proposal Nursing Assignment

Wide Variation in practice:

I chose this area because every NICU that I have worked at practices differently concerning the maintenance of CLABSI, ventilators, and feedings. I have even worked within the same hospital system, just in a separate location and saw a vast difference in how they did things compared to their partners up the road. For example, some hospitals require everybody in the room to wear a hat and mask when inserting a central line, whereas other hospitals only require the person entering the catheter of a central line to wear a hat and mask. Some hospitals are strict about suctioning an intubated baby before turning their head or repositioning, while some hospitals have no preference on which order this happens.  Some hospitals will clean an infant’s nasogastric/orogastric tube with alcohol before beginning a gavage feeding, while some hospitals don’t see it necessary.  Design for Change Proposal Nursing Assignment

Clinical practice issue is a concern:

I chose this because I believe that many hospitals are relaxed about their infection policies. I have worked in hospitals that are very strict about preventing infection in our NICU babies, and I have also worked in hospitals that hardly have a policy for infection written. Regardless of whether or not a NICU is a level IV or a level II, infection protocols should be followed consistently and concisely by all staff.Design for Change Proposal Nursing Assignment

___ Guidelines

___ Expert Opinion

___ Patient Preferences

___ Financial Analysis

___ Standards (Regulatory, professional, community)

___ Other

Literature Search:

A reasonable basis of literature is fundamental regarding proving the significance of a clinical problem. A literature search is a systematic, thorough search of all types of published literature to identify a magnitude of excellent quality references relevant to a specific topic and is a fundamental element of the methodology of any research project. A Literature search is necessary to research because it can help to draw information for making sound evidence-based guidelines.Design for Change Proposal Nursing Assignment

Clinical Expertise:

Clinical expertise will need to be assessed to determine whether the newly implanted infection bundles are beneficial to our tiny patients. Evidence-based practice involves integrating the best evidence and clinical expertise.Design for Change Proposal Nursing Assignment

Guidelines:

Guidelines from organizations such as the National Women’s Newborn Service, Centers for Disease Control and the World health organization should be evaluated to determine what infection procedures are recommended in the NICU setting.

Design for Change Proposal Nursing Assignment

The practice problem that I have identified is whether or not the implementation of new NCU infection bundles are beneficial to our tiny NICU patients. The practice problem identified by our assigned article Interventions to improve professional adherence to guidelines for prevention of device-related infections refers to the fact that healthcare associated infections (HAI’s) are detrimental to the well-being of our patients. When infection procedures, or bundles, are not strictly followed in the NICU this can lead to patients to the subjection of acquiring device-related infections. Nosocomial infections in the NICU are a significant cause of morbidity. Premature infants are especially vulnerable since they can undergo many invasive procedures and are often times dependent on invasive devices such as feeding tubes, central lines, and ventilators. The very mechanisms that sustain life can be a reservoir for bacterial invasion, especially in those with immature immune systems. The use of Aseptic and sterile technique should always be involved when handling invasive devices in the NICU. This has been found to decrease the incidence of infection in the NICU. It would be essential to measure this outcome within a six-month time span to determine the number of babies that fall victim to infections related to invasive devices within this time frame regarding the different policies and bundles used in a particular NICU.Design for Change Proposal Nursing Assignment

Flodgren G, Conterno LO, Mayhew A, Omar O, Pereira CR, Shepperd S. Interventions to improve professional adherence to guidelines for prevention of device-related infections. Cochrane Database of Systematic Reviews 2013, Issue 3, Art., No.: CD006559. doi:10.1002/14651858.CD006559.pub2.Design for Change Proposal Nursing Assignment

Hocevar, S. N., Lessa, F. C., Gallagher, L., Conover, C., Gorwitz, R., & Iwamoto, M                (2014).InfectionPrevention Practices in Neonatal Intensive Care Units Reporting to the National                Healthcare Safety Network. Infection Control and Hospital Epidemiology, 35(9), 1126–1132.                http://doi.org/10.1086/677636

The objective of the study that I have chosen is to figure out quality improvement strategies to change clinical practice in improving the rate of device-related infections in the healthcare setting. The article looks at the care bundles developed by the HAI’s and suggests that bundling interventions an effective form of decreasing healthcare-associated infections. The report assesses the effectiveness of different interventions, with or without various combinations, to target healthcare professionals/healthcare organizations to improve professional adherence to infection control guidelines on device-related infection rates and also aims to measure adherence to these guidelines.Design for Change Proposal Nursing Assignment

Provide a statement of the questions being addressed in the work and how these relate to your practice issue:

The matters discussed in the article deal with assessing the different interventions in targeting infection control regarding device-related infections. This is similar to my capstone question because I am seeking to establish whether or not the use of newly implanted infection bundles has a profound effect on decreasing the incidence of infections in the NICU brought on invasive devices such as central lines, feeding tubes, and ventilators. The article also talks about the breakdown of aseptic technique during insertion of invasive devices as well as the duration of the devices use. These areas are all critical factors in whether or not NICU bundles will be successful in decreasing the incidence of invasive device-related infections Design for Change Proposal Nursing Assignment

Some of the interventions that the authors have found to be effective in preventing ventilator-associated pneumonia include elevating the head of the bed by 30 degrees; continuous suctioning when there is evidence of increased sections, not changing circuits on ventilators unless it is entirely indicative, oral care and hand hygiene. The article talked about daily sedation use, however, in the NICU we rarely use sedation unless the baby is high risk for pulling out their endotracheal tube. The questions being addressed in the article deal with assessing the different interventions in targeting infection control concerning device-related infections. This is similar to my capstone question because I am seeking to establish whether or not the use of newly implanted infection bundles has a profound effect on decreasing the incidence of infections in the NICU brought on invasive devices such as central lines, feeding tubes, and ventilators. The article also talks about the breakdown of aseptic technique during insertion of invasive devices as well as the duration of the devices use. These areas are all critical factors in whether or not NICU bundles will be successful in decreasing the incidence of invasive device-related infections. In regards to the prevention of CLASI infections, the article has found that timely dressing changes using aseptic techniques, daily audits of central line site, chlorhexidine on the skin with the preparation of insertion of a sterile catheter, and the use of sterile barriers during catheter insertion, such as a hat, and mask.Design for Change Proposal Nursing Assignment

Summarize the main findings by the authors of your systematic review including the strength of evidence for each main outcome.  Consider the relevance to your project proposal for the Milestone 2 project paper. (If an optional supplemental source is also used, include a statement of relevance to it as well.)Design for Change Proposal Nursing Assignment 

The main findings of the studies showed that adherence to invasive device related bundles could help decrease the risk of nosocomial infections in this population. Many of these infection prevention practices are implemented in the newly recommended NICU bundles. The study found that there were beneficial effects regarding the use of these infection bundles up to three months, nine months, and twelve months after initiated. The study found a decrease in VAP rates between 5 and 23 cases per 1,000 ventilator days. The article highlights that for effective prevention of device-related hospital infections, it is vital to ensure that the clinical practice bundles/policies that are implemented have an evidence-based backing and target the critical risk factors for the specific indwelling medical devices in question. However, the study emphasizes that further research should be done to come to a definitive answer.Design for Change Proposal Nursing Assignment

·         Whether or not suctioning an infant’s ET tube and oral secretions before repositioning decrease the incidence of VAP

·         Whether or not cleaning a nasogastric/orogastric feeding tube with alcohol for at least 15 seconds decreases the incidence of necrotizing fasciitis

·         Whether or not using a mask and hat is crucial for everybody to have one when PICC line placement has begun

·         Providing education and demonstration to NICU nurses and doctors to make sure infection bundles are properly being followed

·         Whether or not the use of aseptic/sterile technique is needed when handling invasive devices in the NICU

·         If changing ventilator circuit only when visibly soiled or malfunctioning is beneficial in decreasing the incidence of VAP Design for Change Proposal Nursing Assignment

·         Minimizing days on ventilation

·         Use of frequent hand hygiene when handling invasive devices

·         Frequent caregiver education and demonstration of NICU bundles to ensure that bundles are being followed consistency and concisely

Discuss any limitations to the studies that you believe impacts your ability to utilize the research in our project.

The main limitation that I can see with my study is that a NICU may have a hospital policy/bundle in place, but it is not implemented effectively by all staff, including nurses and doctors. Even though there may be a strict and effective prevention of invasive device-related infections in place, studies may still show that the rate of NICU acquired infections are still steadily increasing. As there is no way to closely monitor every nurse, on every shift, at every assessment, this is the only barrier I can see that may skew the results of infections acquired in the NICU.Design for Change Proposal Nursing Assignment