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Benchmark – Change Initiative: Implementation, Evaluation, and Sustainability

LDR-615 Benchmark – Change Initiative: Implementation, Evaluation, and Sustainability

The promotion of quality, efficiency, and safety in patient care is important in healthcare. Nurses and other healthcare providers employ evidence-based interventions to achieve optimum care outcomes for their patient populations. Despite such a focus, critically ill patients in acute care settings in the organization I work with as a nurse are still increasingly predisposed to ventilator-associated pneumonia (VAP). VAP has significant adverse effects on the health and health outcomes of critically ill patients. Nurses have the responsibility of implementing change initiatives that address this issue of practice in their settings. Therefore, the purpose of this paper is to propose a change initiative that is needed to address the issue of VAP in my organization.

Nurses strive to provide the best possible care to diverse clients under consistently cha

Benchmark  Change Initiative Implementation Evaluation and Sustainability
Benchmark  Change Initiative Implementation Evaluation and Sustainability

nging conditions. From the medications administered to the type of dressing used to heal a wound, nurses apply procedures that have been tested through research and deemed appropriate according to evidence-based standards of practice. Through foundational knowledge related to research methods, translation of research data is used to improve nursing practice and, ultimately, patient outcomes. Therefore, nurses must become familiar with the specific language of scientific research and the research process. As health care professionals, nurses seek to provide their patients with the best possible health care. To determine which approaches to care result in the best possible care, the effectiveness of each approach specific to a chosen population must be investigated. The pursuit of knowledge is the basis for research. Researchers seek to find answers to various scientific questions, but there are the boundaries associated with the pursuit of knowledge (Helbig, 2018).

Issue Description

The selected issue in my area of practice is the rising rates of VAP in critically ill patients. VAP refers to pneumonia that develops following the intubation of a patient with a tracheostomy or endotracheal tube within 48 hours or more (Burja et al., 2018). Critically ill, intubated patients are highly predisposed to VAP due to factors that include patient characteristics such as advancing age, prolonged hospital stay and mechanical ventilation, comorbidities, and invasive operations (Wu et al., 2019). Studies have documented the effects of VAP. VAP is associated with adverse patient outcomes. One of them is the prolonged hospital stay due to the increased need for treatment and prevention of septicemia. The prolonged hospital stay increases the costs incurred for care by patients, their significant others and the healthcare institution (Luo et al., 2021). VAP also increases the risk for pneumonia among the affected patient populations. For instance, Feng et al., (2019) reports that the risk of mortality due to VAP in intensive care units’ ranges from 19.3% to 53%. Consequently, it increases the need for the adoption of change initiatives the prevent and reduces the risk and rate of VAP among hospitalized patients in the institution.

External and or Internal Driving Forces

VAP is attributable to a number of external and internal driving forces. One of the external driving forces is the emergence of new

Benchmark - Change Initiative Implementation, Evaluation, and Sustainability
Benchmark – Change Initiative Implementation, Evaluation, and Sustainability

health problems. The emergence of health problems such as covid19 placed immense pressure on healthcare facilities. Most patients required mechanical intubation to sustain respiratory functions, predisposing them to VAP. Maes et al., (2021) showed in their study that covid19 patients were highly likely to develop VAP when compared to patients without covid19, with the incidence density rate of 28/1000 ventilator days versus 13/1000 days for those without covid19. The other external factor contributing to VAP in critically ill patients on mechanical ventilation includes patient factors such as age, comorbidities, and lifestyle and behavioral factors such as smoking and hyperoxemia (Wu et al., 2019). Internal factors also contribute to the problem. They include duration of mechanical ventilation, invasive procedures, and use of aseptic techniques by healthcare providers, which increases the risk of cross-transmission of nosocomial infections (Arumugam et al., 2018). The people affected by VAP include patients, their significant others and healthcare providers.

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Stakeholders Involved and How Change Initiative will affect Them

The proposed change initiative entails the implementation of a care bundle for use in the intensive care units to prevent and reduce the risk and rate of VAP. According to Lavallée et al., (2017) care bundles refer to practice interventions that comprise of three to five evidence-based practices performed simultaneously to improve the quality of care and outcomes. Care bundles prevent and manage conditions including VAP in intensive care settings (Lavallée et al., 2017). The proposed care bundle will comprise of practices that include elevation of the head of the bed, performing oral hygiene with chlorhexidine, daily assessment for extubation and the need for the administration of proton-pump inhibitors, maintain the cuff pressure of the endotracheal tube at 25 cmH20, and using closed suctioning system (Burja et al., 2018). The stakeholders that will be affected by the change initiative will comprise of the intensive care nurses and physicians. They will be affected by the proposed initiative, as they will have to change their existing practices on prevention of VAP in patient care. They will also have to change the existing policies on VAP prevention to align with the proposed change.

Role and Responsibility

I will play a number of roles as a change leader in the implementation of the care bundle to prevent and reduce the risk and rate of VAP in the setting. One of the roles will be acting as a communicator. I will facilitate open and transparent communication among the stakeholders who will be involved in the implementation of the initiative. Open communication will ensure the stakeholders understand their expected roles and objectives to be achieved with the implementation of the change initiative. The other role will be advocating the adoption of the initiative. I will lead the adoption of interventions that will enhance the utilization of the proposed change in patient care. The other role will be mobilizing, allocating and overseeing the use of resources (Göker, 2021). I will ensure the efficient use of the allocated resources to achieve optimum outcomes related to the project. I will utilize servant leadership to guide the change process. Servant leadership entails leaders existing to facilitate the realization of the needs of the followers. Servant leaders use practices such as coaching and mentoring, open communication, listening skills, and creating positive working environment to enable the change process (Greenhalgh, 2017). I will therefore adopt the above practices to facilitate the change process.

Change Agents

Change agents refer to individuals tasked with the responsibility of initiating as well as managing change in an organization. The change agents for the proposed initiative include nurse managers, nurse leaders, and unit preceptors (Greenhalgh, 2017). Nurse Managers will play the roles of overseeing the consistent use of the care bundle by the nurses and physicians in the acute care settings. They will also act as coaches and mentors for the nurses involved in the implementation of the change. They will also provide feedback about the success and improvement strategies needed for the realization of the desired goals of the change. Nurse leaders will lobby for the needed resources for sustained and effective implementation of the change. They will also guide the alignment of the change with the organizational mission. The preceptors in each unit will guide the effective and consistent use of the care bundle in patients on mechanical ventilation. They will act as coaches and mentors for the other nursing staffs. They will also provide feedback on the success and change initiatives needed for the successful implementation of the change.

Relevance of the Change Model

The developed change model comprises of steps that include needs assessment, strategy development, training, change implementation, monitoring, evaluation, and communication of feedback. The model is relevant to the organization, as it considers the systematic implementation of organizational change. It also recognizes the need for the preparation of adopters for the change. The preparation minimizes the risk of resistance from them. The model also strengthens sustainable change. The gradual nature of change implementation facilitates its incorporation into the existing processes and systems for sustainability of change. Therefore, it is anticipated to facilitate the successful implementation of the change.

Strategic Aspects

One of the strategic aspects of the developed model is needs assessment. Needs assessment entails the determination of knowledge and skills of the adopters of the change. Needs assessment informs the training objectives to be achieved prior to the implementation of the change. The second strategic aspect is training, which aims at equipping the adopters with the needed knowledge and skills relevant to the change. Training on the use of care bundle will be offered to eliminate resistance to change by the nurses and physicians. The other strategic aspect of the model is collaboration in the implementation of the change. Collaboration will ensure the realization of optimum outcomes of the change. The last strategic aspect will be monitoring change. Monitoring will aim at identifying any issues that might affect the realization of the desired outcomes and interventions needed to address them (Greenhalgh, 2017). It will also strengthen the use of best practices in the implementation process.

Potential Barriers to Change

One of the potential barriers to change that may be experienced is resistance to change. Nurses and physicians may resist implementation of the change due to their lack of knowledge and skills and fear of unknown outcomes associated with it. This barrier will be addressed by providing training to the adopters to ensure they have the desired competence in the implementation of change. The second barrier that may be experienced is inadequate institutional support. The institution is expected to provide human resource and financial support to ensure the successful implementation of change. Lack of adequate support will affect the project outcomes (Montgomery et al., 2021). The barrier will be addressed by ensuring that the proposed change underpins the realization of the organizational mission and vision, hence, adequate support from the institution.

Evaluation Methods

The proposed change will be evaluated based on its outcomes. The extent to which the developed outcomes were achieved will be used to measure the success of the change. The outcome metrics of focus will include the rate of VAP before and after the implementation of change, mortality rate due to VAP, average hospital stay for mechanically intubated patients, and cost of care incurred by these patients before and after the implementation of the change. A positive change in any of the measures will translate into the success of the change initiative.

Anchoring and Supporting Change

One of the interventions that will be adopted to support change in the organization is frequent assessment and provision of feedback. Frequent assessment will inform the improvement interventions needed to ensure sustainable change. The other strategy will be the formulation of new policies supporting the change (Göker, 2021). Policies requiring the use of care bundle in critically ill patients on mechanical ventilation will be developed and implemented for use, hence, anchoring and supporting the change.

How it Supports Organizational Mission/Goal and Addresses Stakeholder Concerns

The proposed change supports the organizational mission of ensuring the provision of high quality, safe and efficient care to patients. The care bundle is anticipated to prevent and reduce the risk and rate of VAP, leading to enhanced quality, safety and efficiency of care. The change also addresses the genuine concerns of stakeholders including nurses, patients and physicians (Burja et al., 2018). It contributes to evidence-based practice in the provision of care to critically ill patients on mechanical ventilation.

Conclusion

Overall, VAP has adverse effects on the health of the patients. Nurses and other healthcare providers have critical roles to play in prevention of VAP. Care bundles are effective in preventing and reducing the risk and rate of VAP, hence, the need for their use in the practice site. Successful implementation of the change involving the use of care bundles will be achieved using models of change as well as effective leadership styles.

References

Arumugam, S. K., Mudali, I., Strandvik, G., El-Menyar, A., Al-Hassani, A., & Al-Thani, H. (2018). Risk factors for ventilator-associated pneumonia in trauma patients: A descriptive analysis. World Journal of Emergency Medicine, 9(3), 203–210. https://doi.org/10.5847/wjem.j.1920-8642.2018.03.007

Burja, S., Belec, T., Bizjak, N., Mori, J., Markota, A., & Sinkovič, A. (2018). Efficacy of a bundle approach in preventing the incidence of ventilator associated pneumonia (VAP). Bosnian Journal of Basic Medical Sciences, 18(1), 105–109. https://doi.org/10.17305/bjbms.2017.2278

Feng, D.-Y., Zhou, Y.-Q., Zhou, M., Zou, X.-L., Wang, Y.-H., & Zhang, T.-T. (2019). Risk Factors for Mortality Due to Ventilator-Associated Pneumonia in a Chinese Hospital: A Retrospective Study. Medical Science Monitor : International Medical Journal of Experimental and Clinical Research, 25, 7660–7665. https://doi.org/10.12659/MSM.916356

Göker, S. D. (2021). A Closer Look at Organizational Culture in Action. BoD – Books on Demand.

Greenhalgh, T. (2017). How to Implement Evidence-Based Healthcare. John Wiley & Sons.

Lavallée, J. F., Gray, T. A., Dumville, J., Russell, W., & Cullum, N. (2017). The effects of care bundles on patient outcomes: A systematic review and meta-analysis. Implementation Science, 12(1), 142. https://doi.org/10.1186/s13012-017-0670-0

Luo, W., Xing, R., & Wang, C. (2021). The effect of ventilator-associated pneumonia on the prognosis of intensive care unit patients within 90 days and 180 days. BMC Infectious Diseases, 21(1), 684. https://doi.org/10.1186/s12879-021-06383-2

Maes, M., Higginson, E., Pereira-Dias, J., Curran, M. D., Parmar, S., Khokhar, F., Cuchet-Lourenço, D., Lux, J., Sharma-Hajela, S., Ravenhill, B., Hamed, I., Heales, L., Mahroof, R., Soderholm, A., Forrest, S., Sridhar, S., Brown, N. M., Baker, S., Navapurkar, V., … Conway Morris, A. (2021). Ventilator-associated pneumonia in critically ill patients with COVID-19. Critical Care, 25(1), 25. https://doi.org/10.1186/s13054-021-03460-5

Montgomery, A., Doef, M. van der, Panagopoulou, E., & Leiter, M. P. (2021). Connecting Healthcare Worker Well-Being, Patient Safety and Organisational Change: The Triple Challenge. Springer Nature.

Wu, D., Wu, C., Zhang, S., & Zhong, Y. (2019). Risk Factors of Ventilator-Associated Pneumonia in Critically III Patients. Frontiers in Pharmacology, 10, 482. https://doi.org/10.3389/fphar.2019.00482