NRSG 314 Unit 1 – Discussion Board 2
At our hospital we have implemented a nurse driven foley protocol in order to minimize catheter acquired urinary tract infections (CAUTI). This protocol allows nurses to asses the need for foley and thus remove foleys promptly post surgery or otherwise. It is a joint effort with the doctors and nurses to bring down the rate of CAUTI in the hospital as it also prolongs the stay of the patient (Hollenbeak & Schilling 2018). When we have done risk assessments in nursing quality council we have always seen that infections could have been prevented had the catheter been removed days earlier.
Another quality improvement project that is always ongoing is Falls. We have started to use a patient fall agreement in which the patient will sign a paper that signifies the patients partnership in following the fall precautions. For instance many patients fail to use the call bell when getting up out of bed thus end of falling as they did not call for help despite being told numerous times. The project is great because it gives the patient awareness that they also need to partner in the precautions, however the con is when the time comes it seems as if the agreement has not really been key in preventing falls. The key is the other precautions like bed alarm and fall mats need to be in place.
Second quality improvement project is that of workplace injuries. We have done training in safe patient handling and have many lift devices in order to save nursing staff from becoming injured. When we have the time and resources the lifts have been great, but one thing nursing tends to do when there are no resources and no time to use and find the lift is they will do it themselves thus get injured.
Hollenbeak, C. S., & Schilling, A. L. (2018). The attributable cost of catheter-associated
urinary tract infections in the United States: A systematic review. American journal of infection control, 46(7), 751-757. https://doi.org/10.1016/j.ajic.2018.01.015
Primary Discussion Response is due by Thursday (11:59:59pm Central), Peer Responses are due by Saturday (11:59:59pm Central).
Primary Task Response: Within the Discussion Board area, write 250 words that respond to the following questions with your thoughts, ideas, and comments. This will be the foundation for future discussions by your classmates. You are required to use 1 scholarly resource in addition to your textbook. Be substantive and clear, and use examples to reinforce your ideas.
You are discussing the quality improvement process with a colleague so that your colleague gains a better understanding of the process. Address the following:
- As either a participant or an implementer, discuss 1 quality improvement process that you have had exposure to or experience with in a heath care setting.
- Briefly compare the pros and cons of 2 quality improvement processes that are used in your health care setting.
Responses to Other Students: Respond to at least 2 of your fellow classmates with at least a 100-word reply about their Primary Task Response regarding items you found to be compelling and enlightening. To help you with your discussion, please consider the following questions:
- What did you learn from your classmate’s posting?
- What additional questions do you have after reading the posting?
- What clarification do you need regarding the posting?
- What differences or similarities do you see between your posting and other classmates’ postings?
Discussion Board Rubric
The Discussion Board Grading Rubric is a scoring tool that represents the performance expectations for the discussion. This grading rubric is divided into components that provide a clear description of what should be included within each component of the discussion. It is the road map that can help lead your discussion. Discussion Board Grading Rubric
For assistance with your assignment, please use your text, Web resources, and all course materials.
Quality improvement processes are crucial to maintain up to date and safe hospital practices. Working in the NeoNatal Intensive Care Unit has provided the opportunity to directly implement quality improvement processes. Many of the patients in this unit are very small. These tiny patients can be easily exsanguinated due to multiple blood draws and require blood transfusions. In order to reduce the need to transfuse blood, our hospital implemented a low birth weight blood draw protocol. This reduced daily blood draws to twice a week blood draws. The patients benefited by losing less blood, thus requiring fewer transfusions, yet they maintained adequate monitoring.
The Golden Hour is another quality improvement process implemented in the NICU. The Golden Hour, refers to the hour after birth in which an infant should be placed skin to skin with the mother, breastfeeding initiated and no other visitors. This has great benefits for the infant as implementing the Golden Hour has shown to reduce infant hypothermia and hypoglycemia rates (Croop et al., 2020). The Golden Hour can negatively impact some families, as they would prefer to be surrounded by family immediately. This can cause emotional distress to families, especially if they do not feel empowered to speak up.
Another quality improvement process in the NICU is the Back to Sleep Program. Parents are educated about infant safe sleep practices such as not co-sleeping and supine positioning. Safe sleep practices have proven to be beneficial by reducing sudden infant death events (McDonald et al., 2019). Many cultures incorporate co-sleeping as part of their culture. Parents may respond negatively when they are told that this is dangerous for their infant. Parents may feel shamed and view this as culturally incompetent care.
It is clear that quality improvement processes must be implemented to provide safe and up to date care. It is also important that we continually reassess the outcomes to ensure we, as health care workers, are adequately serving our patient populations.
References
Croop, S., Thoyre, S. M., Aliaga, S., McCaffrey, M. J., & Peter-Wohl, S. (2020). The Golden Hour: a quality improvement initiative for extremely premature infants in the neonatal intensive care unit. Journal of perinatology : Official journal of the California Perinatal Association, 40(3), 530–539. https://doi.org/10.1038/s41372-019-0545-0
McDonald, E. M., Davani, A., Price, A., Mahoney, P., Shields, W., Musci, R. J., Solomon, B. S., Stuart, E. A., & Gielen, A. C. (2019). Health education intervention promoting infant safe sleep in paediatric primary care: randomised controlled trial. Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention, 25(3), 146–151. https://doi.org/10.1136/injuryprev-2017-042421
During the monthly Unit Based Teams (UBT) meeting of a busy 35-bed med-Surg unit, it was identified on the STATiT scorecard that there was an increase in hospital-acquired pressure injury (HAPI). Nurses play a vital role in job improvement because they see the inconsistency in care with results that do not match benchmarks (Sherwood & Barnsteiner, 2021). A PICOT question was developed, and a project was put in place. A PICOT question serves the straightforward function of finding the search words to be used to find the best evidence to address a pressing clinical concern (Gallagher & Melnyk, 2019). The intervention is a process named Four Eyes Assessment. Within four hours of being admitted or moved to the unit, two registered nurses complete a head-to-toe focused skin check on each patient as part of the four eyes intervention. Because there were 3 HAPIs noted in 1 month, the outcome is to reduce the number of HAPIs to less than 3 per month. A three-month time frame was set to conclude on June 30, 2022. After three months outcomes were assessed through documentation audits following the Four Eyes Assessment trial. The results revealed an improvement in both the number of recognized pressure injuries on admission and no HAPIs were found.
The Statit scorecard results versus the documentation audits have both pros and cons. Statit only identifies the areas for improvement if it is reported. In comparison, documentation audits show areas of improvement in real-time. The con of documentation audits is having the manpower to do those audits.
P: Hospital Acquired Pressure Injury
I: Four Eyes Assessment on admission and transfer
C: Use the Epic Rover device to photograph any identifying wounds and add them to the wound care flowsheet
O: Reduce HAPI to <3/month
T: June 30, 2022
Gallagher Ford, L., & Melnyk, B. M. (2019). The Underappreciated and Misunderstood PICOT Question: A Critical Step in the EBP Process. Worldviews on Evidence-Based Nursing, 16(6), 422–423.
Sherwood, G., & Barnsteiner, J. (2021). Quality and Safety in Nursing (3rd Edition). Wiley Global Research (STMS).