NR 451 Milestone 2 Design Proposal Outline
NR 451 Milestone 2 Design Proposal Outline
This paragraph(s) is to introduce the paper. State the problem and potential solutions backed by evidence. Briefly, introduce the nursing focused plan. Remember this is a scholarly APA assignment so you cannot use first person. Remember also that you will keep all the bolded headings and just remove the non-bolded content when you start your paper.
Change Model Overview
In this first paragraph, provide an overview of the ACE Star model Evidence-Based Practice Process. Feel free to state why nurses should use this model as a guide to facilitate change. Under each of the second level headers listed below, you now link your identified topic to the ACE Star model EBP Process.
Define the Scope of the EBP
Restate your practice issue. Why is this a problem? Give statistics and information to back the scope of the problem at your facility/work area. How does this problem impact healthcare on a broader scale?
Stakeholders
You will be the leader of the team since this is your project. Who will you also include in your team? Make sure you choose relevant stakeholders. You should have no more than eight members. Do not list your team members by name but instead by position (pharmacists, charge nurse, etc.).
Determine Responsibility of Team Members
Why are the members chosen important to your project? What are their roles?
Evidence
Conduct internal/ external search for evidence. What type of evidence did you find in addition to you Evidence Summary? EBP guidelines? Quality improvement data? Position statements? Clinical Practice Guidelines? Briefly discuss the strength of this research. This is not where you describe the results of your studies. This is done in the following steps.
Summarize the Evidence
In this section, you need to synthesize the information from the systematic review article. What are some of the evidence-based interventions you discovered in your Evidence Summary that do you plan to use? Be sure and cite all of your references, in proper APA format, from any and all articles into this one paragraph.
NR 451 Milestone 2 Design Proposal Outline
Develop Recommendations for Change Based on Evidence
What is your recommendation based on the research? Ideally, you will have found enough support in your evidence to proceed with implementing your pilot program.
Translation
Action Plan
You have not implemented your project yet, therefore, this section will be hypothetical. Develop your plan for implementation. What are the specific steps you will take to implement your pilot study? What is the timeline for your plan? Make sure you include a plan for evaluation of outcomes and method to report the results.
Process, Outcomes Evaluation and Reporting
What are the desired outcomes? How will they be measured? How will you report the results to the key stakeholders?
Identify Next Steps
How will you implement the plan on a larger scale? Will this be applicable to other units or the facility as a whole? What will you do to ensure that the implementation becomes permanent?
Disseminate Findings
How will you communicate your findings internally (within your organization) and externally (to others outside of your organization)?
Conclusion
Provide a clear and concise summary. Review the key aspects of the problem as well as the change model. Be sure to include important aspects of the five points of the ACE Star change model EBP process and ways to maintain the change plan.
References
Reducing Surgical Site Infections
Surgical site infections have long appeared as devastating occurrences in the preoperative process. Studies reveal that the prevalence of occurrence of these health care associated infections ranges from 1%-2% after numerous operations such as total knee arthroplasty (Wang et al., 2017). In order to combat these infections, physicians have employed the usage of preoperative antiseptics and surgical soaps with varied results. According to Wang et al. (2017), surgical units in hospitals commonly employ the usage of antiseptics in preoperative skin preparations. Thus, the present nursing focused plan will address the application of chlorhexidine gluconate to reduce surgical site infections. Evidence-based clinical research studies have supported the usage of the antiseptic since they have demonstrated it as an effective and somewhat safe antiseptic in the preparation of the skin preoperatively (Hsieh et al., 2014). However, renewed interest has emerged for the utilization of chlorhexidine antiseptic shower/bath concentration to eliminate the microbial skin burden before the admission of a patient. Therefore, the current study will seek to examine the correct standardized protocol for the same as well the efficacious concentration of the antiseptic as regards preoperative skin preparation using showers/baths.
Change Model Overview
The ACE Star Model of Knowledge Transformation offers a way that facilitates the transformation of nursing knowledge into practice. Demonstrated as a five pointed-star, the integration of knowledge into practice starts at the Discovery of novel knowledge as being representative of the research procedure. The next star point, known as the Evidence Summary, embodies the advancement of evidence summaries, a unique phase to the EBP procedure. Upon research offering sufficient evidence, an abridgment of deductions founded on that evidence can undergo reproduction, generating an elevated level of knowledge (Parkosewitch, 2013). The third star point known as Translation depends on this evidence. The translation phase happens when the generated evidence summaries get utilized in the establishment of clinical guidelines, procedures, and protocols. The completion of the above paves way to the next phase known as Integration. During this phase, the clinical guidelines become executed by nurses. Integration allows for the application of change theories and its associated procedures in the creation and sustenance of the changes advised in the implementation of guidelines (In Nelson & In Staggers, 2014). The final phase in the ACE process known as Evaluation happens when PI and QA processes take center stage. Whereas QA processes significance entails monitoring for anticipated outcomes, the PI processes become important when the outcomes do not align with expectations from evidence. The ACE model has particular significance to nurses as it allows them to offer consistent, excellent quality care via the implementation of the finest available practice knowledge (Parkosewitch, 2013). As a consequence, this will harmonize practice among health care professionals irrespective of their geographical locations.
Define the Scope of the EBP
As already mentioned, medical practitioners have adopted the utilization of 4% chlorhexidine during the preoperative bathing process so as to prevent surgical site infection. However, the effectiveness of the methodology has not received any confirmation yet from researchers. The usage of this antiseptic has characteristic lack of standardization during the preoperative bathing phase. The absence of the standardization process with regards to the usage of chlorhexidine gluconate has become a major area of concern for nurses as the global rate of surgical site infections stand at 7.2% (Franco, Cota, Pinto, & Ercole, 2017). In addition, patients have expressed dissatisfaction with the adopted regimen at the hospital since they have always complained of their inability to complete their pre-operative practice regimen. Further, the patients have complained of skin reaction to the regimen that has so far been applied at the hospital.
Therefore, the absence of a standardized and specific regimen for preoperative preparation of elective surgery patients exposes patients to SSIs. As a consequence, the satisfaction of patients who have undergone surgery reduces, which affects the quality of care of hospitals. Moreover, the presence of SSIs as a result of the absence of this harmony increases the cost of care. The economic burden borne by both the patient and the hospital forms a negative indicator on the quality of services offered by health care facilities. To this end, it becomes important to use evidence-based practice to identify a standard procedure and concentration of chlorhexidine gluconate that elective surgery patients should employ.
Stakeholders
In order to achieve the objectives of the evidence-based practice change proposed herein, interprofessional collaboration between the current author, the hospitals nurse leader, the hospital pharmacist, the surgeon, the anesthetist, and a librarian will have substantial importance. Therefore, these individuals will be assembled into the present authors team and given a brief to determine a standardized protocol and concentration of the chlorhexidine gluconate.
Determine Responsibility of Team Members
The members elected above are important to the prospect of determining the standard protocol and concentration of the chlorhexidine gluconate antiseptic bath/shower. The nurse leader will play a role of facilitating the implementation of the results of the evidence-based changes as nurses will feel owning the process. The surgeon will also play a significant role as he will examine the post-operation wounds after application of the antiseptic to determine the effectiveness of the chosen protocol and concentration. The role of the pharmacist will entail acquiring the correct amount of the antiseptic and ensuring that the antiseptic has the right concentration. The anesthetist plays a significant function of ensuring that the prospective patients for elective surgery appropriately apply the antiseptic preoperatively. However, the librarian plays the most significant role among the team members. All the above roles will be a consequence of the evidence-based research that he will have conducted and provided to the team.
Evidence
The evidence in support of this practice change solution was conducted externally and internally. Quality improvement data evidence was primarily found during the research. This type of evidence is important as it allows nurses to utilize already established knowledge to inform their practice change.
Summarize the Evidence
In the evidence summary, Webster and Osborne (2015) used antiseptic bathing products and compared them to non-antiseptic soaps, solutions without shower/bath. The specific focus of the study was on chlorhexidine as a bathing antiseptic. Further, Edmistorn et al. (2013) systematically reviewed several studies that employed the usage of standardized 2% -4% chlorhexidine bath solution to preoperatively prepare the skins of elective surgery patients. Flavio, Cota, Pinto and Ercole (2017) similarly conducted a review that aimed at determining the effectiveness of 4% chlorhexidine to prevent SSIs in clean surgeries in comparison to placebo and soap solutions.
Develop Recommendations for Change Based on Evidence
Based on the research, the hospital should adopt the usage of 2% chlorhexidine for two days during the preoperative phase of a surgery. The above research reveals that while using the antiseptic at 2% is effective, it also reduces the side-effects such as itching associated with the 4% concentrated chlorhexidine. Thus, bathing in the diluted 2% chlorhexidine for two days reduces the prevalence of side-effects in preoperative patients.
Translation
Action Plan
The following action plan will be utilized to translate the knowledge into evidence:
The nurse leader will be responsible for data collection, analysis, as well as graphical presentation (generation of graphs and charts).
The project will be expected to reduce the number of complaints from patients by 85% when 2% of chlorhexidine shower is used to prepare elective surgery patients preoperatively.
A baseline data of all the complaints made by patients who may have used 4% of the antiseptic for three days from hospital records will be collected. The intervention will then be implemented. The same data will again be collected on the material day of the surgery for side-effects and then 48% hours after the surgery for SSIs. Results comparison between the data collected pre-intervention and that collected after the intervention will be made.
The data will be collected from elective surgery patients at the hospital including vaginal surgery ones.
The above group will be compared to a placebo group and those who use bathing soaps preoperatively.
The anesthetist and the surgeon will collect the data from hospital records, before the surgery and after the surgery. One of the methods that will be employed here is the interview process in addition to secondary data collection.
The collected data will be analyzed using comparative analysis of the rates of side-effects and infections when using the chlorhexidine for three days and the same aspects when 2% of chlorhexidine is applied for two days.
All these will occur within 4 months
Process, Outcomes Evaluation and Reporting
The team process measure will be the number of patients who complain of itchiness after using 2% of chlorhexidine antiseptic shower during preparation for surgery as well as the rate of occurrence of SSIs. The reduction of complaints of side-effects and prevalence of surgery site infections after application of 2% of chlorhexidine as will be reported by the surgeon will form the clinical evaluation. The results of this study will be reported to the key stakeholders during a presentation event for releasing the results of the study.
Identify Next Steps
The plan will be applicable to other units of the hospital. In order for this to become permanent, a multidisciplinary team will be assembled to present the findings to the administration of the facility asking them to approve the change as the standard preoperative protocol for elective surgical cases.
Disseminate Findings
The dissemination of these findings will occur through publication in a peer-reviewed journal as a clinical assessment study. This publication will be shared with both the colleagues of the present author and even external colleagues.
Conclusion
The health-associated infections such as surgical site infections play a fundamental role in the determination of the quality of services offered by health care settings. However, the application of antiseptic solutions such as chlorhexidine in preoperative bathing/shower preparation can reduce the incidences of the same. The absence of a standardized protocol involving the application and concentration of the solution has often exposed patients to side-effects including itching. Using ACE Model phases such as discovery of knowledge, and placing it in an evidence summary, the research study revealed that the most ideal application of the chlorhexidine gluconate should entail its 2% concentrated form and two days before the surgery in a bathing/showering form. In order to maintain the change plan, the information needs to be disseminated to peer-reviewed journals and lobbied for adoption as the standard preoperative preparation strategy at the hospital.
References
Edmistorn, C., Bruden, B., Rucinski, M., Henen, C., Graham, M., & Lewis, B. (2013). Reducing the risk of surgical site infections: Does chlorhexidine gluconate provide a risk reduction benefit? American Journal of Infection Control, 41(5), 49-55
Franco, L., Costa, G., Pinto, T., & Ercole, F. (2016). Preoperative bathing of the surgical site with chlorhexidine for infection prevention: Systematic review with Meta-analysis. American Journal of Infection Control, 45(4), 343-349
In Nelson, R., & In Staggers, N. (2014). Health informatics: An interprofessional approach. St. Louis, Mo. : Elsevier Mosby.
Hsieh, C. S., Cheng, H. C., Lin, J. S., Kuo, S. J., & Chen, Y. L. (2014). Effect of 4% chlorhexidine gluconate predisinfection skin scrub prior to hepatectomy: a double-blinded, randomized control study. International surgery, 99(6), 787-94.
Parkosewithc, J.A. (2013). An infrastructure to advance the scholarly work of staff nurses. The Yale journal of biology and medicine, 86(1), 63-77.
Wang, Z., Zheng, J., Zhao, Y., Xiang, Y., Chen, X., Zhao, F., & Jin, Y. (2017). Preoperative bathing with chlorhexidine reduces the incidence of surgical site infections after total knee arthroplasty: A meta-analysis. Medicine, 96(47), e8321.
Webster, J., & Osborne, S. (2015, February 20). Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Retrieved from Cochrane Database of Systematic Reviews: http://onlinelibrary.wiley.com.proxy.chamberlain.edu:8080/doi/10.1002/14651858.CD004985.pub5/full
