Assessment 2: Strategic plan for change
Name
NURS-FPX6201: Leading in Nursing and Healthcare
Capella University
Instructor Name
July 2024
Strategic plan for change
Most patients access hospital services when they are ill and put their lives in the hands of healthcare givers with the expectation of receiving the best care possible. All possible precautions shall be taken to ensure the patient is not harmed in the hospital. The patients acquire nosocomial infections or hospital-acquired infections while in the hospital. These infections are costly in their management, contribute to longer hospitalizations, result in other complications, and are potentially deadly in serious cases. Some common hospital-acquired infections affecting ICU patients include ventilator-associated pneumonia, ranging from 10-30% (Mumtaz et al., 2023).
The pressures on our hospital include a high acuity level that demands increased use of ICU beds and short patient length of stays shorter than expected limiting prolonged hospitalizations to be a severe adverse event that affects patient care outcomes and the operational effectiveness of several departments. When performing quality control checks on a set of patients at the end of the last quarter, it was established that VAP cases had risen by 17% compared to before (Mastrogianni et al., 2023). It is necessary to put in strategic practice change to practice the kind of VAP prevention that is so clearly required. Detailed observational audits and live interviews with families, nurses, and healthcare aides highlighted key issues. The ICU department has a VAP prevention bundle, including HOB elevation, readiness assessment for extubation, periods without sedation, early enteral feeding, oral hygiene adherence, and endotracheal tubes with subglottic secretion suction ports (Abad et al., 2021). However, reviews revealed that the primary cause of increased VAP rates is inadequate HOB elevation in most cases.
Literature Review
A literature review requires much time and focus as it entails the evaluation of literature by other researchers. A literature review is a crucial step in any research study as it minimizes the main researcher’s repetition and identifies breakthroughs in the existing literature to help fill the gaps (Luft et al., 2022). Besides, reviewing literature is an essential prerequisite for any research because it helps define the problem under investigation. This process has to be thorough and, to the extent possible, exact because it affects the overall validity of the study results. Therefore, a careful literature review is a critical component of the research process to generate valid and relevant outcomes.
Baccolini, V., Migliara, G., Isonne, C., Dorelli, B., Barone, L. C., Giannini, D., Marotta, D., Marte, M., Mazzalai, E., Alessandri, F., Pugliese, F., Ceccarelli, G., Vito, C., Marzuillo, C., Giusti, M., & Villari, P. (2021). The impact of the COVID-19 pandemic on healthcare-associated infections in intensive care unit patients: A retrospective cohort study. Antimicrobial Resistance and Infection Control, 10(1), 87. https://doi.org/10.1186/s13756-021-00959-y
This retrospective cohort study compares the rates of HAI pre- and during the pandemic in ICU patients, particularly in VAP. To understand the extent of infection during and pre-pandemic, this research compares the two and unveils that HAIs recorded a high increment during the pandemic. They attributed its rise to higher ICU bed occupancy, longer stay on ventilators among COVID-19 patients, and healthcare worker burnout during COVID challenges to infection control measures. The study emphasizes proper infection control measures and strategies since the risk of infections increases during a health crisis. It is, therefore, necessary to increasingly increase alertness, adherence to the measures that can prevent transmission of viruses, and better methods of observation of infections to minimize the effects caused by the pandemic in HAIs and increase the safety of patients admitted to ICU. These findings urge for a more strategic implementation of approaches to infection prevention due to the challenges that accompany different pandemics, all in the name of patient safety. Implementing these approaches, on the other hand, can assist healthcare systems in developing the necessary ‘edge’ in times of the next pandemic or certain other related disaster. The study reveals the importance of structural changes and creativity in set measures of fighting infections due to the emerging threats posed by global health crises.
Chapman, L., Hargett, L., Anderson, T., Galluzzo, J., & Zimand, P. (2021). Chlorhexidine gluconate bathing program to reduce healthcare-associated infections in both critically ill and non-critically ill patients. Critical Care Nurse, 41(5), e1–e8. https://doi.org/10.4037/ccn2021340
This study emphasizes the impact of 4% chlorhexidine gluconate bathing to reduce HAIs. After the assessment of results spread over several years, a decrease in infection rates, especially among the ICU and postoperative telemetry patients after using the CHG bathing protocol, was observed. Several units responded. For instance, the CHG bathing program in the ICU reduced infection rates by 52% and the postoperative telemetry unit had a reduction of 45%. Infection from specific bacteria showed significant declines these included methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and Clostridioides difficile. Therefore, the findings affirm the ability of CHG bathing to reduce HAIs and endorse its incorporation into common infection elimination practices in diversified hospital domains to boost patient security and results. The research also emphasizes the necessity of a constant assessment and plan alteration regarding infection prevention activities to develop and sustain the efficiency of the measures in question. Adhering to the policy as the standard procedure in patient handling will go a long way in enhancing patients’ health status, besides improving the hospital’s general hygiene status. Based on these deductions, more implementation of CHG protocols should be encouraged to augment infection control and patient safety in healthcare organizations.
Maes, M., Higginson, E., Pereira J., Curran, M. D., Parmar, S., Khokhar, F., Cuchet, D., Lux, J., Sharma, S., Ravenhill, B., Hamed, I., Heales, L., Mahroof, R., Soderholm, A., Forrest, S., Sridhar, S., Brown, N. M., Baker, S., Navapurkar, V., Dougan, G., & Conway, 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
This article investigates the prevalence of VAP complications in patients with severe COVID-19 illnesses and their predictors. It was found that COVID-19 patients acquire VAP at a much higher rate as compared to patients who did not contract the virus (48% VS 13%). This is due to patients’ longer days on mechanical ventilation due to severe coronavirus disease. There is a clear implication of the need to ensure standard compliance to provided VAP prevention procedures at any given time, but especially during an epidemic with the patient at high risk. Increased infection control measures include the optimum use of antimicrobial agents, good oral hygiene, and effective measures toward the right air exchange. The present implications are that amongst critically ill patients, there is a need to embrace specific approaches to enhance the patients’ health and contain VAP occurrences during emergencies. Dissemination of information and constant implementation of measures are essential to overcome the problems set by the pandemic. Thus, the study indicated that more elaborate and evolving methods are required for infection control to address the high risks of COVID-19. There are various ways of strengthening solutions, and the ability to integrate such measures can significantly lessen mortality and facilitate the improvement of patients’ general health in the ICU. This research suggests that hospitals should change and improve their infection control measures to deal with the emerging complications linked to COVID-19 and similar epidemics.
Moniz, P., Coelho, L., & Póvoa, P. (2021). Antimicrobial stewardship in the intensive care unit: The role of biomarkers, pharmacokinetics, and pharmacodynamics. Advances in Therapy, 38(1), 164–179. https://doi.org/10.1007/s12325-020-01558-w
This article discusses how biomarkers can be used to direct AMT to ensure that appropriate treatment circumscription and AMR avoidance in the ICU is accomplished. C-reactive protein and procalcitonin are highlighted as valuable in framing the management of AMT since they will eliminate the use of antimicrobial drugs that are not required and enhance the facility in handling infections. It identifies that although it is creatively apparent that there remain relatively few sure-fire biomarkers, the place of both CRP and PCT in antimicrobial stewardship strategies can nonetheless substantially refine the stake of infection control. Thus, these biomarkers help clinicians identify the exact status of a particular infection and assist the staff in making correct decisions concerning the start and cessation of AMT, thus preventing such infections as VAP and enhancing patient outcomes in the ICU. This approach makes using antimicrobials in clinical practice easier and more efficient, thus encouraging precision medicine in critical care. Hence, incorporating biomarkers in the clinical setting can be regarded as a shift in an individualized treatment paradigm in managing ICU patients, improving patients’ prognosis, and decreasing the expenses linked to longer admissions and inefficiency in the treatment of reoccurring infections. Thus, the study supports the need for constant exploration and development of more biomarker labels to improve the effectiveness of antimicrobial stewardship initiatives.
Wei, J., He, L., Weng, F., Huang, F., & Teng, P. (2021). Effectiveness of chlorhexidine in preventing infections among patients undergoing cardiac surgeries: A meta-analysis and systematic review. Antimicrobial Resistance and Infection Control, 10(1), 140. https://doi.org/10.1186/s13756-021-01009-3
In the meta-analysis, the authors review the effectiveness of using chlorhexidine (CHX) to reduce surgical site infection (SSI) and other healthcare-associated infections (HAIs) in patients undergoing cardiac surgery. This present meta-analysis thus pools data from several controlled trials and cohort studies on the effect of CHX on infection rates. The findings show that CHX bathing decreases the occurrence of SSIs and other HAIs, and the efficacy of CHX bathing is somehow relative to the type of control for intervention used in several analyses. For example, it was established that CHX demonstrated a more significant difference than no intervention, but in contrast to isopropyl alcohol, it played a fairly good role. The meta-analysis provides evidence that CHX should be implemented into infection prevention measures in surgical and ICU patients to reduce the impact of HAIs. These findings have highlighted the value of transportable and sustainable infection control entities similar to the guidelines recommended by WHO to minimize microbial colonization to improve the security associated with patients’ results. These issues point towards the need for constant reassessment and application of CHX in other practices in infection control to get the most from it. Furthermore, CHX bathing avoids or reduces HAIs, implying more minimized costs of treating the diseases and early recovery of patients. Thus, the study calls for enhancing best practice guidelines in implementing CHX bathing across organizations for patients’ optimum advantage.
Synthesis of the Evidence
Evidence synthesis entails synthesizing that enables a summary and balanced review of the available evidence (Chapman et al., 2021). It aims to improve the comprehensiveness and focus by organizing the current literature systematically and unreservedly, thereby strengthening their internal cohesion. Synthesizing evidence is a rather complex and unexciting process however, doing it reveals a lot of interesting information and data. Going through the findings of the articles mentioned above, one can conclude that ventilator-associated pneumonia is reduced by applying a VAP prevention bundle. One of this bundle’s elements is to keep the HOB elevation at more than 30 degrees. The literature review confirms that this approach efficiently manages and decreases the VAP rate (Maes et al., 2021). Therefore, my organization’s best course of action is to incorporate the elevation of all ventilated patients’ HOB as part of nursing care in the ICU. This implementation will comply with the best practices identified in the evidence and enhance the value of patient care.
Suggested Courses of Action
Evidence-based practice (EBP) incorporates the use of research findings that are current and credible, together with the knowledge of practitioners in making decisions related to healthcare. As acknowledged healthcare providers and leaders, we must do no wrong and deliver the best to our patients. Strategies must be implemented to achieve modifications that will help prevent VAP efficiently. Recommendations for these early stages should include recognizing changes that may be needed and redesigning the current practices, setting goals for these changes, deciding timelines for the expected outcomes, involving the personnel in the process, and creating an overall change plan. Staff needs to be involved in introducing new practices to achieve the intended goals (Martinez et al., 2023).
The strategy can be described as an important change in the organizational culture in the ICU through the reinforcement of the key principles of the intervention, such as HOB elevation, and improving the knowledge about potential outcomes and effects of this measure. It would be useful for the staff to see the findings of other related studies to ensure such practice is emphasized more. Therefore, for the change to be enduring, Lewin’s theory of planned change is advised. This type of change management requires a step-by-step, timely approach preceded by the diagnosis of culture, readiness to change, and motivation (Stanz et al., 2022). Thus, sustaining rather than transforming is critical, or shifting gradually rather than abruptly or erratically. The staff will be provided with educational and follow–up sessions for change that will help to have the change- plan coming from every staff member. Moreover, having the staff appoint VAP champions to oversee the occasional checks of the HOB angles and to be a source of enthusiasm for the long-term sustenance of the practices will be beneficial. This way, implementing the changes is successful, well-executed, and carried out in the long term to improve patients’ quality of care and protection.
NURS FPX 6201 Assessment 2 Strategic plan for change Summary
VAP is expensive and has various adverse effects on the patient’s health. It lengthens the duration of hospitalization and increases the possibility of further related complications for patients under ventilators in the ICU (Moniz et al., 2021). Prevention is key, and awareness is vital when introducing and enforcing VAP preventive measures (Abad et al., 2021). By implementing the practical and research-based approaches coupled with a proper assessment and consequent alterations, healthcare centers can upgrade infection prevention procedures, thereby contributing to patient protection and decreasing healthcare expenses.
NURS FPX 6201 Assessment 2 Strategic plan for change References
Abad, L., Formalejo, P., & Mantaring, L. (2021). Assessment of knowledge and implementation practices of the ventilator-acquired pneumonia (VAP) bundle in the intensive care unit of a private hospital. Antimicrobial Resistance and Infection Control, 10(1), 161. https://doi.org/10.1186/s13756-021-01027-1
Baccolini, V., Migliara, G., Isonne, C., Dorelli, B., Barone, L. C., Giannini, D., Marotta, D., Marte, M., Mazzalai, E., Alessandri, F., Pugliese, F., Ceccarelli, G., Vito, C., Marzuillo, C., Giusti, M., & Villari, P. (2021). The impact of the COVID-19 pandemic on healthcare-associated infections in intensive care unit patients: A retrospective cohort study. Antimicrobial Resistance and Infection Control, 10(1), 87. https://doi.org/10.1186/s13756-021-00959-y
Chapman, L., Hargett, L., Anderson, T., Galluzzo, J., & Zimand, P. (2021). Chlorhexidine gluconate bathing program to reduce healthcare-associated infections in both critically ill and non-critically ill patients. Critical Care Nurse, 41(5), e1–e8. https://doi.org/10.4037/ccn2021340
Luft, J. A., Jeong, S., Idsardi, R., & Gardner, G. (2022). Literature reviews, theoretical and conceptual frameworks: An introduction for new biology education researchers. CBE Life Sciences Education, 21(3), rm33. https://doi.org/10.1187/cbe.21-05-0134
Maes, M., Higginson, E., Pereira J., Curran, M. D., Parmar, S., Khokhar, F., Cuchet, D., Lux, J., Sharma, S., Ravenhill, B., Hamed, I., Heales, L., Mahroof, R., Soderholm, A., Forrest, S., Sridhar, S., Brown, M., Baker, S., Navapurkar, V., Dougan, G., & Conway, 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
Martinez, R., Tejada, S., Jansson, M., Ruiz, A., Ramirez, S., Ege, D., Vieceli, T., Maertens, B., Blot, S., & Rello, J. (2023). Prevention of ventilator-associated pneumonia through care bundles: A systematic review and meta-analysis. Journal of Intensive Medicine, 3(4), 352–364. https://doi.org/10.1016/j.jointm.2023.04.004
Mastrogianni, M., Katsoulas, T., Galanis, P., Korompeli, A., & Myrianthefs, P. (2023). The impact of care bundles on ventilator-associated pneumonia (VAP) prevention in adult ICUS: A systematic review. Antibiotics, 12(2), 227. https://doi.org/10.3390/antibiotics12020227
Moniz, P., Coelho, L., & Póvoa, P. (2021). Antimicrobial stewardship in the intensive care unit: The role of biomarkers, pharmacokinetics, and pharmacodynamics. Advances in Therapy, 38(1), 164–179. https://doi.org/10.1007/s12325-020-01558-w
Mumtaz, H., Saqib, M., Khan, W., Ismail, M., Sohail, H., Muneeb, M., & Sheikh, S. (2023). Ventilator-associated pneumonia in intensive care unit patients: A systematic review. Annals of Medicine and Surgery, 85(6), 2932–2939. https://doi.org/10.1097/MS9.0000000000000836
Stanz, L., Silverstein, S., Vo, D., & Thompson, J. (2022). Leading through rapid change management. Hospital Pharmacy, 57(4), 422–424. https://doi.org/10.1177/00185787211046855
Wei, J., He, L., Weng, F., Huang, F., & Teng, P. (2021). Effectiveness of chlorhexidine in preventing infections among patients undergoing cardiac surgeries: A meta-analysis and systematic review. Antimicrobial Resistance and Infection Control, 10(1), 140. https://doi.org/10.1186/s13756-021-01009-3
