Surveillance of Healthcare-Associated - Case Study Example

NURS2006 ASSIGNMENT 3 Clinical Practice Improvement Project Report Student Name, FAN and ID: Type your assignment into the white spaces in the template and the rows will expand as much as you need them to.ie Alex Smith smit0000 ID 1234567 Project Title: Implementation of Surveillance of Healthcare Associated Infections (HAIs) Program in Australian Hospitals. Project Aim: To reduce rates of HAIs in hospitalised patients by 20% in Australia through effective surveillance. The focus of this project will be to develop a framework that can be used in improving surveillance of HAIs in Australia in order to prevent and reduce HAIs. The project is based on previous studies on effective evidence-based surveillance programs and strategies for assessing, reducing and preventing HAIs. Relevance of Clinical Governance to your project Clinical governance focuses on making sure that patients get safe and quality healthcare. Concerning clinical governance, this project aims at surveillance which is an intervention recommended by Patient Safety Report. Surveillance of HAIs aims at constant monitoring of the rates of HAIs as well as monitoring hygiene activities through evaluation and performing regular studies (Sydnor & Perl, 2011, p. 153). Clinical governance will be relevant in the project when it comes to monitoring of surveillance of HAIs programs. Clinical governance entails clinical performance and evaluation and because this project involves surveillance of HAIs, clinical governance is relevant in monitoring and evaluating HAIs in order to establish the patterns of progression of HAIs. Therefore, it will facilitate prediction, observation as well as reducing the harm that is cause by HAIs (Zingg et al. 2015, p. 214). In addition, clinical governance also involves reducing risk and improving overall safety and hence it is relevant in this project in that effective surveillance of HAIs in hospitals will ensure reduced risk of HAIs as well as improve clinical safety in the hospitals (Zingg et al. 2015, p. 214). In regard to clinical governance, surveillance of HAIs calls for healthcare facilities to regularly conduct review, monitoring and evaluation of HAIs within hospitals. The key aim of surveillance is to prevent HAIs and effectively management infections when they occur through evidence based strategies (Russo et al. 2014, p. 2). Additionally, the Nursing and Midwifery Board of Australia (2010) stipulates that nurses should endeavour participate in quality improvement activities. Nurses are supposed to continually review and use practice in regard to practice outcomes, guidelines and new developments. Nurses should also use recent evidence to update their practices (Nursing and Midwifery Board of Australia, 2010). This project is relevant to this in that, information used to inform this project will come from the most recent evidence and that this project is a quality improvement activity where nurses will be required to take part in. Evidence that the issue / problem is worth solving: Healthcare-associated infections (HAIs) have significant medical consequences and pose a substantial problem for patient safety (Ling et al, 2015, p. 1690). A systematic review and meta-analysis by Ling et al (2015, p. 1694) demonstrated that the prevalence of HAIs is 10% per 100 patients. The systematic review also indicated that the degree of infected patients with HAIs is above 10% per 100 patients. In Australia, it is estimated that approximately 175, 000 HAIs occur yearly (Russo et al. 2014, p. 1). These studies demonstrate that HAIs are the most common complication in hospitalized patients. HAIs are preventable adverse incidents and hence it is possible to significantly decrease the rate of HAIs using effective infection prevention and control programs (ACHS NSQHS, 2014, p. 2). Prevention of HAIs is possible through sustained, multifaceted infection prevention and control programs, including surveillance programs. Even though active surveillance is perceived as the gold standard for surveillance, prevalence surveys are also important because they can give baseline information regarding the occurrence and distribution of hospital acquired infections (Russo et al. 2014, p. 1). In countries such as North America as well as a good number of European counties, national surveillance programs have been introduced. However, in Australia there is definite national strategy and surveillance system that specifically addresses hospital acquired infections. Additionally, even though numerous states in Australia have surveillance programs for healthcare associated infections, the surveillance programs have significant differences and there is variability in surveyed infections(Gardner et al. 2014, p. 2). Moreover, the level of participation by hospitals in HAIs surveillance is not mandatory apart from New South Wales State. Generally, currently there is not national or state level surveillance for HAIs within Australian hospitals and thus Australia lacks a specific national strategy and surveillance system for undertaking surveillance activities for HAIs (Gardner et al. 2014, p. 2). This is in spite of high rate of HAIs in Australian hospitals. Additionally, Australia has not carried out a national point prevalence study on HAIs for a long time since the last national prevalence study for HAIS was carried out in 1984 where prevalence of HAIs was found to be at 6.3% and urinary tract infections contributing to 22% of HAIs (Gardner et al. 2014, p. 3). Key Stakeholders: Stakeholders in this project include; registered nurses, doctors, patient care technicians, hospital’s management, leadership team and infection control team. The change will also affect patients by reducing complications and infections that result from HAIs as well as increase patient safety. This project aims at improving the quality of care at Australian hospitals by effective surveillance of HAIs. The management in the selected hospital will continue to adhering to the surveillance programs. The doctors and nursing staff will be monitored in regard to HAIs prevention strategies and also assist in providing data regarding the rate of HAIs in the hospitals. On the other hand, the leadership team will support the funding of the proposed change and in return the management team will benefit from reduced rate and prevention of HAIs due to patients’ satisfaction as well as improved revenue and reduced costs (Reed & Kemmerly, 2009, p. 29). CPI Tool: Plan-Do-Study-Act (PDSA) cycle Plan, Do, Study and Act (PDSA) tool will be used in planning and implementing this project. Evidence shows that PDSA tool is effective in implementing quality improvement projects because it operates in a cycle and therefore provides a constant quality improvement process (Curnock, 2013, p. 2). Plan This phase involves developing goals for the project. In this project, the goals of the planning phase will include: To reduce rates of HAIs in hospitalised patients by 20% in Australia through effective surveillance To ensure the hospitals adhere to the recommended surveillance programs To ensure healthcare workers adhere to the recommended hand hygiene procedures (World Health Organization, 2009, p. 17) Do This phase will entail performing actions that will result to implementation of the change. The tasks that will be involved include: Evaluating the costs of the project and seeking for finances and resources for carrying out the project Educating the stakeholders as well as other staff members regarding the change in order to reduce resistance to change Direct monitoring of the healthcare providers to observe if they are adhering the required hand hygiene practices Assessing the hospital records regarding the rates of HAIs before, during and after the implementation of the project (Sydnor & Perl, 2011, p. 142) Study Collecting the results from the previous data on rates of HAIs and comparing against baseline findings Study and compare the hand hygiene adherence of healthcare provider before the project and after the implementation of the project Study and compare the rates of HAIs in the hospital before and after the implementation of this project (Sydnor & Perl, 2011, p. 142) Act Depending on the results of obtained after the implementation of the project; various actions will be performed to ensure continuity of the implemented activities as well as improvement. Some of the activities that will be performed to ensure successful project implementation and its continuity include: Education all healthcare providers on the significance of always performing hand hygiene practices Poster presentation on how to carry out various hand hygiene practice Distribution of the project results regarding how HAIs rates can be reduced by adhering to hand hygiene and ensuring effective surveillance of HAIs is carried out PowerPoint and Poster presentation on HAIs surveillance to the hospital management as well as healthcare providers for further knowledge improvement (Hanrahan, Marlow K &Hiatt, 2010, p. 4) Summary of proposed interventions: Data Collection Data regarding the rate of HAIs will be collected. Data collection will be conducted before the project and after the project implementation. This data will be obtained from the hospital records on HAIs. The collected data will be used to evaluate if the project was effective in reducing the rates of HAIs or not (Sydnor & Perl, 2011, p. 142). Monitoring and Evaluation The process of monitoring can evaluation has to be carried out through predicting, observing and minimizing harm resulting from the hospital associated infections (Zingg et al. 2015). The prediction involves a careful analysis of the hospital environment as well as the practices involved in the care of the patients. The data at the facility has to be reviewed in order to determine the past experience of the hospital regarding the hospital associated infections. This is for ensuring that more information about the infections is obtained. A careful analysis of the data is vital in obtaining detailed information about the risk areas (Babbie, R, 2010, p. 2). Observation Observation involves obtaining information based on how the healthcare providers are carrying out their activities. This is useful in ensuring that the possible areas of weaknesses are identified. The observation may involve how the nurses carry out their activities where nurses are assessed using observation to establish if they are adhering to hygiene practices (Russo, Barnett, Cheng, Richards, Graves & Hall, 2015). Minimizing harm is also part of the proposed intervention. This mainly involves embracing the practices that minimizes the hospital associated infections. The data collected from the surveillance process will form the basis of implementing the activities aimed at minimizing the harm caused to the patients (Babbie, R, 2010, p. 2). Barriers to implementation and sustaining change: Barriers to change in this project will be related to the effect of active surveillance on reducing HAIs rates. One key barrier in this project will be gaining support from the hospital management as well as healthcare providers(Bruce, 2013, p. 27). This might be worsened by resistance to change by staff members which is very common during organisational change. Time-frame will also be another barrier in this project. The time frame is 3 months and in order to demonstrate substantial decline in acquisition of HAIs it would require a long monitoring period; nonetheless, because of the project’s short time frame, effective surveillance of HAIs rates and monitoring of compliance of healthcare providers to infection control standards will not be possible(Bruce, 2013, p. 27). In addition, implementation to the surveillance program will also be limited to the time that the infection control team is on the site. Other barriers to implementation of surveillance programs in the hospital will include; the inadequate number of supervisory personnel available for training new staff members as well lack of adequate involvement of all healthcare providers in the program (IMPAQ International, 2014, p. 57). Evaluation of the project: 1. The outcome measurement for the project will be reduction of the rate of HAIs in the hospital as well as adherence to HAI prevention strategies. 2. Interviews will be carried out to find out if the healthcare providers and the management are of the opinion that the project has been successful in ensuring effective surveillance of HAIs rates 3. Another evaluation strategy will involve project team members conducting active assessment in order to identify HAIs rates. The HAI rates will then be compared to the baseline HAI rates obtained before the project started to find out if the project was successful in reducing the HAIs rates. 4. Project team members will analyse the project’s outcome and compare with outcomes from evidence-based international guidelines on HAIs surveillance. In case any gaps are identified, quality improvement project will be implemented to correct the deficits in the project. 5. The project will also be evaluated by assessing if the healthcare providers are adhering to the required infection control protocols (Henry et al, 2013, p. 4) Reference List Australian Council on Healthcare Standards. National Safety and Quality Health Service Standards Program, 2012, An introduction to the ACHS NSQHS Standards program. Ultimo, NSW: ACHS. https://www.safetyandquality.gov.au/wp-content/uploads/2011/09/NSQHS-Standards-Sept-2012.pdf Australian Nursing and Midwifery Board (2010).Available at: http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Codes-Guidelines.aspx Babbie, R, 2010,The Practice of Social Research. 12th ed. Belmont, CA: Wadsworth Cengage, 2010; Muijs, Daniel. Doing Quantitative Research in Education with SPSS. 2nd edition. London: SAGE Publications, 2010. Bruce, N, 2013, Improving Compliance with Healthcare Associated Infection (HAI) Practice Guidelines to Reduce the Acquisition of HAIs, Doctor of Nursing Practice (DNP) Capstone Projects. Paper 30. Curnock E, Ferguson J, McKay J & Bowie P, 2013, Healthcare Improvement and Rapid PDSA Cycles of Change: A Realist Synthesis of the Literature, NHS Education for Scotland Department of Postgraduate General Practice Education. < http://www.nes.scot.nhs.uk/media/1389875/pdsa_realist_synthesis.pdf> Gardner, A, Mitchell, B, Beckingham, W &Fasugba, O 2014, 'A point prevalence cross-sectional study of healthcare-associated urinary tract infections in six Australian hospitals', BMJ Open, vol. 4, no. 7, p. e005099. Hanrahan, K, Marlow K &Hiatt A, 2010, Dissemination of Nursing Knowledge: Tips and Resources, The University of Lowa. Henry G, Holmboe E & Frankel R, 2013, Evidence-based competencies for improving communication skills in graduate medical education: A review with suggestions for implementation. Medical Teacher, 1-9. IMPAQ International, 2014, Advances in the Prevention and Control of HAIs, Columbia, IMPAQ International. Ling M, Apisarnthanarak A, Madriaga G & Weinstein R, 2015, The Burden of Healthcare-Associated Infections in Southeast Asia: A Systematic Literature Review and Meta-analysis, Clin Infect Dis, vol. 60, no. 11, pp. 1690-1699. Russo, PL, Cheng, AC, Richards, M, Graves, N & Hall, L 2014, 'Healthcare-associated infections in Australia: time for national surveillance', Australian Health Review, vol. 39, no. 1, pp. 37-43. Reed D & Kemmerly S, 2009, Infection Control and Prevention: A Review of Hospital-Acquired Infections and the Economic Implications, The Ochsneer Journal, vol. 9, no. 1, p: 27–31. < https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096239/> Sydnor E & Perl T, 2011, Hospital Epidemiology and Infection Control in Acute-Care Settings, Clin Microbiol Rev, vol. 24, no. 1, p: 141–173. < https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3021207/> World Health Organization, 2009, WHO Guidelines on Hand Hygiene in Health Care: a Summary First Global Patient Safety Challenge Clean Care is Safer Care, World Health Organization. < http://www.who.int/gpsc/5may/tools/who_guidelines-handhygiene_summary.pdf> Zingg, W, Holmes, A, Dettenkofer, M, Goetting, T, Secci, F, Clack, L, Allegranzi, B, Magiorakos, AP &Pittet, D 2015, ’Hospital organisation, management, and structure for prevention of health-care-associated infection: a systematic review and expert consensus', The Lancet Infectious Diseases, vol. 15, no. 2, pp. 212-224 NURS2006 Assignment 3- CPI paper Marking Rubric PERFORMANCE STANDARD CATEGORY & WEIGHTING Excellent Work Good Work Passing Work Unsatisfactory work Project Aim and Evidence the issue is worth solving 20% Aim succinct & clearly defined. All evidence relevant & rigorous. Shows a very high level of insight & relevance to the issue. (17-20)  Aim well defined. Some irrelevant information but most evidence relevant & rigorous. Shows a very good level of insight & relevance to the issue. (13-16.5)  Aim stated with some ambiguity. Some evidence relevant and rigorous, Acceptable level of insight. Quite a lot of irrelevant information is present. May be overlong/ too brief (10-12.5)  Aim not clearly stated Most evidence is not relevant or rigorous. Poor level of insight & relevance to the issue. Significant amount of irrelevant/ missing information. (0–9.5)  Relevance of Clinical Governance to your project 10% Succinct and highly relevant discussion of the relevant pillar of clinical governance related to the chosen clinical issue. (9-10)  Succinct and mostly relevant discussion of the relevant pillar of clinical governance related to the chosen clinical issue. (7-8.5)  Adequate discussion of the relevant pillar of clinical governance related to the chosen clinical issue. Some parts not relevant Overlong / too brief, may be missing relevant information. (5-6.5)  Inadequate discussion of the relevant pillar of clinical governance related to the chosen clinical issue. Overlong / too brief, may be missing a significant amount of relevant information (0-4.5)  Key Stakeholders 5% Identifies most relevant key stakeholders. Discusses clearly how they could be involved in the project. Succinctly and expertly written. Very high level of insight into the role of stakeholders. (4.5 - 5)  Identifies some relevant key stakeholders and adequately discusses how they could be involved in the project. Very well written. Good level of insight into the role of stakeholders. (3.5-4.25)  Identifies a few relevant key stakeholders. Mentions briefly how they could be involved. Quite well written but contains some irrelevant information, or minor information is missing. Adequate level of insight into the stakeholder role. (2.5 – 3.25- )  Contains irrelevant information, or major information is missing. Inappropriate or no key stakeholders are identified Poor insight into the stakeholder role. (0-2)  Clinical Practice Improvement Tool 20% Describes a relevant CPI tool Very clearly discusses how it could be used to address the aim and implement the interventions. Succinctly and expertly written with no omissions of relevant information. (17-20)  Describes a relevant CPI tool Discusses quite clearly how the tool could be used to address the aim and implement the interventions. Well written but may contain some irrelevant information, or some minor information is missing (13-16.5)  Describes a relevant CPI tool and adequately discusses how the tool could be used to address the aim and implement the interventions. Not succinct, contains irrelevant information, significant information is missing (10-12.5)  A relevant CPI tool is not identified. There is no adequate discussion of how the tool could be used to meet the aim or implement the interventions. Contains irrelevant information or some major information is missing. (0–9.5)  Summary of proposed interventions 20% All relevant interventions are discussed very well. Project outline is very clear and the relevance to clinical practice is very high. (17-20)  Most relevant interventions discussed quite well. Project outline is clear & relevance to clinical practice is good. Contains some irrelevant information, minor information may be missing. (13-16.5)  Acceptable level of relevant interventions discussed. Project outline mostly clear, although it may be unclear how the project would actually be implemented in clinical practice due to irrelevant/missing info (10-12.5)  Some elements missing or incomplete. May contain large amounts of irrelevant information. Project poorly described and it is unclear what the project actually entails or its relevance to clinical practice. (0–9.5)  Barriers to Implementation 15% Identifies most potential barriers to implementation & clinical change. Discusses in depth how these barriers could be overcome or minimised. (13-15)  Identifies some potential barriers to implementation & clinical change. Discusses how these barriers could be overcome or minimised. (10-12.5)  Identifies a few potential barriers to implementation & clinical change. Discusses how barriers could be overcome or minimised. Minor omissions and/or some irrelevant information present (7.5-9.5)  Relevant barriers not identified. Poor or no discussion about how they could be overcome or minimised. Major omissions, much of the information provided is irrelevant / unrelated to the CPI goal. (0-7)  Evaluation of the project 10% Succinct discussion of an excellent and achievable plan for how the intervention/s could be evaluated. (9-10)  Succinct discussion of a very good and mostly achievable plan for how the intervention/s could be evaluated. (7-8.5)  Discussion of an adequate plan for how the intervention/s could be evaluated. Some parts not relevant or achievable Overlong / too brief, may be missing relevant information. (5-6.5)  Plan absent or not well described. Most or all of the plan is not relevant or achievable Overlong / too brief, may be missing a significant amount of relevant information (0-4.5)  Name of Marker Grade Overall Comments Read More