Obtaining Approvals and Securing Support - Assignment Example

Developing an Implementation Plan al Affiliation Developing an Implementation Plan Obtaining Approval(s) and Securing Support for Proposal The first step in the implementation of this program is obtaining approval. The program will be approved in two ways. First, there will be informal approval, which will involve getting the support of peers and unit leaders. Second, the program will undergo formal approval through Site-Based Research (SBR) Units Review (Carter, Reitmeier & Goodloe, 2014). The success of this program implementation process will rely on the support and participation of peers and unit leaders. Peer support will ensure that the implementation process will take the shortest time possible. Additionally, peer support will contribute to enthusiasm and buy-in for the implementation process. Administrative support is equally important because it will influence the degree to which institutions will implement the program. Below is the process of obtaining informal approval: A. Gather feedback from stakeholders during the early stages of the proposal. Feedback will collected through staff participation and the participation of physicians. B. Communicate the commitment of the project to stakeholders C. Fill out a nursing research feasibility form D. Obtain signatures from the nurse manager and the nurse research scientist. E. File the completed feasibility form in the regulatory binder Formal approval will require the submission of the program implementation plan to Site Based Research Review. SBR will review the proposal to assess the validity and legality of the contents of the plan. Afterward, the SBR will assign a director who will then forward the proposal to the Institutional Review Board (IRB) for review. The implementation will then commence after the approval of the IRB. Analysis of the Problem Research studies reveal that health associated infections (HAIs) are some of the most common complications that healthcare organizations and practitioners face. For instance, a new research study reveals that more than two million people develop HAIs every year. The infections result in approximately 1,000 deaths every year. HAIs are also responsible for health care costs in excess of 30 billion dollars. Thus, addressing the issue of HAIs is critical in reducing healthcare costs and enhance patient safety. One of the approaches to addressing the problem of HAIs is reducing the prevalence of Catheter-Associated Urinary Tract Infection (CAUTI) among patients. CAUTIs are the most typical examples of HAIs, and they account for more than 35 percent of infections. The U.S. Department of Health estimates the total annual cost of CAUTI to be 565 million dollars, and the annual rate of deaths from CAUTI is 8,205 (). Additionally, approximately six hundred thousand patients develop urinary tract infections from hospitals and cases of CAUTI are approximately 75 percent. However, the good news is that researchers have revealed that healthcare systems can prevent CAUTIs and that approximately 70 percent of CAUTI episodes can be prevented. Additional research studies reveal that patients with indwelling urinary catheters have a higher risk of developing UTIs along with the risk of bacteriuria. Researchers note that the risk of infection increases is directly related to the use of urinary catheters. Thus, infections increase with the increase in the use of urinary catheters. Some of the risk factors of CAUTI include female gender, prolonged catheterization and catheter insertion outside a healthcare setting. Approximately 25 percent of patients will be inserted with a urinary catheter during the period of their hospitalization. The insertion occurs in areas such as the emergency department, the operating room, and the intensive care unit. There is a high prevalence of CAUTI because approximately 50 percent of patients from non-intensive medical units may lack valid indications that they were inserted with a urinary catheter. In 2000, a research survey revealed that approximately 33 percent of the physicians were unaware that their patients had indwelling catheters (Meddings, Rogers, Macy & Saint, 2010). In response to the growing spread of CAUTIs, Medicare & Medicaid Services (CMS) has noted that it will reimburse funds for CAUTI. In fact, a 2007 survey indicated that CAUTIs were responsible for an additional cost of between 1,300 dollars and 1,600 dollars in every patient. Another report by the Veteran’s Health Administration reported that approximately 50 percent of the patients are uncomfortable with the use of indwelling catheters. The subjects also noted that indwelling catheters are painful. The primary goal of this program is to develop clinical interventions for indwelling catheters to ensure appropriate insertion and appropriate removal. Additionally, the project focuses on enhancing unit safety culture. The Comprehensive Unit-based Safety Program (CUSP) from the Armstrong Institute will aid in developing the unit safety culture. The objectives of the current program include: Reducing the mean CAUTI rates by 25 percent in units that will implement the program Improve safety culture using the CUSP methodology Promote appropriate use of catheters Enhance the proper placement technique and care of the catheter Proposed Solution The best solution that can address the problem of widespread CAUTI is patient-centered care. Healthcare providers should focus on addressing the individual needs of patients. The most important approach is developing a strategy that will address both technical and adaptive problems associated with CAUTI. It is easy to address technical problems because the problems have already been identified (Meddings, Rogers, Macy & Saint, 2010). However, an adaptive problem is not readily identifiable, and it is hard to get solutions because the solutions are never apparent. The current program will meet its objectives by implementing the following: Interventions (technical and adaptive) Measures of success Coaching support Project infrastructure Therefore, the current program will combine the activities mentioned above to ensure that the program spread across different areas. A. Adaptive and Technical Interventions ADAPTIVE 4 E’s Model The current program will engage, educate, execute and evaluate the safety of patients to address the initial objectives. Comprehensive Unit-based Safety Program (CUSP) CUSP will enhance safety in clinical units by offering a common platform for understanding safety and integrating habits in the daily routines of a clinical area. TECHNICAL Educating staff on the appropriate use of catheters Promoting proper catheter insertion and maintenance by ensuring that properly trained clinicians insert the catheter Encourage prompt removal if catheters B. Measures of Success: the project will use data to justify the allocation of resources C. Coaching Support: the program will disseminate information to frontline staff to ensure that members of staff promote safety and minimize costs. D. Project Infrastructure: the current program will rely on the contributions of various stakeholders including the government and hospitals to ensure that there are adequate resources. Rationale for Selecting Proposed Solution The current program will combine adaptive and technical interventions because of the complexity of the situation. CAUTI is a serious problem in the field of healthcare services, and the problem arises on two fronts. One front is the role of catheters in the spread of CAUTI. The technical problems have well-established solutions. On a different note, there is the issue of risk factors and the role of physicians, which lacks implicit solutions. A combination of both adaptive and technical interventions will ensure that the two approaches compensate for the weaknesses of each other. The rationale for using a patient-centered approach is that it is holistic and offers the opportunity for healthcare providers to engage patients as active participants in every aspect of their health. Additionally, patient-centered care enhances patient satisfaction without increasing costs. Literature Review Patient-Centered Care is among the critical areas that improve the quality of healthcare. According to the Institute of Medicine (IOM), patient-centeredness refers to a form of health care that encourages partnership between the patient and the healthcare practitioner. It also establishes collaboration between healthcare providers and the families of the patient. The collaboration enables patients to make personal choices that affect their care (Meddings, Rogers, Macy & Saint, 2010). Patient-Centered Care focuses on the needs of the patient and allows the healthcare provider to adapt to the changing needs of the patient. Some of the elements of patient-centered care include cultural competence and effective communication (Carter, Reitmeier & Goodloe, 2014). Communication is one of the factors that promote the effective application of patient-centered care. Communication enables the nurse to understand the needs of the patient and corresponding perspectives. It also enables the patient to participate in their care and assists them to correct any false expectations (Carter, Reitmeier & Goodloe, 2014). Research studies reveal that skillful communication enables the physician to explore what the patient hopes to achieve during the period of hospitalization (Vacca & Angelos, 2013). Implementation Logistics The following is a list of steps that will be involved in the implementation of the program: A. Assemble a Team The project leader will establish a multidisciplinary team and obtain the support of leaders including administrators, nurses, and physicians. B. Teamwork and communication tools The project leader will use tools and resources identified in the succeeding section to enhance communication in the unit. Members of the team will decide on the most appropriate tool for the program. C. Learning from defects Members of the team will investigate all infections and use the process as an opportunity to learn from the defects. Meetings will offer the best opportunity for team members to learn from defects. D. Team Meetings The team leader, executive partner, physician champion and nurse champion will at least meet once in a month for the sake of assessing changes that could reduce harm and improve safety. E. Education Team members will conduct face-to-face meetings with the aim of assessing the progress of the program and even share data. Team members will participate in various educational opportunities The team leader will educate members of staff with regards to safety using a video presentation Issue feedback on the progress of the implementation process The team leader will lead by example with the aim of championing the program Educate other units by increasing awareness of the team’s efforts through the following approaches: Display of CAUSTI posters Posting reminders Posting updates on the hospital website Publishing monthly progress reports in newsletters F. Data Members of the team will collect data on the prevalence of urinary catheter and determine the rationale behind the use of all catheters. The process of collecting data will involve team members discussing and reinforcing daily assessments of catheter use. It will also reinforce the identification of various indications and subsequent removal of catheters that have already served their purpose. Team members will submit data into care counts The team leader will review reports and during team meetings and use the reports to measure the rates of prevalence and identify the necessary improvements. The team leader will post data on areas of improvements so that team members can make the appropriate changes. G. Coaching The state lead and the national project team will assist team members by providing coaching support. Team members will visit healthcare settings and collaborate with healthcare providers including physicians and nurses. Resources A. CUSP Toolkit Resources The AHRQ website provides access to the CUSP toolkit, which includes training tools. The training tools enhance the safety of healthcare by enhancing the foundation of clinical team members that work together. B. Project Sustainability Action Plan Tool A worksheet that monitors the progress of the program and helps the team to identify areas of strength and areas of weakness. It also outlines future goals and develops an action for achieving such goals. C. HSOPS Poster A template that will encourage patients to complete the AHRQ Hospital Survey on patient safety culture. D. Oregon Team Coaching Model The model identifies questions that will encourage team members to focus on serious issues related to catheter utilization. E. The University of Michigan CatheterOut.org Website The website offers information such as data collection, protocols and a cost calculator for the program. F. Guidelines and protocols They will direct the actions of team members so that they can work towards achieving the goals of the program. G. Staff Physicians and nurses will be part of the implementation process. Additionally, administrators will also oversee the implementation of the project. H. Funds The program will require funds to finance its operations including staff training, purchase of printing materials and data collection. References Carter, N. M., Reitmeier, L., & Goodloe, L. R. (2014). An Evidence-Based Approach To the Prevention of Catheter-Associated Urinary Tract Infections. Urologic Nursing, 34(5), 238-245. Meddings, J., Rogers, M. M., Macy, M., & Saint, S. (2010). Systematic Review and Meta-Analysis: Reminder Systems to Reduce Catheter-Associated Urinary Tract Infections and Urinary Catheter Use in Hospitalized Patients. Clinical Infectious Diseases, 51(5), 550-560. Vacca, M., & Angelos, D. (2013). Elimination of Catheter-Associated Urinary Tract Infections in an Adult Neurological Intensive Care Unit. Critical Care Nurse, 33(6), 78-80. Read More