DNP 835 Topic 4 DQ 1 Describe how your direct practice improvement project achieves clinical improvement.

DNP 835 Topic 4 DQ 1 Describe how your direct practice improvement project achieves clinical improvement.

DNP 835 Topic 4 DQ 1 Describe how your direct practice improvement project achieves clinical improvement.

DNP 835 Topic 4 DQ 1 Describe how your direct practice improvement project achieves clinical improvement.

Topic 4 DQ 1

Reflecting on the “IHI Module QI 202: Addressing Small Problems to Build Safer, More Reliable Systems,” describe how your direct practice improvement project achieves clinical improvement. How will you achieve widespread change? How would the widespread change of your DPI Project be affected if it were implemented in a country with universal health care. Describe how the health outcome would be impacted. Provide supporting evidence.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.

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Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.

One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.

I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.

In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.

Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).

Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).

Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.

I highly recommend using the APA Publication Manual, 6th edition.

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Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.

As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.

It is best to paraphrase content and cite your source.

LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.

Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?

Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Enhancing the quality and safety of health care is a main concern of governments, health care workers, and the public with endeavors often concentrated on contributions made towards having changes in how health care is structured and provided. Quality improvement projects have been done continuously in healthcare settings in an effort to enhance the quality of care of individuals, improve the health of community members and reduce healthcare costs thus attaining clinical improvement (Hill et al., 2020). Wounds can add substantially to healthcare costs and influence healthcare professionals’ time. The use of Mepilex Border dressings in hospital-acquired pressure injuries (HAPI) has been mentioned to achieve clinical improvement and has been clinically effective in numerous studies (Santamaria et al., 2018; Hahnel et al., 2020; Padula, 2017). Hill et al. (2020) mentioned that by decreasing the number of dressing changes, Mepilex foam dressings protect the wound, assure optimal healing, lowers material costs, and increase health service efficiency by releasing healthcare practitioners’ time to care for patients. This absorbent single dressing enables a longer wear time retains exudate, and avoids wound maceration and associated complications.

Widespread change can be accomplished through continuous professional education to ensure that healthcare professionals’ competencies, knowledge, and skills are aligned with current standards and evidenced-based practice (Nilsen et al.,2020). In Australia, a country with universal health care, foam dressing was compared with other absorbent dressings and was mentioned to be cost-effective when compared to saline dressings in treating HAPI (Walker et al., 2017). Padula (2017) was applicable in describing the usefulness of the foam sacral dressing and its cost-effectiveness in a country without Universal Health Coverage, the United States. This was a concern for this scholar’s DPI project, but the study highlighted its effectiveness when used prophylactically and financially and hence can be translated into practice to support this DPI project. This foam dressing will be initiated into a long-term care setting using Lewin’s theory of change over a period of eight weeks. The dressing is available at the facility however there is no policy providing the wound nurse with specific guidelines on its use. Hence, it is the aim of this DPI project to translate the use of the Mepilex foam dressings into practice and to continually educate staff on its usage.

References

Hahnel, E., El Genedy, M., Tomova-Simitchieva, T., Hauß, A., Stroux, A., Lechner, A., Richter, C., Akdeniz, M., Blume-Peytavi, U., Löber, N., & Kottner, J. (2020). The effectiveness of two silicone dressings for sacral and heel pressure ulcer prevention compared with no dressings in high-risk intensive care unit patients: a randomized controlled parallel-group trial. The British Journal of Dermatology, 183(2), 256– 264. https://doi.org/10.1111/bjd.18621

Hill, J.E., Stephani, AM., Sapple, P. et al.  (2020). The effectiveness of continuous quality improvement for developing professional practice and improving health care outcomes: a systematic review. Implementation Science, 15, 23. https://doi.org/10.1186/s13012-020-0975-2

Nilsen, P., Seing, I., Ericsson, C., Birken, S. A., & Schildmeijer, K. (2020). Characteristics of successful changes in health care organizations: an interview study with physicians, registered nurses and assistant nurses. BMC Health Services Research, 20(1), 147. https://doi.org/10.1186/s12913-020-4999-8

Padula W. V. (2017). Effectiveness and Value of Prophylactic 5-Layer Foam Sacral Dressings to Prevent Hospital-Acquired Pressure Injuries in Acute Care Hospitals: An Observational Cohort Study. Journal Of Wound, Ostomy, and Continence Nursing: Official Publication of The Wound, Ostomy and Continence Nurses Society, 44(5), 413–419. https://doi.org/10.1097/WON.0000000000000358

Santamaria, N., Gerdtz, M., Kapp, S., Wilson, L., & Gefen, A. (2018). A randomised controlled trial of the clinical effectiveness of multi-layer silicone foam dressings for the prevention of pressure injuries in high-risk aged care residents: The Border III Trial. International Wound Journal, 15(3), 482–490. https://doi.org/10.1111/iwj.12891

Walker, R. M., Gillespie, B. M., Thalib, L., Higgins, N. S., & Whitty, J. A. (2017). Foam dressings for treating pressure ulcers. The Cochrane Database of Systematic Reviews, 10(10), CD011332. https://doi.org/10.1002/14651858.CD011332.pub2

I agree with you that governments in conjunction with healthcare stakeholders are always committed to enhance the quality and safety of health care. Therefore, these players are involved in various routines that guarantee improved healthcare services. Change is a common result in improving the quality of healthcare services. Healthcare professionals play an important role of informing changes in healthcare settings (Xu et al., 2022). However, governments play regulatory obligations among other assignment. Quality improvement projects have been done continuously in healthcare settings in an effort to enhance the quality of care of individuals, improve the health of community members (Kumar et al., 2019). At the same time these initiatives reduce healthcare cost. The reduction of healthcare costs increases accessibility to quality healthcare services. Therefore, governments have been directly involved in quality improvement projects in healthcare environment.  Handling certain health issues such as wounds and hospital-acquired pressure injuries (HAPI) can be stressing at the same time costly.   Stakeholder involvement in addressing these health problems may go a long way in improving treatment process through reduction of healthcare costs.

References

Kumar, A., Nesbitt, K. M., & Bakkum-Gamez, J. N. (2019). Quality improvement in gynecologic oncology: Current successes and future promise. Gynecologic oncology152(3), 486-491. https://doi.org/10.1016/j.ygyno.2018.10.046

Xu, W., Zheng, J., Huang, Y., & Zhang, M. (2022). Quality improvement and patient safety in China, present and future. Pediatric Anesthesia32(11), 1201-1208. https://doi.org/10.1111/pan.14550

Reflecting on the “IHI Module Q1 202: Addressing Small Problems to Build Safer, More Reliable Systems” Steve Spears identifies the challenge of change in healthcare is attributed to the complexity of the systems and the need for a multidisciplinary approach. The healthcare clinical staff should be educated on what is “normal” in the healthcare setting and if an issue arises the staff should be able to identify who is responsible for responding to problems and be aware of how to escalate. This process disables “workarounds” in order to make a system more reliable and problem solve in real-time to avoid potential safety concerns and hazards within the department.

The implementation of a provider in triage (PIT) within the emergency department (ED) aids in increasing turnaround times for diagnostics, decreases the ED left without being seen rate, decreases total length of stay, minimizes ED crowding, and overall, positively impacts patient satisfaction and net revenue (Franklin, et.al., 2021). These aspects of clinical improvements are initiated through provider and nurse collaboration within the front-end processes of the department in order to complete medical screens and assessments upon patient arrivals causing efficient discharges for low acuity patients and rapid orders for higher acuity patients. Widespread change is achieved through communication and involvement in coordinated effort with all disciplines involved. In this instance, the involvement of multiple avenues of nursing, clinicians, and scribes will work together to positively impact patient outcomes and care. Although this direct practice improvement project is specifically aimed to improve emergency care, the integration of a PIT can occur in any level of urgent/emergency care throughout the healthcare system. According to the Centers for Disease Control and Prevention (CDC, n.d.), widespread system change can be facilitated by learning how disciplines would like to be involved and learning their expectations, project’s limitations, seeking involvement, participation, and support of healthcare leaders, utilize testimonials from those who have participated, and receiving support from champions.

An organization with universal health care can incorporate a PIT intervention similar to an institution in the United States (U.S). For example, Sweden, a foreign country with universal healthcare, completed a study including two interventions: (1) physical-led triage and (2) interprofessional teamwork triage, to determine if these interventions had a positive impact on throughout times and the proportion of patients who left without being seen by a physician (Liu et.al., 2018). Emergency care is often rendered in any country regardless of healthcare coverage. The authors identified similar outcomes to studies in the U.S., the effectiveness of a collaborative triage with a nurse and provider led to higher effectiveness on ED length of stay metrics (Liu, et.al., 2018).

Franklin, B. J., Li, K. Y., Somand, D. M., Kocher, K. E., Kronick, S. L., Parekh, V. I., Goralnick, E., Nix, A. T., & Haas, N. L. (2021). Emergency department provider in triage: Assessing site‐specific rationale, operational feasibility, and financial impact. Journal of the American College of Emergency Physicians Open2(3). https://doi.org/10.1002/emp2.12450

Health Systems Change – Centers for Disease Control and Prevention. (n.d.). Retrieved February 25, 2023, from https://www.cdc.gov/dhdsp/programs/spha/docs/guide_facilitating_hs_change.pdf

Liu, J., Masiello, I., Ponzer, S., & Farrokhnia, N. (2018). Can interprofessional teamwork reduce patient throughput times? A longitudinal single-centre study of three different triage processes at a Swedish emergency department. BMJ Open8(4). https://doi.org/10.1136/bmjopen-2017-019744

I agree with you that competent healthcare clinical staff are beneficial in overcoming challenges associated with change. At the same time, educated workforce plays a significant role in implementing and managing change (McGregor et al., 2019). These professionals are involved in policymaking and facilitation of other duties in the change process. Besides, their professional competence enables them to detect challenges of change and develop suitable measures to address these issues (Bowen et al., 2020). Unfortunately, other healthcare institutions have limited competent healthcare workers. As a result, these organizations are exposed to human and medication errors. However, other healthcare facilities prepared their workforce to participate in the change process through introducing training programs. These training programs aim at improving the competence levels of healthcare clinical staff.  The implementation of a provider in triage (PIT) within the emergency department (ED) aids in increasing turnaround times for diagnostics. Most healthcare organizations are always keen to avoid errors in ED.  Therefore, competent healthcare workers are assigned roles in ED.

References

Bowen, C. N., Havercamp, S. M., Bowen, S. K., & Nye, G. (2020). A call to action: Preparing a disability-competent health care workforce. Disability and Health Journal13(4), 100941. https://doi.org/10.1016/j.dhjo.2020.100941

McGregor, B., Belton, A., Henry, T. L., Wrenn, G., & Holden, K. B. (2019). Improving behavioral health equity through cultural competence training of health care providers. Ethnicity & disease29(Suppl 2), 359. doi: 10.18865/ed.29.S2.359

Decreasing Hospital Acquired Pressure Injury (HAPI) rate through SEM-scanner implementation is the title of the direct practice improvement (DPI) project. The goal is to achieve clinical improvement through reducing HAPI rate, which in turn decreases secondary complications, infections, pain, mortality, and morbidity. “Pressure injuries have a significant impact on short-term outcomes in US inpatient populations; patients with at least 1 pressure injury have double the median length of stay and median treatment costs and more than a 5-fold increase in mortality compared with patients without pressure injuries” (Kim et al., 2022). The literature supports the intervention of a subepidermal moisture scanner (SEM) as an adjunct to current practice for a more accurate risk prediction.

As mentioned in the IHI module for this week, Steve Spear described learning about the science of systems and participation of multiple disciplines. He described how recognizing problems and drive improvements. To achieve affective change within an organization and this is surroundings concepts such as driving forces and restraining forces.  Lewin’s change theory can apply to this DPI by identifying the driving and restraining forces to facilitate change within the organization. Lewin’s model includes three major concepts, or stages, that are forces within the organization that provides a basis for planned change. These include unfreezing, moving, and refreezing. As we have learned, sustainable change is not easy and requires a multifaceted approach to implementation. Prior to any implementation there is a great deal of work to be done and onboarding of supporters within the hospital environment. The DPI project is going to be implemented over 8 weeks as a quality improvement project for the hospital. The timeline was cut from 16 weeks for cost reasons. If the data shows a positive improvement, as the evidence suggest it will, then the hospital will consider picking up this scanning tool as a long-term solution. Sustainable change will require a team approach and application of the science of systems as discussed in the module.

However, this specific DPI project has a lot of barriers because it requires technology, which means cost. So, I am currently in the long and tedious process of grant application and other sources to help with funding for the process. While the evidence is supporting the intervention, the 8-week implementation will give data on the effectiveness specifically with a patient population in the hospital in Baltimore City. Wide-spread change in a country with universal healthcare has been done. In Ireland, this scanning technology has been adapted into practice and the country has a universal healthcare system. In a study by de Oliveria & Lucia (2022) found consideration of the use of innovative diagnostic tools like SEM measurement, which may enhance the ability to detect early PU/PI presence is important.

References

de Oliveria, M., & Lucia, A. (2022)

Sub-epidermal moisture versus traditional and visual skin assessments to assess pressure ulcer risk in surgery patients. Journal of Wound Care ,31(3):254-264.

Kim, P., Aribindi, V. K., Shui, A. M., Deshpande, S. S., Rangarajan, S., Schorger, K., Aldrich, J. M., & Lee, H.

(2022). Risk factors for hospital-acquired pressure injury in adult critical care patients. American Journal of Critical Care, 31(1), 42–50. https://doi-org.proxy-tu.researchport.umd.edu/10.4037/ajcc2022657

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