C493 Leadership Experience Proposal- JLP1
Part A
Problem Issue
In these organizational settings, pneumonia infection which is associated with the intensive use of hospital ventilators is the problem identified. This problem is related to the changing practice by making use of the IHI ventilator bundle to improve the outcomes of the patient being administered in the healthcare facility.
Explanation of the Problem Issue and why applicable
Pneumonia is one of the most prevalent healthcare-acquired diseases in the patient healthcare facility’s Intensive Care Unit, with ventilator usage accounting for a substantial percentage of infections reported by acute care hospitals. Approximately 12 percent to 16 percent of adult inpatients will have an indwelling ventilator throughout their stay in the hospital. The patient’s chance of contracting pneumonia increases with each day that the ventilator is used. Working in an Intense Care Unit, patients often get pneumonia as a result of the intensive sharing of ventilators that are inadequately maintained. It is critical that these patients get safe, high-quality treatment and are certain that they will not become infected during ventilation.
Using the IHI Ventilator Bundle Checklist is a good way to keep track of the organization’s compliance with the IHI Ventilator Bundle. Increased compliance with the bundle’s contents results in an even higher decrease in ventilator-associated pneumonia rates. A patient is said to be compliant with the Ventilator Bundle if all four of the Ventilator Bundle components are noted on daily objectives sheets or elsewhere in the medical record.
Discussion of the Investigation of the Problem
Ventilators may have a substantial impact on patient clinical outcomes by raising the chances of additional health concerns including COPD, Chronic Bronchitis, Emphysema, Cystic Fibrosis, and even Pleural Effusion. In addition, the patient’s financial burden is raised, as are hospital stays and fatality rates. Each year, about 14,000 fatalities are linked to pneumonia infections, according to research from the Centers for Disease Control and Prevention (2020). Furthermore, the Centers for Medicare and Medicaid Expenses (CMS) will not pay hospitals for services connected to the treatment of healthcare ventilator-associated infections, necessitating hospitals’ focus on infection prevention (Bassi et al., 2017).
As previously said, pneumonia may have a negative influence on patients, leading to greater complications and morbidity. The presence of a badly maintained ventilator raises the risk of harm to the respiratory system and defense systems, allowing more germs to enter. A healthcare-acquired infection affects both the patient and the facility. Because of the enormous rise in healthcare-associated infections, government organizations such as CMS have started restricting compensation for hospital stays when patients have acquired an infection. The cost of treating pneumonia is projected to be between $700 and $1300 per case, depending on the increased duration of hospital stay, and this cost must be covered by the hospital (Timsit et al., 2017). As a consequence, the financial burden on healthcare personnel and the hospital has grown.
Analysis of the Situation using Current Data
The Centers for Disease Control and Prevention (CDC) has a set of recommendations for the proper use of ventilators in its current evidence-based practice guidelines. Identifying the right criteria for ventilator use, good hand hygiene, the use of aseptic and sterile technique, maintaining clear airflow, and a closed air-circulation flow are examples of such treatments. Unfortunately, this is a list of suggested recommendations, and institutions have had difficulty establishing standard practice approaches. Physician and nurse participation, limited education, patient and family demands, and premature ventilator withdrawal are all obstacles to implementation (DeCarvalho et al., 2018). In addition, rates of pneumonia induced by ventilators are recorded to a national database, and those numbers are compared to those from other institutions to create a baseline for safety evaluation. According to data, the average hospital score for pneumonia infection is 0.775, while my facility’s score is 1.096, which is much higher than the national average (The Leapfrog Group, 2020). These figures indicate that a system to avoid pneumonia should be created.
Proposal for a Solution or Innovation for the Problem
It is estimated that patients with critical illness who get VAPI have an increased mortality risk and an increased time on ventilator, duration of hospitalization, and financial burden. It’s a difficult ailment to detect, much alone cure, so staying on top of things is critical.
Nurses are often the first healthcare practitioners to visit patients, and they are able to assess the safety and quality of treatment provided. The number of hospital-acquired illnesses is directly proportional to the total hours of patient care delivered by nurses every day (Khan et al., 2016). Nurses are on the cutting edge of pneumonia prevention, since they are in charge of ventilator use, cleaning, and other regular care. A plethora of studies have shown that daily indwelling ventilator treatments that follow the CDC’s evidence-based recommendations dramatically decrease pneumonia incidence.
By following the evidence-based pneumonia prevention recommendations (CDC, 2020), which include early ventilation withdrawal, thorough training of employees responsible for ventilator intubation, and the use of a physician. Kalil et al (2016) conducted a systematic analysis to look for risk factors of ventilator-associated pneumonia infection in hospitalized patients and discovered that most patients had an elevated risk of infection owing to extended ventilation and longer hospital stays. A University Hospital found a 69 percent reduction in VAPI incidence after introducing a nurse-driven procedure that reduced the number of ventilation days (DwCristofano et al., 2016). Most significantly, all of the publications that have been evaluated have consistently established the need of ongoing staff and patient education or training. In research conducted by Monona Edmundo, the effect of VAPI education on their components (avoiding needless ventilator usage, adherence to evidence-based recommendations, and maintenance) was assessed (2016). According to the findings of the research, the instructional package has a considerable influence on VAPI prevention by the use of the IHI ventilators.
A successful intervention bundle would enhance overall VAPI rates and length of Ventilation alternatives by establishing IHI ventilator bundle. When these elements are put together, they form a bundle of care. “A bundle of care is an organized technique of enhancing patient care procedures that consists of three to five evidence-based practices that, when implemented consistently and collectively, may improve health satisfaction” (Bassi et al., 2017). A nurse-driven procedure empowers trained nurses to make autonomous choices regarding ventilator placement and removal based on a medically authorized rubric. In an educational hospital, a group of nurse leaders and doctors devised a nurse-driven ventilation removal process checklist, which reduced ventilator usage and made the nurse’s work easier (Timsit et al., 2017).
The nurse’s ability to evaluate for the requirement of ventilation, using proper application procedures, continued daily maintenance review through checklists, and evaluating for ventilator need to help in prompt removal are all components of the suggested bundle of care. If the patient meets the removal conditions indicated by the facility in the ventilator care bundle, the nurse will be permitted to remove the ventilator without obtaining prior instructions from the doctor.
Recommended Resources to Implement Proposed Solution
Five critical resources are needed to assist the implementation of the suggested innovation in this paper’s strategy of avoiding the Ventilator Associated Pneumonia Infection. All of these elements must be present in order for a health institution to go from drafting an innovation strategy to implementing it.
Timeline for Implementation
My proposed solution would take three months to implement on a rough timeframe, with the implementation beginning in March. This is based on yearly competency conducted in December, with the goal of educating and training all employees, including safety champions, on suitable practices and policies for moving and repositioning patients. The three months would provide the unit ample time to locate staff members who are committed to become the unit’s safety champions. Finally, the three months may be used to form a safety and health committee with representatives from the safety champions, managers, and risk management.
Discussion why Key Stakeholder is Important for Implementation of the Innovation
Members of the hospital’s interdisciplinary team are key stakeholders in the implementation of change. The chief executive officer and the chief financial officer of a hospital will be essential in implementing change. It is expected that they will collect and analyze the data needed for outcome assessment, as well as estimate the financial effect the procedure would have. Medical executives (such as department heads, the chief medical officer and nurse managers) will also be able to assist, collaborate and communicate amongst the many disciplines in the health care system. Having this team involved in the creation of protocols might help to identify the strengths and weaknesses of the procedure in various sections of the hospital. As a result, this group may keep track of the protocol’s progress by analyzing the efficacy of checklists, evaluations, and Ventilation orders. Finally, clinical and technology education divisions are tasked with ensuring that all employees, including nurses, doctors, and even transportation workers, are adequately taught on the new guidelines.
The stakeholders for the solution implementation would comprise the unit’s personnel, management, and the risk assessment department. Because I work at a hospital with a labor-management partnership, both sides are crucial to the implementation. There is a need for cohesion between the workers and management since they will have to agree on how the suggested implementation will operate. It would be up to staff and management to choose the function of the workplace safety champion, as well as who would fill this position.
In terms of execution, I had largely favorable response from both the personnel and management who were supportive of my plan. To my delight, both of them agreed that having safety advocates would help reduce work – related injuries. They also agreed that a safety committee would be a good way to keep the patient’s safety under check. negative comment I heard was that each workplace safety champion would need to be capable of speaking up to any employee who was not adhering to safety policies and procedures.
How to work with Stakeholder to Achieve Success
There is a need to think about what actions and activities are necessary to meet the project’s declared objectives and business case. As part of the overall project plan, the Stakeholder Planning Team will produce this plan. The following steps in stakeholder planning will indeed be taken by the planning team, who will use a draft project plan as their main guide. Stakeholder Management Plan actions and activities are likely to lead to suggestions for changes to the draft project plan.
How the Innovation would be implemented
Data from the previous year on VAPI rates at the hospital and financial data connected to rates of catheter-associated infection should be used to establish baseline trends for evaluating results. It is important to gather data on a regular basis in order to identify the protocol’s strengths and weaknesses. As a result, the team would have the chance to make improvements to their procedures. With a IHI ventilator system in place by year’s end, VAPI rates will be drastically decreased.The recommended approach might be adopted by first training the employees on correct body mechanics and lift equipment policy and procedure. This training may be done as part of the annual competencies or at each new recruit orientation. This would ensure that all employees had the same understanding of how to transport patients safely.
The next step would be to make a public announcement regarding the appointment of safety advocate. This would contain a summary of what the job entails as well as what the safety champion is expected to do. Once a few staff members volunteer to be safety champions, they will be ready to inspect the unit for risky patient handling scenarios.The safety champions would be an additional safety measure to help avoid workplace accidents.The formation of an occupational safety committee would be the last stage in the process. Once a month, this group would convene to review what is going well with the implementation and what may need to be tweaked. The group would review the kind of injuries that occur in the hospital and come up with new ideas or initiatives to help employees avoid accidents.
Risk management might offer data on workplace injuries during workplace safety meetings to assess the performance of the implementation. If the suggested remedy is effective, the number of occupational injuries connected to body mechanics or not using lift equipment with patient handling will be determined. Following the receipt of these data, the team may go forward with implementing the initiative on further hospital units.
Part B
How Scientist, detective and manager of the Healing Environment were fulfilled during investigation Process and Proposal Development
I played the part of a scientist by starting research in my hospital unit to evaluate the personnel as they placed their patients. I also kept track of the information I gathered while monitoring the employees so that I might later utilize it to build a strategy, or conduct an experiment, to address the problem of workplace injuries. Finally, I requested further information from risk management and evaluated their reports in order to gather relevant information for my project.
I took on the role of a detective by looking into a problem that had arisen in my medical unit. I looked into the matter to learn more about how and why occupational injuries occurred while relocating patients. I spent many hours quietly studying personnel in order to create the most natural workplace possible. It was my intention to utilize this inquiry to find a solution to the issue. By formulating a plan to reduce workplace injuries, I fulfilled the job of a manager of the healing environment. My aim as a healing environment manager was to promote patient and staff safety by adopting my proposed solution. My unit’s safety would improve, allowing it to concentrate on delivering high-quality nursing care to our patients.
References
Bassi, G. L., Senussi, T., & Xiol, E. A. (2017). Prevention of ventilator-associated pneumonia. Current opinion in infectious diseases, 30(2), 214-220.
https://link.springer.com/chapter/10.1007/5584_2020_591
de Carvalho Baptista, I. M., Martinho, F. C., Nascimento, G. G., da Rocha Santos, C. E., do Prado, R. F., & Valera, M. C. (2018). Colonization of oropharynx and lower respiratory tract in critical patients: risk of ventilator-associated pneumonia. Archives of oral biology, 85, 64-69.
https://www.sciencedirect.com/science/article/abs/pii/S0003996917303114
De Cristofano, A., Peuchot, V., Canepari, A., Franco, V., Perez, A., & Eulmesekian, P. (2016). Implementation of a ventilator-associated pneumonia prevention bundle in a single PICU. Pediatric critical care medicine, 17(5), 451-456.
https://www.ingentaconnect.com/content/wk/pcc/2016/00000017/00000005/art00017
Kalil, A. C., Metersky, M. L., Klompas, M., Muscedere, J., Sweeney, D. A., Palmer, L. B., … & Brozek, J. L. (2016). Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clinical Infectious Diseases, 63(5), e61-e111.
Khan, R., Al-Dorzi, H. M., Al-Attas, K., Ahmed, F. W., Marini, A. M., Mundekkadan, S., … & Arabi, Y. M. (2016). The impact of implementing multifaceted interventions on the prevention of ventilator-associated pneumonia. American journal of infection control, 44(3), 320-326.
Timsit, J. F., Esaied, W., Neuville, M., Bouadma, L., & Mourvillier, B. (2017). Update on ventilator-associated pneumonia. F1000Research, 6.
