WGU C493 Task 1 Leadership Experience Essay proposal change in practice
A1. PROBLEM OR ISSUE
This paper projects issues and problems that are skin related i.e., cost inefficiency, time-consuming, the cumbersome and redundant process of tracking skin conditions
A1a: EXPLANATION OF PROBLEM OR ISSUE
The use of cameras in monitoring skin conditions such as wounds, pressure ulcers or bedsores, surgical infections among other skin conditions and infections by taking pictures of the affected sites. These pictures are then attached to a skin assessment form that is later used for studies or monitoring interventions applied. All these processes are time-consuming and hectic but they are the requirement of modern medicine in the management of skin conditions.
A2: INVESTIGATION
The nurses are not happy with the protocol though it is necessary. It is more stressful when they attend to a patient with multiple skin conditions or ulcers. Upon interviewing health care providers mostly nurses, it was common that they both complain about the process and require improvement in the current process.
A2a: EVIDENCE OF PROBLEM
During an interview with one of the attending nurse, she complained of the frustration that she had experienced the previous day when she was handling a skin patient with multiple ulcers. She confessed to spending more than two hours to complete a complete skin assessment, wound care and documentation on just one patient. These complaints were aired by other nurses too and they feel frustrated when it comes to dealing with the skin condition tracking process.
In one case, nurse W opened up one occasion when she had an encounter with the process and was very much mad at the process. The patient had bedsores and five open wounds, the patient had a history of other illnesses such as diabetes, hypertension, and chronic kidney diseases stage 4 on hemodialysis, right BKA, below knee amputation, heart disease and mental challenges. The patient was under the care of his mother who took care of him, the patient was a 30-year old man with a development stage of five years old. Nurse V was able to take pictures of the ulcers with the help of the patient’s mother and charge nurse. The nurse later provides basic wound care according to the policies of wound care, until the wound care nurse arrived and asked for a more specified care plan for the patient. Nurse W confessed to taking too much time in taking pictures of the wound when compared to the time she took to printing out pictures, labelling each one, attaching them to skin form and placing them in the chart. Nurse V also complained that all these data needs to be recorded in the EPIC’s electronic medical records. The nurse also complains of too much time consumption in printing out pictures the printers take an average of 1-2 minutes to print out one picture, there are other challenges faced by the printers such as the ink or paper running out in the middle of the printing process. Nurse V mentioned that for a complete printout plus pictures placement process, it could take 1/3 the nursing staff time of the entire skin tracking process, especially in the case of multiple skin issue patient.
A3: ANALYSIS
I have spoken to many nurses on both morning and night shifts. Everyone agrees with the fact that the process is tedious, time-consuming even for support staffs such as the unit clerk or PCA who at times can help with the printing job. From the case above, it is evident that nurses use a lot of time in documenting and performing a full assessment of skin condition. Nurse W confesses to taking two hours for one patient. The process to obtain pictures for wound issue involves skin issues, carefully label and take/printout pictures with the right patient identification, place pictures incorrect chart, and thereafter, documenting the details in EHR, EPIC. Additionally, the process of printing faces other challenges such as ink cartridge, printer papers, skin form which occasionally experience shortage mostly in the weekend, holidays and when the high demand for supplies due to influx of admission.
A3a: CONTRIBUTORS TO PROBLEM OR ISSUE
The longer the process, the more amount of time, energy, and effort caregivers have to put in the process that will lead to fatigue as nursing care is offered 24 hours, 7 days a week all year around. Fatigue causes other potential problems such as HIPPA violation, patient quality of care…etc. in another instance: nurse A told me about how frustrated she was after obtaining wounds pictures from a difficult patient. The problem started when she found out that the printer was broken. She could ask for help from a CNA or charge nurse but she lacked support as it was at night, she was on nightshift. She had to go to another unit to seek help in printing her pictures. This proved that the process is time-consuming and is cumbersome. Besides, having a picture printer and maintain that is cost-ineffective. The printer supplies are not always fully stoked as nurses experience shortages especially during holidays, nightshifts or even when the process is ongoing, printer is also very slow.
A4: PROPOSED SOLUTION OR INNOVATION
With the help of EPIC ROVER, one can upload pictures capability from the hospital iPhone via the application to the EPIC system. It is advised that if an organization has not yet shifted to this system they do so as our hospital shifted from Sunrise to EPIC. The hospital’s IT manager also confirmed that we could add that option into our contract with the EPIC system (Almomani, 2020). My proposal is for all nurses to acquire this functionality as soon as possible.
A4a: JUSTIFICATION OF PROPOSED SOLUTION OR INNOVATION
The implementation of this system will improve the efficiency of uploading pictures into the EPIC system, nursing skin tracking, skincare and skin documentation process. Moreover, potential cost saving on staff overtime, equipment, equipment maintenance and supplies are tremendous. Work satisfaction and reduction in errors made by nurses the organization to save money and prevent the possibility of any risk for a lawsuit or prolong patient stay developing which Medicare and insurance always don’t pay. Staff will be able to save time, effort and focus more on the patient’s quality of care.
A5: RESOURCES AND COST-BENEFIT ANALYSIS
Every staff in the hospital is equipped with the organization’s iPhone that is to ease the communication between health care providers. With all this, the only budget that is to be considered is the budget on the EPIC system that will be on our smartphone when we purchase the EPIC ROVER app for the phone, which is capable of taking pictures and upload them live into the EPIC system (Tayyib, 2021). This process would improve the workflow, staff satisfaction and ultimate quality of care for our patients. Here is the table for Resources and Cost-Benefit analysis:
| Resource Needed | Estimated Costs | Anticipated Benefits |
| Approval from the nursing director, Chief nursing officer for the Epic Rover app. | $110,000 monthly service for our organization usage. | Eliminate cost for ink, papers, maintenance. Improve workflow, staff satisfaction and quality patient care. |
| IT team to help to install Epic Rover app on clinical staff iPhone. | Estimate $9,000 for 10 hours of IT team. | One time cost so that every clinical work IPhone have a proper Epic Rover application. |
| SuperUser Staffs and nurse educator. | Estimate $4500 for about 50 hours. | SuperUser staff provide in-service for AM & PM shifts. Besides, Nurse educator creates instructional email and education board for nursing staff to read and self-learn. |
| Work iPhone | No extra cost | Save cost to utilize the current iPhone. |
A6: TIMELINE
The process may take a week to get all the iPhones to be installed with the EPIC ROVER app, that is according to the IT manager and EPIC support. The use of the system in taking and uploading pictures will utilize little time as people nowadays have smartphones and they use them to take photos and upload or send them to someone. New implementations can be approved by the administration, which normally takes a month, which will enable the clinical staffs to be able to use the app within one week. This app will help in taking pictures and uploading them simultaneously.
A7: IMPORTANCE OF KEY STAKEHOLDERS OR PARTNERS
The major key stakeholders are nursing staffs; the manager/administration and the IT team.
A7a: ENGAGEMENT WITH KEY STAKEHOLDERS OR PARTNERS
I have engaged in many practices and worked along with other nurses and I have directly experienced the cumbersome skin tracking process and complained a lot about it. We discussed it and agreed that we need to ask management to do something to help us out. Our hospital changed the operating system from the EHR (electronic health record) system to an EPIC.
A7b: SUCCESS
After finding out that EPIC ROVER could integrate any clinical media into the system, my idea had gained fame and was supported by nursing staffs and the IT manager told me that the implementation would be an easy process from the IT perspective. Our nurse manager, Ms. K also agreed with the idea as she understands better, she also plans to present to CNO (chief nursing officer) and she believes that we will not have any issue with getting approval from the administration for this project.
A8: IMPLEMENTATION
As I mentioned earlier, the IT team will install the system on every clinical nursing staff work iPhone after approval from the administration. Our Super User nursing staffs can provide in-service and troubleshoot the problem for the first launching week. A nurse educator can create instruction pamphlets, an instruction board and email “how to use Epic Rover app” for nursing staff to read and self-learn before launching.
B1: ROLE OF SCIENTIST
The incorporation of IT in health care requires an in-depth understanding of the circle of medicine and its requirements. One needs to appreciate the role of communication and technology in hospitals. This is the mind of a scientist, their role is to invent, and innovation and this system is an invention.
B2: ROLE OF DETECTIVE
The major role of a detective is to investigate the aetiology of any issue. When issues are raised, to solve them one has to understand the origin of the issue. Evidence-based data is used in drawing informed conclusions that will be used to made decisions. This process of identifying, collecting data, analyzing and drawing conclusions are the roles of a detective.
B3: ROLE OF MANAGER OF THE HEALING ENVIRONMENT
He healing process is time-oriented as it takes time. The healing process is influenced by the environment in which the patient is. the healing environment requires a lot and maintaining the appropriate healing environment is the role of the healing environment manager.
References
Almomani, S. (2020). Assessment of Virtual Reality technology as a tool to enhance beauty and skincare e-commerce targeting Gen X, Millennials and Gen Z in Dubai, United Arab Emirates (Doctoral dissertation, The British University in Dubai (BUiD).
Tayyib, N., Asiri, M. Y., Danic, S., Sahi, S. L., Lasafin, J., Generale, L. F., … & Reyes, M. (2021). The Effectiveness of the SKINCARE Bundle in Preventing Medical-Device Related Pressure Injuries in Critical Care Units: A Clinical Trial. Advances in Skin & Wound Care, 34(2), 75-80.
