Essay

 

Directions

Please do not use any of the Nurse Daniel information for your own topic, nursing intervention, or change project. Nurse Daniel serves as an example only to illustrate the change process.

1. Please review the infographic as way to guide you in getting started with your assignment: Developing an Assignment with Integrity (Links to an external site.)
2. View a short tutorial with tips for completing this assignment: Evidence-Based Practice Change Process Assignment Tutorial (Links to an external site.) or by reading the transcript (Links to an external site.).
3. Download the EBP Change Process form (Links to an external site.) during Week 1. The use of this specific form is REQUIRED 
4. Identify a clinical topic and related nursing practice issue you think needs to be changed. 
5. Locate a systematic review on your topic from the CCN Library databases. Be sure this involves nursing actions.
6. Work through each step of the ACE Star Model as outlined on the assignment form (Star Points 1-5: Discovery, Summary, Translation, Implementation, and Evaluation). Respond to the instructions provided on the form.
7. Follow the activities and thinking of Nurse Daniel in Weeks 1-6 in the ‘Illustration’ part of each lesson. He will be working through a clinical topic and nursing practice issue to demonstrate a change (ACE Star Model and systematic review).
8. Work on a portion of the process each week, as the illustration unfolds.

Best Practices

• Please reach out to your instructor for feedback or assistance with your PICOT question as needed.
• Required and Additional Background Reading in Weeks 1 and 2 under Readings is available for more information on the ACE Star Model and the use of systematic reviews.
• Please see the grading criteria and rubrics on this page.
• Please use your browser’s File setting to save or print this page.

Scholarly Sources and Citations

• Please cite any references (in APA format) of your systematic review or other scholarly document (optional) as needed.
• Paraphrasing information, rather than quoting, is expected. No quotes for this assignment please!

**Academic Integrity**

Chamberlain College of Nursing values honesty and integrity. All students should be aware of the Academic Integrity policy and follow it in all discussions and assignments.

By submitting this assignment, I pledge on my honor that all content contained is my own original work except as quoted and cited appropriately. I have not received any unauthorized assistance on this assignment.

Rubric

Week 6: EBP Change Process Assignment Grading RubricWeek 6: EBP Change Process Assignment Grading RubricCriteriaRatingsPtsThis criterion is linked to a Learning OutcomeSelected Systematic ReviewA systematic review from the CCN Library databases was selected, identified, and was appropriate for the selected nursing change process.25 ptsOne systematic review from the CCN Library databases was identified and was clearly appropriate.22 ptsA systematic review was selected from the CCN Library databases and was mostly appropriate for a nursing change process.20 ptsA systematic review was selected from the CCN Library databases and was fairly appropriate for a nursing change process.10 ptsA systematic review was selected, but not from the CCN Library databases and/or was not appropriate for this assignment.0 ptsNo systematic review selected or used.25 pts
This criterion is linked to a Learning OutcomeStar Point 1 (Discovery)The topic, nursing practice issue, rationale and scope of the problem were clearly identified and described.25 ptsStar Point 1 elements in the first column were thoroughly addressed.22 ptsStar Point 1 elements in the first column were mostly well addressed.20 ptsStar Point 1 was missing one element in the first column or one lacked detail.10 ptsStar Point 1 was missing more than one element in the first column and others lacked detail.0 ptsThe ACE Star Model Star Point 1 was not completed.25 pts
This criterion is linked to a Learning OutcomeStar Point 2 (Summary)The NURSING practice problem, NURSING related PICOT question, a systematic review from any database in the Chamberlain Library, and other optional references, evidence summary, strength, and solutions, are listed and described.35 ptsStar Point 2 elements in the first column were thoroughly addressed.31 ptsStar Point 2 elements in the first column were mostly well addressed.28 ptsStar Point 2 was missing one element in the first column or one lacked detail.13 ptsStar Point 2 was missing more than one element in the first column and others lacked detail. or were inappropriate.0 ptsThe ACE Star Model Star Point 2 was not completed.35 pts
This criterion is linked to a Learning OutcomeStar Point 3 (Translation)Care standards, practice guidelines, or protocols; stakeholders and their roles and responsibilities; the nursing role; rationale for including certain stakeholders, and cost analysis plan are addressed.35 ptsStar Point 3 elements in the first column were thoroughly addressed.31 ptsStar Point 3 elements in the first column were mostly well addressed.28 ptsStar Point 3. was missing one element in the first column or one lacked detail.13 ptsStar Point 3 was missing more than one element in the first column and others lacked detail.0 ptsThe ACE Star Model Star Point 3 was not completed.35 pts
This criterion is linked to a Learning OutcomeStar Point 4 (Implementation)Permission process, education plan, timeline, measurable outcomes, forms, resources, and stakeholder meetings, are addressed.35 ptsStar Point 4 elements in the first column were thoroughly addressed.31 ptsStar Point 4 elements in the first column were mostly well addressed28 ptsStar Point 4 was missing one element in the first column or one lacked detail.13 ptsStar Point 4 was missing more than one element in the first column and others lacked detail.0 ptsThe ACE Star Model Star Point 4 was not completed.35 pts
This criterion is linked to a Learning OutcomeStar Point 5 (Evaluation)Reporting results, process and next steps are addressed.35 ptsStar Point 5 elements in the first column were thoroughly addressed.31 ptsStar Point 5 elements in the first column were mostly well addressed28 ptsStar Point 5 was missing one element in the first column or one lacked detail.13 ptsStar Point 5 was missing more than one element in the first column and others lacked detail.0 ptsThe ACE Star Model Star Point 5 was not completed.35 pts
This criterion is linked to a Learning OutcomePresentationInformation was presented clearly and thoughts were well organized and logical.20 ptsInformation was presented clearly and thoughts were well organized and logical throughout.18 ptsInformation was presented clearly and thoughts were mainly organized and logical throughout.16 ptsInformation was presented clearly and thoughts were somewhat organized and logical throughout.8 ptsInformation was not consistently clear and/or was not consistently organized and logical.0 ptsInformation was disorganized and difficult to understand.20 pts
This criterion is linked to a Learning OutcomeMechanics/APAThe systematic review and any other scholarly resources were properly listed in APA format.
The writing includes error free grammar and spelling, and complete sentence structure.15 ptsExcellent mechanics and APA formatting with minimal errors in grammar, spelling, and sentence structure.13 ptsGood mechanics and formatting considering the elements listed in the first column12 ptsFair mechanics and formatting considering the elements listed in the first column6 ptsPoor mechanics and formatting considering the elements listed in the first column0 ptsVery poor mechanics and formatting such that information is difficult to read.15 pts
This criterion is linked to a Learning OutcomeAssignment Form Used0 pts0 points deductedCorrect assignment form used0 pts22.5 points (10%) deductedIncorrect form used resulting in point deduction0 pts
This criterion is linked to a Learning OutcomeLate Deduction0 pts0 points deductedSubmitted on time0 ptsNot submitted on time – Point deduction1 day late =11.25 deduction; 2 days=22.5 deduction; 3 days=33.75 deduction; 4 days =45 deduction; 5 days = 56.25 deduction; 6 days =67.5 deduction; 7 days =78.75 deduction; Score of 0 if more than 7 days late0 pts
Total Points: 225

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Week 6 Assignment: EBP Change Process form

ACE Star Model of Knowledge Transformation

Follow Nurse Daniel as your process mentor in the weekly Illustration section of the lesson. Please do not use any of the Nurse Daniel information for your own topic, nursing intervention, or change project. Nurse Daniel serves as an example only to illustrate the change process.

Name: ___Nataliya Izarova__________________

Star Point 1: Discovery (Identify topic and practice issue)

Identify the topic and the nursing practice issue related to this topic. (This MUST involve a nursing practice issue.)

The topic of my nursing practice issue is reducing of patient’s medications errors at home in post hospital 30 days period.

Briefly describe your rationale for your topic selection. Include the scope of the issue/problem.

There is 10–20% of hospital admissions among older people are associated with medication errors (Brekke et al. 

2008

). RN is the first medical professional who patient meets at home after hospital discharge. Medications reconciliation is # 1 nursing issue in hand off process when nurse visited patient home. RN must reconcile meds with discharged MD to make sure patient has and willing to take proper medications and dosages. RN must report any side effects or adverse reactions if any noted in the patient’s to prevent further body( systems) damage and re-hospitalization to correct the problem.

Star Point 2: Summary (Evidence to support need for a change)

Describe the practice problem in your own words and formulate your PICOT question.

It is often happens visiting nurses document medications list that is written in the discharge papers with no checking actual medications that patient has at home. This problem may lead to big discrepancies between medications that was recommended by a doctor who discharge patient home and actual medications at home.

PICOT question: Does timely nursing medications reconciliation will improve patient’s medications compliance and decrease risk of re-hospitalization during 30-days post hospital discharge?

List the systematic review chosen from the CCN Library databases. Type the complete APA reference for the systematic review selected.

Berland, A., Bentsen, S. B.,. (2017, March 28). Medication errors in home care: a qualitative focus group study. Journal of Clinical Nursing, 26(21-22), pp. 3734-3741. Retrieved from https://eds-a-ebscohost-com.chamberlainuniversity.idm.oclc.org/eds/detail/detail?vid=1&sid=9cd0736f-fe8f-425b-a17f-a478bca4f603%40sdc-v-sessmgr03&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=28152226&db=cmedm

List and briefly describe other sources used for data and information. List any other optional scholarly source used as a supplement to the systematic review in APA format
.

Engelke, Z. (2018, April 13). Patient Education: Home Care — Teaching Medication Self-Administration. Nursing Practice and Skill. Retrieved from https://eds-a-ebscohost-com.chamberlainuniversity.idm.oclc.org/eds/detail/detail?vid=2&sid=6c2f560a-bbdb-4658-b167-fe6940399d46%40sdc-v-sessmgr01&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=T706566&db=nup

Briefly summarize the main findings (in your own words) from the systematic review and the strength of the evidence.
The study reveals the important role of nursing to follow agency’s policies and procedures in hands off process such as timely( within 24 hours) communication with discharged doctors, pharmacies. The study underlined the importance of nursing competency in pharmacology such as knowlege of generics and brands meds, to report any issues found in the home medications to avoid medications errors and patient’s taking unnecessary meds. Also, review stressed the importance to have all necessary documentation from a hospital during the first home visit as the references for medications reconciliation.

Outline one or two evidence-based solutions you will consider for the trial project.

Proper communication with referring doctor will be a visiting nurse priority to compare medications at home with medications doctor discharged patient with. This evidence-based solution will objectively provide accuracy in dosages and clear questions if nurse have any. For example if patient has aspirin 81 at home but doctor prescribed 325. Visiting nurse must confirm the dosage or even ask MD what was the reason meds dosage changed. In such situation the picture will be cleared with no questions behind.

Star Point 3: Translation (Action Plan)

Identify care standards, practice guidelines, or protocols that may be in place to support your intervention planning (These may come from your organization or from the other sources listed in your Summary section in Star Point 2).

List your stakeholders (by title and not names; include yourself) and describe their roles and responsibilities in the change process (no more than 5).

What specifically is your nursing role in the change process? Other nursing roles?

List your stakeholders by position titles (charge nurse, pharmacist, etc.). Why are the members chosen (stakeholders) important to your project?

What type of cost analysis will be needed prior to a trial? Who needs to be involved with this?

Star Point 4: (Implementation)

Describe the process for gaining permission to plan and begin a trial. Is there a specific group, committee, or nurse leader involved?

Describe the plan for educating the staff about the change process trial and how they will be impacted or asked to participate.

Outline the implementation timeline for the change process (start time/end time, what steps are to occur along the timeline).

List the measurable outcomes
based on the PICOT. How will these be measured?

What forms, if any, might be used for recording purposes during the pilot change process. Describe.

What resources are available to staff (include yourself) during the change pilot?

Will there be meetings of certain stakeholders throughout the trial? If so, who and when will they meet?

Star Point 5: (Evaluation)

How will you report the outcomes of the trial?

What would be the next steps for the use of the change process information?

9.2019 Update. DLP
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Week 6 Assignment: EBP Change Process form

ACE Star Model of Knowledge Transformation

Follow Nurse Daniel as your process mentor in the weekly Illustration section of the lesson. Please do not use any of the Nurse Daniel information for your own topic, nursing intervention, or change project. Nurse Daniel serves as an example only to illustrate the change process.

Name:

Star Point 1: Discovery (Identify topic and practice issue)

Identify the topic and the nursing practice issue related to this topic. (This MUST involve a nursing practice issue.)

The topic of my nursing practice issue is reducing surgical infection rate by prohibiting artificial nails among clinical staff members.

Briefly describe your rationale for your topic selection. Include the scope of the issue/problem.

Hospital Acquired Infections (HAIs) are a major concern for all types of healthcare facilities. The Center for Disease Control and Prevention states that on any given day, about one in 31 hospital patients has at least one healthcare-associated infection. (2018). Hand hygiene is the most important method of preventing infections and this is especially true in the perioperative field. Outbreaks of similar infections cultured from the surgical site can be traced back to individuals who wear artificial nails. Infections are a major post-surgical complication and costs the healthcare facility money and can cost a patient their life.

Star Point 2: Summary (Evidence to support need for a change)

Describe the practice problem in your own words and formulate your PICOT question.

Artificial nails are breeding grounds for bacteria, fungus and viruses. Staff at my facility wear these nail enhancements and studies reveal adverse patient outcomes when providing patient care while having nail enhancements. Among surgical staff members, would banning artificial nail enhancements lead to a decrease in surgical site infections in postoperative adult patients over a 3 month period?

List the systematic review chosen from the CCN Library databases. Type the complete APA reference for the systematic review selected.

Winslow, E, Jacobson, A. (2001 October). The case against artificial nails. In Combating Infection. Retrieved from :

https://eds-b-ebscohost-com.chamberlainuniversity.idm.oclc.org/eds/detail/detail?vid=1&sid=8cf67705-a24d-462f-87a9-13f8bcb8b5db%40sessionmgr103&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#db=c8h&AN=106889325

List and briefly describe other sources used for data and information. List any other optional scholarly source used as a supplement to the systematic review in APA format.

Hand Hygiene in Healthcare Setting. (2020 January 31). The Center for Disease Control and Prevention. Retrieved from: https://www.cdc.gov/handhygiene/providers/index.html

Marchetti, A., Rossiter R. (2013 December).Economic burden of healthcare-associated infection in US acute care hospitals: societal perspective. J Med Econ;16(12):1399-404. doi: 10.3111/13696998.2013.842922. PMID: 24024988.

Briefly summarize the main findings (in your own words) from the systematic review and the strength of the evidence.

This review was written to inform healthcare professionals about the danger of wearing nail extensions in the workplace. It references different root-cause analysis which revealed that the patients who suffered a postsurgical infection in a specific time period were all traced back to operating room staff whose artificial nails were cultured to the corresponding infection. This is evident of a direct correlation between nail extensions and infections. Also, the review explains that even after performing hand hygiene, more pathogens are cultured from healthcare workers with artificial nails than those without.

Outline one or two evidence-based solutions you will consider for the trial project.

The article referenced the CDC guidelines for all perioperative team members to have short, clean nails free of any enhancements. This evidence based solution helps prevent HAIs by reducing the surface area of the fingernails which harbor a flora of pathogens.

Star Point 3: Translation (Action Plan)

Identify care standards, practice guidelines, or protocols that may be in place to support your intervention planning (These may come from your organization or from the other sources listed in your Summary section in Star Point 2).

Our facility policies on hand hygiene include using an alcohol-based hand rub before donning and after doffing gloves and between patient contact.
Team members that work inside the sterile field (surgeons and operating room technicians) must scrub using a Chlorhexidine hand scrub for 5 minutes prior to donning sterile gloves for the surgical procedure.
The CDC, “recommended that healthcare providers do not wear artificial fingernails or extensions when having direct contact with patients at high risk (e.g., those in intensive-care units or operating rooms)”. (2020).
Keep natural nail tips less than ¼ inch long.”
Avagard nail scrub must be used under the nails.

List your stakeholders (by title and not names; include yourself) and describe their roles and responsibilities in the change process (no more than 5).

Nurses and Operating Room Technicians- These are the most hands-on team members whose’ hand hygiene directly impacts patient outcomes.
Nurse Managers – Enforce the policies and oversee their compliance.
Director of Nursing – Creating new guidelines and policies with respect to state and federal mandates and under the standards of the accreditation organization, Joint Commission.
Compliance Manager – Reports to the state Department of Health and the Center for Medicare & Medicaid Services all reportable incidents including post-surgical infection rates.  

What specifically is your nursing role in the change process? Other nursing roles?

As an assistant nurse manager, it is my job to explain the new policy to the staff members. I usually do this during in-service meetings and open the floor for questions and concerns brought up by my team. I also observe to see if the new policy is being embraced by the staff. If not, I must investigate the motivations behind the policy non-compliance. The staff nurses’ responsibility is to be the link in the prevention of infection which starts with proper hand hygiene as explained in the new policy. The Director of Nursing has a role to report occurrences and infection rates to outside committees which oversee our facility’s accreditation.

List your stakeholders by position titles (charge nurse, pharmacist, etc.).-Why are the members chosen (stakeholders) important to your project?

Staff nurses, operating room technicians, surgeons, nurse managers, director of nursing, compliance manager. These team members are the most important stakeholders in implementing this change. The clinical staff mentioned are the ones that perform all hands-on care. They are the main catalysts in spreading infection in the operating room. Middle management is important in making sure that clinical staff members adhere to the new policy and they are the ones that will report to upper management. In turn, upper management uses this data when compiling their quarterly reports for the Joint Commission and this information will also be used in their annual report to CMS.

What type of cost analysis will be needed prior to a trial? Who needs to be involved with this?

The cost analysis is leaning towards embracing the new policy of banning nail extensions for clinical staff. The cost of not adopting this policy would lead to an increase in infection rates in postoperative patients. According to Marchetti and Rossiter, “HAIs in US acute-care hospitals lead to direct and indirect costs totaling $96-$147 billion annually.” (2013). Not only do HAIs burden the facility financially, they can threaten to shut down the center. The Joint Commission is who accredits ambulatory surgery facilities. Adverse patient outcomes such as medication errors, surgical site infections and falls are reasons for Joint Commission to withdraw accreditation. Without this we cannot continue the day to day operations.

Star Point 4: (Implementation)

Describe the process for gaining permission to plan and begin a trial. Is there a specific group, committee, or nurse leader involved?

In order to implement change there must be a need for it. Seeing that some staff members go against policy, this matter needs to be brought to the nurse manager in charge of the unit. Then, she will discuss this matter with the most senior nurse, the Director of Nursing as well as the Medical Director. Ultimately, they are the ones who will deem the policy necessary to implement.
Describe the plan for educating the staff about the change process trial and how they will be impacted or asked to participate.
In my facility, any changes in policy must be explained to the staff during in-service meetings. This gives the staff that are impacted by the policy a rationale for why this will lead to better patient outcomes as well as giving them an opportunity to voice their concerns over the proposed changes. Staff members who chose to wear nail enhancements will be asked to have them removed and begin working in accordance with policy. Issues with non-compliance with the policy may warrant grounds for termination of employment.  

Outline the implementation timeline for the change process (start time/end time, what steps are to occur along the timeline).
Week 1 – Compliance Manager must compile a statistical report on all reportable incidents. Rates on infection must be singled out. Nurse Manager and Director of Nursing have a meeting on trial.
Week 2- In-service for staff about the need to remove artificial nails.

Week 2 – Week 14- Nurse Manager conducts audits and collects data on reportable incidences and infection rates.

Week 15- Compliance Manager assessed efficacy or failure of initiative

Week 15- Director of Nursing compiles information to be reported to Department of Health

Week 16- Policy is revisited by management and becomes permanent policy or removed.

List the measurable outcomes based on the PICOT. How will these be measured?

The measurable outcomes would be an increase or a decrease in post-surgical infection rates. They will be measured by a patient survey, in which one question asks “Have you had a surgical site infection postoperatively?”. To have a baseline for measuring the effectiveness, the Compliance Manager must compile a statistical report based on infection rates which occurred during a period of time when clinical staff members wore nail enhancements

What forms, if any, might be used for recording purposes during the pilot change process. Describe.
All reportable incidents must be documented on a Quality Assessment Form which the Compliance Manager keeps a record of. This is the information that must be reported to the Joint Commission and CMS.

What resources are available to staff (include yourself) during the change pilot?

Nurse Managers are available as resources for the staff to voice their concerns about the change. The managers are also there to provide information about the process. Visual resources are a great idea such as CDC posters on hand hygiene.

Will there be meetings of certain stakeholders throughout the trial? If so, who and when will they meet?

The primary meeting of stakeholders is the only meeting necessary due to the small size of the facility.

Star Point 5: (Evaluation)

How will you report the outcomes of the trial?

Outcomes of the trial will be reported to upper management by the middle management (nurse managers). From there, it will trickle down to the staff members where it will be reported to them during another in-service meeting. A good idea would be to present the ongoing evaluation of outcomes in a visual representation such as a frequency chart. This will encourage the staff to adhere to policy because they can visually see that these interventions are making a difference.

What would be the next steps for the use of the change process information?

This information would be used as a basis for hand hygiene protocols in the surgery center. It will provide insight with factual data about the efficacy of our trial. In addition, this information can be used during the pre-employment on boarding process where all newly hired staff must agree to the Dress Code Policy which states that nail enhancements are not permitted.

9.2019 Update. DLP