NUR 550 Identify a quality initiative from your workplace

One quality initiative that has been rolled out in my workplace is replacing verbal nurse to nurse report with electronic SBAR report from admitted Emergency Department patients to some of the inpatient units. This initiative excludes the critical care or neurological units. The SBAR format of report consists of situation, background, assessment, and recommendation. This written communication tool is said to “help provide essential, concise information, usually during crucial situations. In some cases, SBAR can even replace an executive summary in a formal report because it provides focused and concise information” (SBAR | ASQ, n.d.). Barriers to this quality initiative have been the lack of acceptance from staff. Nurses receiving report prefer a verbal SBAR handoff so that they may ask questions for clarification and prepare for the patient’s arrival. The downfall of verbal report is that many times the nurse is not available to take report, and this delays care and patient transfer. This causes a backup in the Emergency Department to turn the exam room and begin caring for a new patient. Staff acceptance to change is common barrier. Other barriers to change include inadequate knowledge, skills, support of belief of change, lack of leadership or mentors, cultural or organizational influences, and budget restrictions (‌Melnyk & Fineout-Overholt, 2018).

References:

SBAR | ASQ. (n.d.). Asq.org. https://asq.org/quality-resources/sbar

‌Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-Based practice in nursing and healthcare (4th ed.). Wolters Kluwer Health.

One of the quality initiatives in my workplace is implementation of CAUTI prevention bundle. This helps to monitor clinical outcomes on a regular basis in order to make ongoing improvements in patient care and to continually assess issues regarding patient safety in order to prevent ,correct , and to reduce errors and foster patient well-being. CAUTI prevention bundle includes daily assessment of need, daily CHG bath, urinary catheter is to the thigh with a stat lock or other securement device, CUROS caps is on the sampling port, drainage system is intact and the plastic seal has not been broken, date of insertion is written on the drainage bag, the bag is less than half full, drainage tubing is free of dependent loops, the drainage bag and tubing never touch on the floor or rises above the bladder, perineal and urinary catheter care is performed every shift and as needed and documented.

Common barriers were: difficulty with nurse and physician engagement; nurses work load , catheter insertion practices and customs in the emergency department, incorporating urinary management (e.g., planned toileting) as part of other patient safety programs, such as a fall reduction program; explicitly discussing risks of indwelling urinary catheters with patients and families; and engaging with emergency department nurses and physicians to implement a process that ensures that appropriate indications for catheter use are followed.(Krien et.al 2013) The most challenging aspect of translating evidence to practice is often related to changing behaviors and sustaining those behaviors rather than simply providing the education for change.(Fencl ,et.al 2017).

References:

Fencl, J. L. & Matthews, C. (2017). AORN Journal, 106 (5), 378-392. doi: 10.1016/j.aorn.2017.09.002.

Krein, S. L., Kowalski, C. P., Harrod, M., Forman, J., & Saint, S. (2013). Barriers to reducing urinary catheter use: a qualitative assessment of a statewide initiative. JAMA internal medicine, 173(10), 881–886. https://doi.org/10.1001/jamainternmed.2013.105

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A Quality Improvement Initiative and Barriers to Implementation

The identified quality improvement initiative isevidence-based practice (EBP). EBP connotes an insightful and cautious utilization of the best available evidence alongside patients’ preferences and values and also the clinical expertise to inform patient care decisions and delivery (Dagne & Beshah, 2021). EBP is credited for the positive impacts on the healthcare system including the promotion of safe and quality care and reduction in healthcare costs.Barriers linked to the implementation of EBP can be categorized into individual and organizational barriers. Individual barriers include heavy workload in nursing practice leading to inadequate time to adopt and implement EBP. Other barriers include poor understanding and inability to analyze literature, lack of interest among nurses to read the literature, poor critical analytical skills, and computer illiteracy. Organizational barriers include heavy work burden on the existing nursing workforce, inadequate vital resources for implementation, and lack of management support (Dagne & Beshah, 2021). Moreover, the acceptance and application of EBP in the healthcare industry is an expanding research area. As a result, this area is marred with inconsistent terminologies and poor application of theory, which is a significant challenge during EBP implementation.

Translation of research into practice is also characterized by massive barriers. The first barrier is difficulty in introducing and sustaining evidence alongside EBP protocols in the face of conflicting healthcare priorities. Also, translating research into practice is contextually inconsistent, which makes it hard to enhance research translation into practice (Dang et al., 2021). Other factors that cause barriers to translating research into practice include poor evidence-based directives, poor structures for training and continuing education, unfavorable organization traditions and policies, lack of inspiration among nurses, and resistance to change.

References

Dagne, A. H., & Beshah, M. H. (2021). Implementation of evidence-based practice: The experience of nurses and midwives. PloS one, 16(8), e0256600. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0256600

Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2021). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines. Sigma Theta Tau.

One quality improvement initiative that my facility recently started is reducing hospital readmission rates by identifying patient’s risk factors and discussing them in our morning meetings and opening an evaluation form in the patient’s electronic health records. Clinicians will have access to view the document and update any pertinent information such as the patient’s diagnoses. It is an internal record that is used by our facility for the purposes of reducing return-to-acute rates. Our rates have gone up in the recent months, so the interdisciplinary team members have been collaborating with each other to come up with ways to improve these rates. We can go back and review this document if a patient is sent out so that we can analyze the patient’s the most common risk factors or conditions. So far we have found that many patients with respiratory conditions are being sent back to the hospital much more than others.

In order to achieve positive outcomes, quality improvement (QI) must be an ongoing process. It is essential in improving population health, enhance patient experience and outcome (Taylor et al, 2020). My facility will benefit from these ongoing efforts as it will help us with improving the identification of the patients that are at a higher risk and managing these patients’ conditions to prevent rehospitalization. This QI process will also help us with implementing practice changes over time as we learn how to manage the patients better. A major barrier to implementation is lack of consistency. The interdisciplinary team has to be consistent and ensure that the meetings are being held and that the evaluation form is being completed for every single patient.

Reference

Taylor, E., Peikes, D., Geonnotti, K., Mcnellis, R., Genevro, J. & Meyers, D. (2020). Quality Improvement in Primary Care. https://www.ahrq.gov/research/findings/factsheets/quality/qipc/index.html

One quality initiative at my workplace is to improve care coordination among different hospital departments. While the surgical services department can be relatively separated from most other hospital departments, we rely heavily on the physical therapy department. We recently had a new surgeon come to our hospital and likes to discharge his patients home the same day after total joint replacements. Since this has not been the hospitals current practice it involved a lot of changes and care coordination between the surgery department and physical therapy. One of the requirements before sending a patient home after a joint replacement is that they are evaluated by physical therapy to ensure the patients is mobile enough to discharge them home. Now physical therapy needs to see the patient in the post anesthesia care unit (PACU) instead of on the floor. Additionally, they need to see them in a timely manner, after the spinal anesthesia wears off but soon enough that the patient can be appropriately evaluated and be discharged without having to wait in PACU.

There are a multitude of barriers to implementing any quality improvement project. Some of the barriers are resistance to change, effects on patient’s outcomes, and misconceptions about the time and effort necessary to implement practice change (MeInyk, 2019). Doing a thorough barrier assessment before the proposed changes and throughout the engagement and integration phases of implementation are necessary to ensure stakeholder buy in (MeInyk, 2019).

References

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: A guide to best practice (4th ed.). Wolters Kluwer. ISBN-13: 9781496384539

NUR 550 Identify a quality initiative from your workplace