D221 Practice Improvement Plan Proposal
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D221 Practice Improvement Plan Proposal
Samantha Hacker
College of Health Professions, Western Governors University
D221: Organizational Systems and Healthcare Transformation
Professor Kevin Sauls
4/26/2023
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Discuss a systems-level safety concern in a healthcare setting by applying the situation,
background, assessment, recommendation (SBAR) format by doing the following
: S- Situation
: Describe a healthcare-related situation (S) prompting a systems-
level patient safety concern that has the potential to impact multiple patients
.
A healthcare-related patient safety concern that has the potential to affect a multitude of patients is surgical site infections. In addition to negatively impacting patients, this issue can also lead to an increase in readmission costs and other resource
utilization. The National Healthcare Safety Network reports that the CDC healthcare-
associated infection prevalence survey shows there were 110,800 surgical site infections associated with surgeries in 2015 (NHSN, 2023). SSI’s or surgical site infections are a serious public health problem and is one of the most common adverse events associated with healthcare.
B- Background: Analyze background (B) information about the concern by doing the following
:
a. Describe the data that support or would support the need for change
.
In a recent article that was published in 2018, the World Health Organization (WHO) states that surgical site infections contribute to patients spending more than 400,000 extra days in the hospital with millions of lives threatened each year and costing up to $10 billion per year (WHO, 2018). With the presented data, surgical site infections are a huge safety risk for patients worldwide. Advances in surgical techniques
have improved since the 19
th
Century such as antimicrobial prophylaxis, sterilization
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methods, conservation of adequate blood supply, hypothermia prevention, maintaining homeostasis and better operating room ventilation, which have shown to decrease surgical site infections. However, SSI continue to cause a significant morbidity and death (Hranjec, 2010). Due to the recent pandemic, surgical services are favoring a shortened postoperative hospital stay, same-day surgery, and outpatient surgery. Because of this more surgical site infections occur after discharge from the hospital. Patient safety is always a number one goal and a national standard the healthcare field strives for, if this safety concern continues to be unmet there must be a change of interventions to better prevent the occurrences of surgical site infections. b. Explain how one or more national patient safety standards apply to this situation
.
Based on the Hospital National Patient Safety Goals by the Joint Commission, the national safety standards that pertain to surgical site infections would be to lower the
risk of health care-associated infections. Minimizing the risk of health care-associated infections relates to this situation because everyone, not only healthcare workers, should be maintaining hand hygiene guidelines. Maintaining and complying with this will
decrease the transmission of infectious agents which will reduce the risk for surgical site
infections. A- Assess: Assess the impact of the safety concern on the patient(s), staff, and the organization as situated in the identified healthcare setting
.
a. Explain how the safety concern affects value for the patient(s) and the healthcare setting
.
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The patient population undergoing surgical procedures would expect that there will be a positive purpose in doing so. Whether it is to relieve or prevent pain, remove or repair, find what could be causing an underlying issue, reduce a symptom of a problem or to improve body function. A huge factor that can affect the patient’s value is their own safety; with surgical site infections the patients are directly impacted. The Society for Healthcare Epidemiology of America (SHEA) reported that up to 60 percent of surgical site infections were preventable by using the evidence-based guidelines (Anderson, 2014). Surgical site infections are the second leading cause of hospital acquired infections leading to increased costs and worse patient outcomes (WHO, 2018). Hranjec concludes approximately 300,00-
500,000 surgical site infections can be predicted to occur annually (Hranjec, 2010). This safety concern not only affects the patient but also impacts the organization and its staff. The
biggest impact for the healthcare organization is the financial costs of surgical site infections which according to CDC is the costliest hospital acquired infection with an estimated yearly cost of $3.3 billion (NHSN, 2023). Staff members are impacted because their job is to maintain patient safety and if guidelines are being followed in regard to preventing surgical site infections, they are demonstrating negligence. R- Recommend: Recommend an evidence-based practice change that addresses the safety concern
.
a. Discuss how this recommendation aligns with the principles of a high-
reliability organization
.
An evidence-based practice change that addresses the safety concern related to surgical site infections would be to implement preoperative antibiotics. Surgical antimicrobial prophylaxis refers to an antibiotic initiated prior to an operation. In a recent
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study, the surgical ward of Goa Medical College conducted a three-month study that included 200 surgical patients who all received preoperative antibiotics prophylactically. Surgical site infections developed in only 3 of the 200 patients which is 1.5 percent (Kudchadkar, 2019). According to the National Healthcare Safety Network (NHSN), the overall national surgical site infection rate is approximately 1.9 percent. Additionally, hospitals that participated in the Agency for Healthcare Research and Quality (AHRQ) Safety Program for Surgery saw a 33 percent reduction in the surgical site infection rate
(NHSN, 2023). Preoperative antibiotics affiliate with the principles of a high-reliability organization because it promotes safety among patients. Sensitivity to operations is shown by maintaining situational awareness, providing staff with feedback during daily check-in meetings on the readmission rates related to surgical site infections and also allowing time for staff express what may or may not be working. Additionally, this practice change could aid in showing the real source of problems such as improper or poor hand hygiene practices and poor nursing care. Nursing staff and employees are able to recommend changes as they can identify the strengths and weaknesses that would provide a better outcome for staff, patients, and the organization. A huge part in integrating preoperative antibiotics is teamwork and collaboration as the nurses will have to work closely with pharmacists and other members of the patients care, with any change in practice there will be questions. The support of staff, patients, and the healthcare organization is a necessity in implementing a practice change, this would be evident by overcoming challenges, prepare for failures, and be able to predict and eliminate catastrophes being surgical site infections. This practice change aligns with
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the characteristics that outline a high reliability organization. Implementing preoperative antibiotics will reduce the risk of surgical site infections which will positively impact patient outcomes. b. Describe two potential barriers to the recommended practice change
.
Two potential barriers to implementing preoperative antibiotics prophylactically include appropriate dosing and lack of proper resources and education. The appropriate
dosing of antibiotics is crucial as it prevents unnecessary use of antibiotics which helps diminish adverse effects and antibiotic resistance development. Weight-based dosing should be followed per standardized protocol; for example when administering a common preoperative antibiotic, Cefazolin, the standard dose is two grams. However, if a patient’s weight is greater than 120kg then three grams of Cefazolin should be administered (Crader, 2022). The lack of proper education along with the necessary resources to safely educate and administer preoperative antibiotics is a major obstacle to this practice change. c. Identify two potential interventions to minimize the barriers from part A4b to the recommended practice change
.
Two interventions to minimize the previously discussed barriers would include providing training and education on the proper dosing of each preoperative antibiotic. By
working closely with the pharmacy staff to ensure each patient is given the correct dose prior to administration. Providing resources such as the rationale behind preoperative antibiotic prophylaxis, correct dosage, evidence for the timing of initial dose and what to watch for if there would be a contraindication.
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d. Discuss the significance of shared decision-making among the healthcare setting’s relevant stakeholders in implementing this recommendation
.
The significance of shared decision-making in implementing preoperative antibiotics, and involving relevant stakeholders which include healthcare providers, physicians, nurses, pharmacists, anesthesiologists, patients, and family members. Creating an interprofessional approach has the potential to optimize antibiotic prophylaxis, minimize adverse events and aide in positive patient outcomes.
e. Describe an outcome measure that could be used to evaluate the results of the
recommendation
.
The outcome measures to determine the effectiveness of implementing the use of preoperative antibiotics would be assessing and evaluating the readmissions rate related to surgical site infections. To be able to efficiently measure the outcome of each patient that receives preoperative antibiotics prophylactically data analysis would be used to monitor the number of readmissions due to surgical site infections or for post-
operative inpatients, watching for the signs and symptoms of infection and filling an incident report if the patient does have a surgical site infection. The numbers of each would be monitored closely to evaluate the effectiveness of implementing this recommendation.
f. Describe the care delivery model currently being used in the healthcare setting
.
The care delivery model currently being used in healthcare involves a team-
based approach. This is a delivery model where a collaborative team share
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responsibilities to achieve efficient and high-quality patient care. These coordinated efforts are among multiple healthcare providers across different care settings. i. Explain how the current care delivery model in the healthcare setting identified in part A4f would be impacted by the recommended change in part A4
.
Implementing preoperative antibiotics would impact the current care delivery model by improving communication and collaboration between different healthcare providers such as pharmacy and nursing staff. Perioperative nurses would be dependent on pharmacy staff to aid in calculating and confirming dosage for each patient. Additionally, perioperative nurses would be collaborating with anesthesiologists, physicians, and operating-room nurses to inform and ensure continuity of care for the patient. The recommended practice change will positively affect the care delivery model of team-based approach which would be evident by an increase in collaboration, minimizing adverse events, drive optimal patient outcomes, and decrease in readmission rates.
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REFERENCES
Anderson, D. J., Podgorny, K., Berríos-Torres, S. I., Bratzler, D. W., Dellinger, E. P., Greene, L., Nyquist, A.-C., Saiman, L., Yokoe, D. S., Maragakis, L. L., & Kaye, K.
S. (2014). Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update. Infection Control and Hospital Epidemiology, 35(6), 605–627. https://doi.org/10.1086/676022
Crader, M. (2022, September). Preoperative Antibiotic Prophylaxis. National Center for Biotechnology Information. Retrieved May 6, 2023, from https://www.ncbi.nlm.nih.gov/books
Hranjec, T., Swenson, B. R., & Sawyer, R. G. (2010). Surgical site infection prevention: How we do it. Surgical Infections, 11(3), 289–294. https://doi.org/10.1089/sur.2010.021
Kudchadkar, A. A., & Bhounsule, S. A. (2019). An observational study on the surgical antibiotic prophylaxis in the surgery ward of a tertiary care hospital. International Journal of Basic & Clinical Pharmacology, 8(7), 1647. https://doi.org/10.18203/2319-2003.ijbcp20192665
National Healthcare Safety Network. (2023, January). Outpatient procedure component surgical site infection (OPC-SSI ... - CDC. Centers for Disease Control and Prevention. Retrieved May 6, 2023, from https://www.cdc.gov/nhsn/pdfs/opc/opc-
ssi-protocol-current-508.pdf
National Healthcare Safety Network. (2023, January). Surgical Site Infection Event (SSI). Centers for Disease Control and Prevention. Retrieved May 7, 2023, from https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf
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Preventing surgical site infections: implementation approaches for evidence-based recommendations. World Health Organization. (2018). Retrieved May 6, 2023, from https://apps.who.int/iris/bitstream/handle/10665/273154/9789241514385-
eng.pdf
Rockville, MD: Agency for Healthcare Research and Quality. December 2017. AHRQ Publication No. 16(18)-0004-1-EF. Retrieved May 11, 2023, from https://psnet.ahrq.gov/issue/ahrq-safety-program-surgery