Quality Improvement Proposal Paper

 Please refer to the uploaded file.  Include the Evidence-based process in the paper.
-ask a question
-find the evidence
appraise the evidence
implement
evaluate

Quality improvement is an important concept in nursing care. That is because it is targeted at ensuring that health care delivers safe and high quality care to patients in all clinical settings. It is concerned with ensuring that every stakeholder in the organization always works towards delivery health health care for patients. As nursing science advances and the profession gains access to good data on measures of quality that are linked to nursing, quality improvement offers an opportunity for nurses to use the collected data and the results of its analysis to improve the quality of nursing care (Helming, Shields & Avino, 2020).Quality Improvement Proposal Paper.  A significant concern in nursing care is central line associated bloodstream infections (CLABSI), describing an infection that develops within 48 hours of placing a central line. It can occur at the site of the infection or at another site. CLABSI is of concern because it is associated with a high cost burden requiring approximately $46,000 to treat every case. In addition, most cases of CLABSI are preventable by applying the proper management, surveillance and aseptic techniques (Chi et al., 2020). The present paper presents a quality improvement proposal for preventing CLABSI incidences.

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Overview of the problem

CLABSI is caused by a range of pathogens when the central line is used. The most common pathogens are gram-positive microorganisms (such as Staphylococcus aureus accounting for 9.9% of cases, enterococci account for 16% of cases and coagulase-negative staphylococci accounting for 34.1% of the cases) with gram-negative microorganisms (such as Candida species accounting for 11.8% of cases, Acinetobacter accounting for 2.2% of cases, Escherichia coli accounting for 2.7% of cases, Pseudomonas accounting for 3.1% of cases, Enterobacter accounting for 3.9% of cases, and Klebsiella accounting for 5.8% of cases) being less common. Quality Improvement Proposal Paper.CLABSI presents a concern at the medical facility because it is associated with increased mortality and health care costs, as well as prolonger hospital stays (Moureau, 2019). A review of statistics reveals that although national baseline data on CLABSI incidence shows significant reductions over a four-year period by 31% from 2015 to 2019, incidences remain high with 18,009 incidences reported for 3,602 facilities across the USA in 2015 (Centers for Disease Control and Prevention, 2020). The presented statistics show that CLABSI incidences remain high and yet there are interventions that can be implemented.

Need for quality improvement initiative and expected outcome

There is a significant concern at the facility that has created the need for the proposed project. The concern is that the facility does not conduct CLABSI surveillance although it has implemented a range of prevention strategies. The prevention strategies begin with limiting the use of central access line to establish indications. If central lines are indicated, then bundles and checklists would be applied to ensure that there is proper insertion. The facility’s protocols determine that if central line access is required, then the type of access must be clearly indicated and insertion planned. In addition, the facility makes use of antimicrobial lines. The bundles and checklists include hand hygiene, chlorhexidine skin prep unless contraindicated, avoidance of femoral vein when possible and maximum sterile barrier precautions (sterile gloves, sterile gown, cap, mask and head-to-toe sterile drape). These are the cornerstones of CLABSI prevention at the facility (Moureau, 2019).

Surveillance is identified as a concern for the facility because it does not conduct surveillance to specifically present CLABSI data. Rather, it presents generalized data on hospital acquired infections (HAI), which includes all nosocomial infections such as surgical site infection, urinary tract infection, ventilator associated pneumonia and bloodstream infection. Generalizing all the surveillance data for HAIs without specifying the surveillance data for CLABSI makes it difficult to evaluate the prevention strategies already applied at the facility (Stanley, 2017). In this case, surveillance implies conducting ongoing, systematic collection and analysis of data to provide information on response to systems, estimates of disease risk factors, morbidity and mortality, population groups at risk, and disease burden. Quality Improvement Proposal Paper.For that matter, surveillance would allow the facility to track risk factor and health outcome trends over time thereby providing essential information for policy and program development even as it acts as an integral tool in efforts to prevent and control CLABSI incidences. Investing in CLABSI surveillance is important because it captures care performance at the facility and enhances the ability to control CLABSI incidences. In fact, it permits early identification patients at risk and allows for targeted prevention and intervention thus allowing for CLABSI incidences to be more easily managed with low-cost interventions than if detected at a later date (Raingruber, 2017).

Besides the mentioned factors, treating CLABSI and its sequelae is costly, so that prevention becomes a key strategy. Prevention is best achieved with surveillance of disease incidence, associated risk factors and actions undertaken to promote the desired changes and risk reduction. As such, investing in surveillance is a cost effective solution (would require initial funding for capacity building and data analysis systems) when compared to the costly impact of CLABSI incidences (McEwen & Wills, 2018). Surveillance is considered a key element of the proposed quality improvement project since this would allow the facility to monitor and evaluate emerging patterns and trends of CLABSI. Surveillance is crucial for the facility because it contributes to better prevention and management of CLABSI. Through the collected data, the facility would be better able to set its priorities and develop targeted interventions (Stanley, 2017).

Review of past research

The proposed quality improvement project seeks to set up a surveillance system for CLABSI by leveraging nursing informatics capabilities at the facility. Disease surveillance is considered as the foundation of effective public health practice since it involves conducting an ongoing systematic data collection, analysis and interpretation. The ideal surveillance system supports interoperable, scalable, flexible, efficient and timely, acquisition, analysis and dissemination of data (Richards et al., 2017). Groseclose and Buckeridge (2017) adds to the discussion by reporting that surveillance is critical for improving health as it generates information that drives action. However, the data must be of sufficient quality with timeliness and resolution that matches its objectives. Aziz (2016) recognizes that health care delivery has increasingly become information intensive thus requiring that accurate and timely information be presented from different sources. Quality Improvement Proposal Paper.With the advances in computing capabilities and informatics sciences, it is only logical that health care resources be targeted at promoting health with a focus in disease prevention rather than treatment in order to prevent chain of events. The possible early detection from using a surveillance system ensures the complete receipt, review and investigation of case reports thus ensuring better management in terms of developing and implementing better prevention strategies (Aziz, 2016). Besides the mentioned factors, implementing a surveillance system specifically for CLABSI would help in achieving flexible, rapid local tracking of incidences, and helping to identify new pathogens at the earliest opportunity. A surveillance system that incorporates data from multiple data streams with spatial resolutions allows the facility to have full situational awareness of what is happening at the facility (Simonsen et al., 2016). In addition, surveillance helps with identifying outbreaks. This is important for the hospital facility since it helps with predicting outbreaks by tracking trends of specific pathogens and their incidences, thus enabling the facility to put measures in place to protect the patients and handle eventual infections in a timely manner (Abat et al., 2016). Overall, this discussion makes it clear that surveillance improves understanding of the situation at the facility and helps with decision making to achieve the desired outcomes.

Implementation steps

Implementation is an important activity that could determine the difference between the success and failure of the project. A five-step plan has been deemed as appropriate for implementing the proposed project. The first step is to prepare the infrastructure. The proposed solution requires that a data analysis tool be implemented for managing CLABSI data. The data analysis software would be acquired at this step.Quality Improvement Proposal Paper. The second step is to coordinate the stakeholders involved in implementing the project. This involves communicating with the medical personnel who would require the surveillance data. In addition, it requires communication with the IT department to install and test the data analysis software. The third step is to implement training in which all the users will be subjected to training on how to read and use the surveillance data. The fourth step is to install the data analysis software while ensuring that it is linked to the appropriate data input and output stations. The fourth step is to implement new procedures and processes to allow the medical personnel to make use of the data. The fifth step is to monitor the solution by collecting data on the outcomes to determine whether the solution had been effective in achieving the set objectives. The final step is making changes to the solution based on the outcomes to ensure that it achieves what was intended (Bemker & Schreiner, 2017).

Evaluating the project to determine improvements

Evaluating the project will dependent on the change idea that has been developed. Three measures will be considered in the outcomes. Firstly, outcome measures that will report presence of accurate, complete and timely surveillance CLABSI data showing effects of the different prevention and intervention measures applied. Secondly, process measures that evaluates the number of medical personnel who access the surveillance data and how the surveillance data is used in the facility. Finally, balancing measures that evaluates the satisfaction levels of the users, time spent and saved by the surveillance data, and changes in CLABSI incidences reported at the facility (Snipes, 2016).

As earlier indicated, the proposed quality improvement project seeks to improve efforts to address CLABSI incidences through improving surveillance. The collected surveillance data is intended to identify the risk factors associated with CLABSI occurrence and assess the effects of control measures. The surveillance system will be evaluated for representativeness in terms of accurately describing: (a) occurrence of CLABSI over time and (b) CLABSI distribution in the population by person and place. The hypothesis presented for the project is that the surveillance system offers a complete reflection of CLABSI data. The hypothesis is presented in terms of the percentage of all eligible subjects whose data is actually recorded in the surveillance system. Quality Improvement Proposal Paper. The representativeness will be assessed by comparing the completeness of the proposed CLABSI system data the and currently used HAI surveillance system that reports on CLABSI data. The variables of interest will be the case load and patient profile. The statistical analysis comparing the two systems (current and proposed surveillance systems) will make use of Wilcoxon signed rank test with the alpha level set at 0.05 (Weaver et al., 2017).

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References

Abat, C., Chaudet, H., Rolain, J., Colson, P., & Raoult, D. (2016). Traditional and syndromic surveillance of infectious diseases and pathogens. International Journal of Infectious Diseases, 48, 22-28. https://doi.org/10.1016/j.ijid.2016.04.021

Aziz, H. A. (2017). A review of the role of public health informatics in healthcare. Journal of Taibah University Medical Sciences, 12(1), 78-81. https://doi.org/10.1016/j.jtumed.2016.08.011

Bemker, M., & Schreiner, B. (Eds.) (2017). The DNP Degree & Capstone Project: A Practical Guide. DEStech Publications, Inc.Quality Improvement Proposal Paper.

Centers for Disease Control and Prevention (2020). Central Line-Associated Bloodstream Infections. https://arpsp.cdc.gov/profile/infections/CLABSI

Chi, X., Guo, J., Niu, X., He, R., Wu, L., & Xu, H. (2020). Prevention of central line-associated bloodstream infections: a survey of ICU nurses’ knowledge and practice in China. Antimicrobial Resistance & Infection Control, 9, Article number 186. https://doi.org/10.1186/s13756-020-00833-3

Groseclose, S. L., & Buckeridge, D. L. (2017). Public Health Surveillance Systems: Recent Advances in Their Use and Evaluation. Annual Review of Public Health, 38, 57-79. https://doi.org/10.1146/annurev-publhealth-031816-044348

Helming, M., Shields, D., & Avino, K. (2020). Dossey & Keegan’s Holistic Nursing: A Handbook for Practice (8^th ed.). Jones & Bartlett Learning, LLC.Quality Improvement Proposal Paper.

Moureau, N. L. (2019). Vessel Health and Preservation: The Right Approach for Vascular Access. Springer.

Raingruber, B. (2017). Contemporary Health Promotion in Nursing Practice (2^nd ed.). Jones & Bartlett Learning, LLC.

Richards, C. L., Iademarco, M. F., Atkinson, D., Pinner, R. W., Yoon, P., Mackenzie, W. R., … & Frieden, T. R. (2017). Advances in Public Health Surveillance and Information Dissemination at the Centers for Disease Control and Prevention. Public Health Reports, 132(4), 403-410. https://doi.org/10.1177/0033354917709542

Simonsen, L., Gog, J. R., Olson, D., & Viboud, C. (2016). Infectious Disease Surveillance in the Big Data Era: Towards Faster and Locally Relevant Systems. The Journal of Infectious Diseases, 214(suppl_4), S380–S385. https://doi.org/10.1093/infdis/jiw376

Snipes, C. (2016). Project Management for the Advanced Practice Nurse. Springer Publishing Company.

Stanley, D. (2017). Clinical Leadership in Nursing and Healthcare: Values into Action (2^nd ed.). John Wiley & Sons, Ltd.

Weaver, K. F., Morales, V. C., Dunn, S. L., Godde, K., & Weaver, P. F. (2018). An Introduction to Statistical Analysis in Research: With Applications in Biological and Life Sciences. John Wiley & Sons, Inc. Quality Improvement Proposal Paper.