Nursing Graduate Level – Improvement Reach Paper (5-7 Pages)

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Running head: QUALITY IMPROVEMENT: MANDATORY TESTING FOR SEPSIS 1

 

Running head: QUALITY IMPROVEMENT: MANDATORY TESTING FOR SEPSIS 1

 

 

 

 

 

 

 

 

 

Quality Improvement: Mandatory Testing for Sepsis

Amber Cajina

Chamberlain College of Nursing

NR505 NP: Advanced Research Methods

 

 

 

 

 

 

Introduction

Screening of sepsis is a safety priority area that requires immediate attention and recognition. There is over one million cases of sepsis every year in the United States and numbers are on the rise. As mentioned in the factsheet published in 2018 by NIGMS, the increasing numbers are in attribute of the higher number of people with chronic illnesses living longer, prevalence of organ transplants and antibiotic-resistance infections. Sepsis has significate clinical markers that makes early detection unpretentious. Bringing awareness to sepsis could lower or possibly halt the increasing 2018 mortality rates of about 35% (Drahnak, 2016, p. 234). Evidence shows that sepsis screening treatment program adoption by hospital has been associated with nurse’s early detection and improved mortality rates due to faster initiation of antibiotics, which is crucial to survival (Drahnak, 2016).

Problem Discussion

Explanation of the selected problem in detail

Research conducted by Ladah, E., House-Kokan, M., & Gillespie, M. (2019) shows sespis is a common diagnosis with an overall mortality rate of around 30% and is leading cause of in-hospital death. As some point, a nurse or provider will come into care of a patient with sepsis. Sepsis has several factors that make detection of the illness tricky to uncover. To overcome the faced difficulties in diagnosing. Sepsis needs to be handled through a mandated testing protocol. To ensure that sepsis is not misdiagnosed.

Identify the stakeholders impacted by the concern.

The stakeholder in this quality care improvement problem, sepsis testing range greatly. First hand, patients and their family and friends are burden of the detrimental effects of the illness. Second hand are the employed healthcare workers handling sepsis patients. As mentioned in Bodolica, V., Spraggon, M., & Tofan, G., 2016 research facilities hospital, urgent care, patients, and healthcare carriers that manage and provide care are on the back end of the cause and effect. The mortality rates and healthcare cost that are associated with the acute illness have a domino effect on healthcare and the governance. The problem is on the micro level, but effects the healthcare facilities and insurance carrier by the increased rates that raise cost, readmissions. Thus adversely affects the organization by reviews and funding.

Identify the consequences/importance of the selected concern; state rationale for selection of the topic.

If the current testing protocols are updated and mandated to include the testing of all critical patients no matter the presents of illness or signs and symptoms. The risk is that the rates of mortality will steadily increase. Which will have the domino effect on health care cost as discussed previously.

Identify a purpose statement (the specific aim) for this EBP proposal.

The Purpose of this paper is to describe the changes needed to provide quality care improvement to sepsis current identification and treatment to lower associated mortality rates.

PICO question and Literature Search Process

Identify the PICO question in correct format with all required elements

Among critical care patients eighteen years an older (P), does SSC recommended consistent sepsis screening once a day (I), ultimately decrease the number of deaths related to sepsis (O) as compared no screening (C).

Identify the steps used to conduct a literature review for this EBP proposal by including:

The steps used to conduct a literature review for this EBP proposal are as followed. Research and review of previous studies guide to understanding topic in depth and the relationship and response of others that reviewed. Hence, the assessment will look at those articles and evaluate whether the topic is even feasible. A comparison of the different findings will enable the audience to identify the appropriate patient outcomes.

The Specific Library Databases Used. In this case, the CINAHL and PubMed databases were used to retrieve the appropriate peer-reviewed sources that sourced required information. The CINAHL and PubMed databases have a wide range of studies. Both databases utilize reliable and peer reviewed provide creditability. The research approach and library databases made it easier to identify the right sources that respond to the PICO question.

The key search terms and phrases used. “Sepsis clinical signs”, “nursing interventions” and “sepsis mortality”. Choosing the right key search terms was a challenge; it involves variety and toggling to get relevant articles. After the appropriate terms were applied, it revealed sources that were fitting to the topic.

The Minor (Additional) Search Terms and Phrases Used. There was a need to utilize other minor search terms to support the key phrases. For instance, “sepsis prevalence AND evidence based practice” and “sespis AND mandatory testing” that were also essential. However, they did not have the appropriate sources that the previous search had provided.

Identify any specialty organization that is relevant to this EBP proposal. A Specialty Organization That Is Relevant to This EBP Proposal. The joint commission a center for transforming healthcare focuses on important quality and safety initiatives. The center vestment in the topic are related to the claims of lives and the cost of care as result of the illness. The claim is that through prevention in control can help the outcomes improve.

Theoretical Framework

Explain the theoretical framework to be used in this EBP proposal.

The most feasible theoretical framework to be used in this EBP proposal is the public health nursing model. This model uses assumptions to as consideration to the interventions and methods. The model also applies concept of caring, nursing process, interdisciplinary collaboration, and community partnership. This model is suggested for utilization in research and practice. The model promotes clarification of population focused nursing roles and also could be individualized for a recipient of care while focusing on the community as client.

Describe how the identified theoretical framework is to be applied to this Quality Improvement Project.

The Public Health Nursing Model is the perfect framework for the development of a health policy or protocol because it encourages the participation from all stakeholders in the process of both policy creation and the implementation of it as a mainstream healthcare policy (Utley, Henry, & Smith, 2018).

 

 

 

 

 

 

 

 

 

Appendix

Johns Hopkins Nursing Evidence-Based Practice: Question Development Tool

1. What is the problem?
Screening of sepsis is a safety priority area that requires immediate attention and recognition. There is over one million cases of sepsis every year in the united states and numbers are on the rise. As mentioned in the factsheet published in 2018 by NIGMS, the increasing numbers are in attribute of the higher number of people with chronic illnesses living longer, prevalence of organ transplants and antibiotic-resistance infections. Sepsis has significate clinical markers that makes early detection unpretentious. Bringing awareness to sepsis could lower or possibly halt the increasing 2018 mortality rates of about 35% (Drahnak, 2016, p. 234).

2. Why is the problem important and relevant? What would happen if it were not addressed?
Evidence shows that sepsis screening treatment program adoption by hospital has been associated with nurse’s early detection and improved mortality rates due to faster initiation of antibiotics, that is crucial to survival (Drahnak, 2016). Without the adoption of the screening, the mortality rates would steadily increase from sepsis yearly.

3. What is the current practice?
Currently there are no federal requirements regarding the adoption of sepsis screening. In 2013, New York adopted a protocol for treatment (University of Pittsburgh, 2019)

4. How was the problem identified? (Check all that apply)
· X Safety and risk-management concerns

· X Quality concerns (efficiency, effectiveness, timeliness, equity, patient-centeredness)

· Unsatisfactory patient, staff, or organizational outcomes

 · Variations in practice within the setting

· Variations in practice compared to community standard

· Current practice that has not been validated

· Financial concerns

5. What are the PICO components?
P– (patient population/patients of interest): Inpatient ICU patients 18+ and older

I– (Intervention): SSC recommended consistent sepsis screen once a day

C– (Comparison): routine care /no screening tools

O– (Measurable outcome): Number of deaths related to sepsis

6. Initial EBP question ❑ Background ❑ X Foreground

 

7. List possible search terms, databases to search, and search strategies.
Sepsis clinical signs, nursing interventions, sepsis mortality, sepsis prevalence and evidence practice

8. What evidence must be gathered? (Check all that apply)
· Publications (e.g., EBSCOHost, PubMed, CINAHL, Embase)

· X Standards (regulatory, professional, community)

· X Guidelines

· Organizational data (e.g., QI, financial data, local clinical expertise, patient/family preferences)

· Position statements

9. Revised EBP question

(Revisions in the EBP question may not be evident until after the initial evidence review; the revision can be in the background question or a change from the background to a foreground question)
Among inpatient ICU patients 18+ and older (P), does SSC recommended consistent sepsis screening once a day (I) Decrease number of deaths related to sepsis (C) compared no screening (O)?

10. Outcome measurement plan
What will we measure?

(structure, process, outcome measure)

 How will we measure it?

(metrics are expressed as rate or percent)

 How often will we measure it?

(frequency)

 Where will we obtain the data? Who will collect the data? To whom will we report the data?
Outcome Measure Death toll count related to sepsis expressed in rate Monthly for 1 year Three local hospitals Supervisors or head nurses of the ICU. The person conducting the research.

 

 

 

 

 

References

Bodolica, V., Spraggon, M., & Tofan, G. (2016). A structuration framework for bridging the macro-micro divide in health-care governance. Health expectations : an international journal of public participation in health care and health policy, 19(4), 790–804. doi:10.1111/hex.12375

Drahnak, D. (2016, July). Evidence-Based Guidelines and Scripting to Support Nurses in Sepsis Recognition, Reporting, and Treatment. CRITICAL CARE NURSE. 25, 4. Retrieved July 28, 2019, from https://search-ebscohost-com.chamberlainuniversity.idm.oclc.org/login.aspx?direct=true&db=edswss&AN=000352625600025&site=eds-live&scope=site

Ladah, E., House-Kokan, M., & Gillespie, M. (2019). The ABCCs of sepsis: A framework for understanding the pathophysiology of sepsis. Canadian Journal of Critical Care Nursing, 30(4), 12–21. Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=141080922&site=eds-live&scope=site

NIGMS: National Institute of General Medical Sciences. (2018, January). Sepsis. Retrieved from https://www.nigms.nih.gov/education/pages/factsheet_sepsis.aspx

The Joint Commission. (2020) Sepsis Introduction. Retrieved from https://www.jointcommission.org/en/resources/patient-safety-topics/infection-prevention-and-control/sepsis/

Utley, R. A., Henry, K., & Smith, L. (2018). Frameworks for Advanced Nursing Practice and Research : Philosophies, Theories, Models, and Taxonomies. New York, NY: Springer Publishing Company. Pg. 253.

Explain why a quality improvement initiative is needed in this area and the expected outcome.

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Identify a quality improvement opportunity in your organization or practice. In a 1,250-1,500 word paper, describe the problem or issue and propose a quality improvement initiative based on evidence-based practice. Apply “The Road to Evidence-Based Practice” process, illustrated in Chapter 4 of your textbook, to create your proposal.

Include the following:

  1. Provide an overview of the problem and the setting in which the problem or issue occurs.
  2. Explain why a quality improvement initiative is needed in this area and the expected outcome.
  3. Discuss how the results of previous research demonstrate support for the quality improvement initiative and its projected outcomes. Include a minimum of three peer-reviewed sources published within the last 5 years, not included in the course materials or textbook, that establish evidence in support of the quality improvement proposed.
  4. Discuss steps necessary to implement the quality improvement initiative. Provide evidence and rationale to support your answer.
  5. Explain how the quality improvement initiative will be evaluated to determine whether there was improvement.
  6. Support your explanation by identifying the variables, hypothesis test, and statistical test that you would need to prove that the quality improvement initiative succeeded.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Discussion 2 Principles Of Teaching And Learning

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Using the hierarchical order of Bloom’s taxonomy for the cognitive domain, develop a learning objective related to a selected nursing course for each of the six categories of cognitive skills: knowledge, comprehension, application, analysis, synthesis, and evaluation. Comment on at least two other student’s postings to enhance or improve learning outcomes.

Ethics Assignment – Miss Evers’ Boys and Ethical Issues in Research

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Ethics Assignment – Miss Evers’ Boys and Ethical Issues in Research

 

Students will watch the movie “Miss Evers’ Boys” about a landmark government study carried out over several decades by the United States government and the outstanding ethical issues surrounding it. Students will also locate another example of a research study that violated ethical standards.

 

The student will reflect upon these studies and respond to the rubric. Students may watch the movie with classmates, but the assignment should reflect each student’s individual thoughts and be in their own words.

 

It is expected that the student will consult additional resources to more fully explore the questions in the ethics reflection assignment.

 

This assignment is written as a paper, not just a document with answers to the questions. It must be in APA format including cover page, paper, and reference page. There is not a minimum number of pages required, should be of sufficient length to thoughtfully address the questions in the assignment. See APA Format in the Additional Items and Policies section after the Course Calendar in this Syllabus. The paper will be submitted through Turnitin and should have a green score to reflect absence of plagiarism.

 

Ethics Reflection Assignment and Rubric

Question Possible points
· Discuss how the Tuskegee Study started out and the intent of the research (3 points).

· Cite additional source(s) and include on reference page in APA (1 point)

· What was unique about the population of Tuskegee, Alabama, as it relates to this study? (2 points)

· Why do you believe Dr. Douglas chose Dr. Brodus and Miss Evers to participate in this study? (2 points)

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· Describe at least three distinct approaches Miss Evers used to convince the men of Tuskegee to participate in the study? (3 points)

· For each activity by Miss Evers – identify if you feel the activity constituted use of coercion, power (implicit or explicit), advocacy, or a mixture of these and explain why? (6 points)

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· In what ways did the United States government use power to influence and propel this study to continue for several decades? (2 points)

· In what ways did roles (e.g. physician, nurse), race, economics, education, or other factors contribute to this study continuing and to Miss Evers staying with the study? (6 points)

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· How do you feel about Miss Evers participation in the Tuskegee Study? (2 points)

· What would you have done the same or differently? (3 points)

· Why? (3 points)

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· Locate another research study that violated ethical standards.

· Describe the study itself (3 points).

· Which ethical standards did it violate and how? (4 points)

· Cite additional source(s) and include on reference page in APA (1 point)

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· Compare and contrast the ethical violations of the study you describe and the Tuskegee Study. In what specific ways are they similar or different?) (4 points) 4
· Describe specific research ethics, laws or practices (names, descriptions of protections) that exist now to prevent the issues that arose from the Tuskegee Study and other unethical studies. (4 points)

· Cite additional source(s) and include on reference page in APA (1 point)

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· Written as a paper in APA, not as a bulleted list of answers

· Paper format (correct APA 7th ed.): font (½ pt), margins/double-spacing (½ pt), page numbers (½ pt), cover page & reference page formats (½ pt)

· Correct spelling and grammar (4 points)

· Citations & References (correct APA 7th ed – graded in sections above with these criteria): all references are cited in paper; each reference includes all required elements (author, year, title, journal name, volume, issue if available, page number or electronic locator, URL/doi

· Turnitin score reflective of original thought (4 points)

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Total 60

 

 

 

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