Develop a data table that illustrates one or more underperforming clinical outcomes in a care environment of your choice. Write an assessment (3-5 pages) in which you set one or more quantitative goals for the outcomes and propose a change plan that is designed to help you achieve the goals.

Knowing what is the best practice for our patients is very important in providing safe and effective care. Understanding best practices can help nurses identify areas of care that need to be improved. To identify areas of need, nurses must use evidence from various sources, such as the literature, clinical practice guidelines (CPG), professional organization practice alerts or position papers, and protocols. These sources of evidence can also be used to set goals for improvement and best practices with an eye toward improving the care experience or outcomes for patients.

The challenge facing many care environments and health care practitioners is how to plan for change and implement changes. For, if we cannot effectively implement changes in practice or procedure, then our goals of improving care will likely amount to nothing. This assessment focuses on allowing you to practice locating, assessing, analyzing, and implementing change strategies in order to improve patient outcomes related to one or more clinical goals.  Change Strategy and Implementation Essay Discussion Paper

This assessment will take the form of a data table to identify areas for improvement and to set one or more outcome goals, as well as a narrative describing a change plan that would help you to achieve the goals you have set.

As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.

The assessment will be based on one or more outcomes that you would like to see improve. Think about experiences you have had working on setting goals for outcomes or using data to identify areas of need. Part of achieving your goal will be your ability to implement change in pursuit of improving outcomes. The Vila Health: Using Evidence to Drive Improvement simulation may be helpful in this regard.

Where do you look for resources and evidence to help you get started when treating a specific condition?
Where do you look for resources and evidence to help you get started when setting clinical goals?
When there are no guidelines or policies for setting clinical goals, where do you look for resources and evidence to help you get started?
How do you use these resources and evidence to begin constructing evidence-based treatment, or developing evidence-based goals?
What data do you plan to use as a basis for setting improved outcome goals?
What care environment do you envision using as the context of your assessment?
How would change models, strategies, or theories need to be applied to help ensure achievement of your outcome goals?
Which change models, strategies, or theories seem to be the best fit for your goals and environments. Why?

For the setting that you choose you will need to have a data set that depicts sub-optimal outcomes related to a clinical issue. This data could be from existing sources in the course (Vila Health: Using Evidence to Drive Improvement), a relevant data set that already exists (a data set from the case study you used as a basis for your Concept Map assessment, or from your current place of practice), or an appropriate data set that you have created yourself. (Note: if you choose to create your own data set, check with your instructor first for approval and guidance.)

After you have selected an appropriate data set, use your understanding of the data to create at least one realistic goal (though you may create more) that will be driven by a change strategy appropriate for the environment and goal.

Potential topics for this assessment could be:

Consider ways to help minimize the rate of secondary infections related to the condition, disease, or disorder that you focused on for your Concept Map assessment. As a starting point you could ask yourself, “What could be changed to facilitate safety and minimize risks of infection?”
Consider how to help a patient experiencing traumatic stress or anxiety over hospitalization. As a starting point you could ask yourself, “How could the care environment be changed to enhance coping?”
Once you determine the change you would like to make, consider the following:

What data will you use to justify the change?
How can the team achieve this change with a reasonable cost?
What are the effects on the workplace?
What other implementation considerations do you need to consider to ensure that the change strategy is successful?
How does your change strategy address all aspects of the Quadruple Aim, especially the well-being of health care professionals?
Once the change strategy is implemented, how would you evaluate the efficiency and effectiveness of the care system if the desired outcomes are met?
Instructions
Your assessment submission should include a data table that illustrates the current and desired states of the clinical issue you are attempting to improve through your application of change strategies. Additionally, you will need to explain the rationale for your decisions around your chosen change strategies, as well as how the change strategies will be successfully implemented.

The bullet points below correspond to the grading criteria in the scoring guide. Be sure that your change strategy addresses all of them. You may also want to read the Change Strategy and Implementation scoring guide and Guiding Questions: Change Strategy and Implementation [DOCX] to better understand how each grading criterion will be assessed.

Develop a data table that accurately reflects the current and desired states of one or more clinical outcomes.
Propose change strategies that will help to achieve the desired state of one or more clinical outcomes.
Justify the specific change strategies used to achieve desired outcomes.
Explain how change strategies will lead to quality improvement with regard to safety and equitable care.
Explain how change strategies will utilize interprofessional considerations to ensure successful implementation.
Communicate the change plan in a way that makes the data and rationale easily understood and compelling.
Integrate relevant sources to support assertions, correctly formatting citations and references using current APA style.

Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

Competency 1: Design patient-centered, evidence-based, advanced nursing care for achieving high-quality patient outcomes.
Develop a data table that accurately reflects the current and desired states of one or more clinical outcomes.
Competency 2: Develop change strategies for improving the care environment.
Propose change strategies that will help to achieve the desired state of one or more clinical outcomes.
Justify the specific change strategies used to achieve desired outcomes.
Competency 3: Apply quality improvement methods to practice that promote safe, equitable quality of care.
Explain how change strategies will lead to quality improvement with regard to safety and equitable care.
Competency 4: Evaluate the efficiency and effectiveness of interprofessional care systems in achieving desired health care improvement outcomes.
Explain how change strategies will utilize interprofessional considerations to ensure successful implementation.
Competency 5: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with organizational, professional, and scholarly standards.
Communicate change plan in a way that makes the data and rationale easily understood and compelling.
Integrate relevant sources to support assertions, correctly formatting citations and references using current APA style

Change Strategy and Implementation

Introduction and analysis

The hospital is an acute care hospital facility. It has indicated a commitment to protecting patients and medical personnel from adverse health care events even as it promotes value, quality and safety in the delivery of healthcare. Preventing hospital acquired infections (HAI), particularly central line-associated bloodstream infection (CLABSI), is a priority for the facility since it is a preventable concern. CLABSI is a concern because it is a HAI that develops within 48 hours of a central line placement. Many of the CLABSI incidences are preventable through proper management strategies, surveillance, and aseptic techniques. Besides that, CLABSI is a concern because it is associated with prolonged hospital stay with higher cost burden as each case requires approximately $30,000 in additional health care costs (Webb et al., 2016).

ORDER A PLAGIARISM-FREE PAPER HERE

The CLABSI performance data for the hospital facility is presented based on standardized infection ratios (SIR), a measure of the progress made in reducing CLABSI compared to the predicted performance given the trends and measures in place. The SIR figure is calculated as the ratio of CLABSI events (observed number of infections) to the number of predicted events for the summarized time period. The predicted CLABSI events is estimated based on risk adjusted national baseline data. The risk adjustment takes into account the state and county averages, and the fact that this is an acute care hospital that treats sicker patients than others (Laitenbach et al., 2018).

A review of the facility-specific CLABSI SIR figures reported for 2020 reveals that the SIRs are all greater than 1. This indicates that the number of actual infections is greater than the number of predicted infections for all patient populations in the ICU, wards and NICU. To be more precise, the CLABSI SIR reported for the whole facility is 1.15 with the figure reported for ICU being 1.16, wards being 1.14, and NICU being 1.16 (see Table 1). Further analysis of the figures reveals that there were 15% more CLABSI cases than had been predicted for the whole facility with 16% more cases reported in the ICU, 14% more cases reported in the wards, and 16% more cases reported in NICU. The higher than expected CLABSI events in the whole facility and across all patient populations indicate that the facility has applied inadequate measures to reduce the CLABSI events.

Table 1. Summary of SIR using facility-specific CLABSI data reported for 2020 by patient population

Intervention (proposed change)

The high SIR figures show that CLABSI is a concern in the facility. To be more precise, the facility is underperforming in its efforts to reduce CLABSI events. To address this concern, a change proposal is presented to implement prevention guidelines during central line insertion. The change has eight key components. Firstly, using a checklist. Secondly, replacing central lines placed during emergencies within 48 hours. Thirdly, promptly removing the central line if not required. Fourthly, preferring subclavian vein and avoiding the femoral vein during central line placement. Fifthly, using ultrasound guidance during placement to avoid mechanical complications. Sixthly, using 2% chlorhexidine skin preparation to clean and disinfect the skin before central line insertion. Seventhly, applying strict aseptic techniques using full-body drape and maximal sterile barrier precautions during insertion. Finally, hand hygiene by washing hands with alcohol based foams/gels or soap and water (Meddings, Chopra & Saint, 2021).

In addition to the insertion guidelines, there is a need to apply maintenance guidelines with three main components. Firstly, assessing the need for the central line on a daily basis. Secondly, replacing administration sets every 96 hours, except for lines used for blood products and lipids. Thirdly, disinfecting the connections, injection ports and catheter hubs before accessing the line (Weber, 2020). Applying the central line insertion and maintenance guidelines is expected to significantly reduce CLABSI incidences in the hospital.

Implementation strategy

A multifaceted implementation strategy that incorporates elements from other strategies has been identified as appropriate for successfully implementing the change. The multifaceted approach takes into account the characteristics of the organization and environment. The first element is the presentation of research evidence presented in peer-reviewed publications to show that the change is appropriate for achieving the desired outcome. The second element is the recruitment of opinion leaders who are recognized as influential persons capable of promoting the change implementation by convincing other stakeholders to support the change. Varying the opinion leaders is important for increasing acceptance of the change and avoiding the impression that only one opinion leader support or mandates the change. The third element is reminders that prompt medical personnel to apply the central line insertion and maintenance guidelines. This is a behavioral approach that is effective if few prompts are presented in the form of posters in health care stations. Too many prompts presented at the same time could become counterproductive. This element utilizes the communication processes that work best in the organization, but minimizes frequent, repetitive formats, as the targeted staff would quickly begin to ignore them (Bemker & Schreiner, 2017).

The fourth element is feedback with audits of clinical performance data and feedback from medical personnel helping to show the effectiveness of the intervention and if additional changes are required. The feedback must be objective as the analysis is based on observation, measurable and fact-based information. The fifth element is educational (interactive) approaches that tailor educational items that are based on assessment of potential barriers and focus on teaching the medical personnel the new guidelines and challenging negative attitudes. The potential barriers must be clearly identified and stakeholders moved through the barriers. This is achieved by consulting successful change agents who may have already encountered and overcome these barriers. The final element is the use of the organization’s quality management process as this creates common language and familiarity that improves communication and minimizes resistance (Garcia-Dia, 2019).

References

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

Garcia-Dia, M. (2019). Project Management in Nursing Informatics. Springer Publishing Company.

Lautenbach, E., Malani, P., Woeltje, K., Han, J., Shuman, E., & Marschall, J. (Eds.) (2018). Practical Healthcare Epidemiology (4^th ed.). The Society for Healthcare Epidemiology of America.

Meddings, J., Chopra, V., & Saint, S. (2021). Preventing Hospital Infections: Real-World Problems, Realistic Solutions (2^nd ed.). Oxford University Press.

Webb, A., Angus, D., Finfer, S., Gattioni, L., & Singer, M. (2016). Oxford Textbook of Critical Care (2^nd ed.). Oxford University Press.

Weber, D. (2020). Mayhall’s Hospital Epidemiology and Infection Prevention (5^th ed.). Lippincott Williams & Wilkins.  Change Strategy and Implementation Essay Discussion Paper