This is a group assignment. During Week 1, you will self-select and self-enroll to groups (3 persons/group). If enrollment numbers/changes require a different number, please coordinate with faculty. Faculty will assign your group a case study and data; this is what you will work with the remainder of the course to create your final QI report. Please find your case study and data, along with other project resources in “QI Project Resources: (button found on L-hand side of course site). The case study will prompt you to consider best practices regarding a particular clinical problem (e.g., preventing/reducing falls). Please note how Discussion board topics Weeks 2-4 prompt you to individually complete several portions of this project. Use the individual work done in these discussions and the opportunity to see others’ work and receive feedback to refine your group’s work on the final QI report.
You and your group mates are responsible for 1) initiating contact with each other, 2) exchanging contact information, 3) creating a timeline for assignment completion, 4) determining collaborative tools you’d like to use to complete the assignment (e.g., Google Docs), 5) identifying and assigning group roles and distributing work load evenly, and 6) maintaining effective communication with each other (e.g., conflict prevention and resolution, timely and frequent communication, etc.). Collaborative resources are available to assist you, under “Course Support” (L-hand side of course site).
Using your assigned project (i.e., case study/data), components of the final written report must include:
Background of the problem
- Depth and breadth of the problem (e.g., national statistics and local data to demonstrate a problem exists)
- Definition of the problem with references
- PICO question
- What evidence did you find? Synthesize the evidence
- Appraisal of the evidence using the JBI appraisal tools (include as appendix)
- Levels of evidence
Analysis of Current Condition
- Narrative and table, graph, flow chart of current condition (data from assigned problem)
- Include missed opportunities (examination of current process versus what the evidence says should be done using a flowchart); these are your indicators.
- Root Cause Analysis and Fishbone Diagram. Identify where the problems exist that you will address.
Action Plan for Each Indicator
- What the evidence says should be done. The changes that should occur in order to improve practice, to include:
- Indicator (look at your indicator sheet): Provide the evidence to support in one sentence.
- Measurement: Numerator and denominator. How will you measure that the change is being done?
- Goal: What is your goal data? Benchmarks?
- Implementation: Include Best Practices for implementing your change and evidence to support your implementation strategy
- Create a table with the following information for each indicator:
- Who (is responsible)?–>Describe who is responsible
- What (are they responsible for?)–>Explain what they are responsible for completing (each indicator described above)
- Why (did you select this person?)–>Rationale for why this person should be responsible for this action
- When (will they perform the action?)–>What is the timeline for completing the task?
- How (will they complete the action?)–>Explain how the person should complete the action (think of implementation described above)
- Completion Date–>Date for completing the action
There is no template for the written report; it is up to your group how to best present content in a professional and scholarly manner. Please include the following as part of your final product:
RCA(Root Cause Analysis):
1- There is only one WSCN for entire facility to provide wound care.
2– The WSCN only provides care on Monday-Friday from 8am-7pm.
3-The WSCN has no speciality certification or master’s degree in wound care.
4- Patients are only assessed once per shift, which should be assessed during every shift.
5- Nurses on the floor don’t have skills and proper training or education on assessment and treatment of pressure ulcers.
6- There is no clear path or protocol in wound care within the facility.
7- Lack of effective communication between nurses for patients who need wound care in case for any technical issue it doesn’t appear in generated computer list.
For hospitalized patients with restricted movement, does the use of I.S.K.I.N bundles reduce the future rate of HAPU compared to the current hospital regulations?
Best Available Evidence Action Plan
-Frequent position changes (at least every two hours)
-Avoid friction and shear when repositioning.
-When repositioning, use proper technique.
-Implement pressure relieving mattresses or surfaces.
-Avoid turning patient on an area that is already reddened related to pressure.
-For pressure ulcer prevention, do not rub or massage area.
-Emollients can be used to hydrate the skin.
-Barrier creams to protect skin from increased moisture.
-Frequent skin assessments per protocol.
-Nutritional risk assessments with interventions.
-Additional protein supplements in additional to their regular diet Alderden et al (2011) list the following best practices in preventing HAPU’s.
Our HAPU rates on Unit A have risen significantly over the past 6 months. We have a Wound and Skin Care Nurse (WSCN) who has training in wound care. This nurse does not have a Master’s degree or specialty certification in this area but does have a lot of experience. The Wound and Skin Care Nurse is scheduled to work from Monday through Friday, 8a-5p. The WSCN nurse visits every unit and asks about each of our patients. If we identify someone as having a red spot or a potential area of breakdown, we let her know during her rounds.
The WSCN visits patients daily if they are on a computer-generated list of patients at risk for skin breakdown. The list is created when a box is checked in the computerized charting skin assessment area that asks if the patient is on bed rest or is unable to move independently. If a ‘yes’ is checked then the patient’s name is automatically placed on the list. In addition, the computerized Braden Scale is added to the patient’s documentation. The WSCN downloads the list every morning. If someone is identified at risk during the day shift the WSCN does not know about it until the next day.
The WSCN spends a lot of time on our unit. We sometimes have a problem when a patient needs to be seen by the WSCN but do not appear on the list. The nurses do not see the list, only the WSCN nurse. Our current process is to perform the Braden Scale upon initial admission assessment, then once a day if the patient is noted to be at risk, usually during the midnight shifts. The information is entered into the electronic chart (documentation system). We can track the patients’ progress and see what treatments are given to the patient. For the most part, the WSCN does all the treatments unless we are given specific instructions about an individual patient. We are not aware of what evidence supports any of the treatments. Because we have a WSCN, the direct care nurses are not familiar with how to care for the patient with skin breakdown unless the WSCN provides specific directions. We need to know what the best practices are for caring for a patient with a HAPU, including nurse driven care versus what the WSCN does for the patient.