NRS 493 Briefly describe your proposed solution to address the problem, issue, suggestion, initiative, or educational need and how it has changed since you first envisioned it

NRS 493 Briefly describe your proposed solution to address the problem, issue, suggestion, initiative, or educational need and how it has changed since you first envisioned it

NRS 493 Briefly describe your proposed solution to address the problem, issue, suggestion, initiative, or educational need and how it has changed since you first envisioned it

My initial capstone topic started out as CAUTI (Catheter Associated Urinary Tract Infection) associated with foley utilization rates. Although there are several evidence-based practices that have been shown to reduce CAUTI including reducing the use of urinary catheters, incorporating interventions to help avoid the use of urinary catheters when they are not indicated including nurse-driven protocols for the removal of urinary catheters as soon as no longer required (Centers for Disease Control and Prevention, 2019).

This is quite different than the current focus of my change proposal. I decided to shift to a more narrowed focus that is a direct reflection of a current need at the rehabilitation hospital. One influential moment for the change came when I was asked by a staff nurse, “Do I really have to change the foley out before I get a specimen?” I thought that she was just joking, considering her experience and longevity with the company. Either way I assumed that she would know the proper procedure to collect from a catheterized patient. After going over the policy of urine specimen collection in catheterized patients, it dawned on me that perhaps she actually didn’t know, which may result in improper collection and false positive readings. After discussing this situation with my preceptor, she shared with me that that hospital just got their second CAUTI of the year, due to urine cultures being ordered without proper clinical indication. After considering these factors, my focus shifted to urine culture collection and how they can increase CAUTI rates.

My capstone change proposal project involves the initiation of a Urine culture stewardship initiative focused on addressing the issue of increased rates in CUATI associated with improper testing of urine cultures for reason that do not indicate the need for culture testing, as well as addresses the significance of proper specimen collection practices and in reducing the overtreatment with antibiotics and other associated treatment costs. Specific studies have shown that urine culture stewardship initiatives aimed at reducing UC overutilization and were correlated with a decrease in CAUTIs, and the addition of urine-culture stewardship to standard best practices could reduce CAUTI in various care settings (Al-Bizri,  Vahia, Rizvi,  Bardossy, Robinson, et al., 2021).

 

Reference

 

Al-Bizri, L., Vahia, A., Rizvi, K., Bardossy, A., Robinson, P., Shelters, R., Alangaden, G. (2021). Effect of a urine culture stewardship initiative on urine culture utilization and catheter-associated urinary tract infections in intensive care units. Infection Control & Hospital Epidemiology, 1-4. doi:10.1017/ice.2021.273

CDC (Centers for Disease Control and Prevention). (2019). Survey Practices and Outcomes. Urine Culture Stewardship. HAI. https://www.cdc.gov/hai/prevent/cauti/indwelling/survey.html 

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The issue I am focusing on for the Capstone Project is an unmet educational need specific to prenatal/postpartum women and newborns. The educational need is in regard to a specific audit tool used when hospitals and/or clinics are working toward the Baby Friendly Hospital Initiative (BFHI). The Ten Steps to Successful Breastfeeding are the broad framework that guide the Baby-Friendly Hospital Initiative. In a recent audit, the scores identified that there were not enough mothers who could list 4-5 benefits of breastfeeding for both mothers and babies. The topic and intervention will target mothers during the prenatal and postpartum period and education will be done at the OB/GYN clinic with their provider. The overall goal is to council and educate mothers of all ages and gravidas on the benefits of breastfeeding to both mom and baby and have them verbalize 4 benefits during an audit.

Education on benefits of breastfeeding is the intervention strategy in this case, as it helps create awareness on the

NRS 493 Briefly describe your proposed solution to address the problem, issue, suggestion, initiative, or educational need and how it has changed since you first envisioned it
NRS 493 Briefly describe your proposed solution to address the problem, issue, suggestion, initiative, or educational need and how it has changed since you first envisioned it

impact. Education could be in through groups or individual visits. Additionally, it can take the form of written materials, videos or orally through talks and demonstrations (Lumbiganon, 2011). Lack of or insufficient knowledge about the necessity of breastfeeding has been demonstrated to be detrimental to an infant’s general growth and development. Preterm newborns cannot be placed under exclusive breastfeeding, according to current clinical or nursing practice. As a result, it focuses on the best time to advise the mother about starting exclusive breastfeeding (Maastrup et.al. 2014). In this example, the intervention technique is education on the benefits of breastfeeding, which serves to raise knowledge about the impact. Individual or group visits could be used to educate. It can also take the shape of textual materials, videos, or spoken presentations and demonstrations (Lumbiganon, 2011). The plan has not really changed much since I first envisioned it. I created a plan and am happy I was able to stick with it and gather more information as I move forward.

References:

 

Lumbiganon, P., Martis, R., Laopaiboon, M., Festin, M. R., Ho, J. J., & Hakimi, M. (2017). Antenatal breastfeeding education for increasing breastfeeding duration. The Cochrane Database of Systematic Reviews, (11), CD006425. Advance online publication. http://doi.org/10.1002/14651858.CD006425.pub2

 

Maastrup, R., Hansen, B. M., Kronborg, H., Bojesen, S. N., Hallum, K., Frandsen, A., … Hallström, I. (2014). Breastfeeding Progression in Preterm Infants Is Influenced by Factors in Infants, Mothers and Clinical Practice: The Results of a National Cohort Study with High Breastfeeding Initiation Rates. PLoS ONE, 9(9), e108208. http://doi.org/10.1371/journal.pone.0108208

My evidence-based practice project is based on the challenge of alarm fatigue among nurses working in the intensive care units. Alarm fatigue is a major problem among nurses working in the intensive care unit because of the numerous alerts from monitoring devices used to inspect patient conditions. Some of the alerts happen to be clinically insignificant while others are false alerts thereby increases unnecessary workload for the nurses leading to fatigue and burnout (Hravnak et al., 2018).

To avert the effects of alarm fatigue among healthcare providers, some interventions are used such as silencing some of the clinically insignificant alerts or adjusting the alert threshold so that some clinically insignificant alerts are eliminated. However, currently the healthcare system has implemented policies that prevent nurses and pother healthcare providers from silencing or adjusting the telemetry alarm systems hence, all alerts have to recur.

To overcome alarm fatigue which can lead to alarm desensitization the proposed solution is on the use of nurse education to helps nurses learn how to manage the large number of alerts and develop resilience to avoid psychological exhaustion by changing their attitude towards clinical alarms. Nurse education allows nurses to recognize the essence of alerts in healthcare and its pivotal role in improving patient outcomes hence eliminate possibilities of alarm desensitization which can lead to alarm fatigue.

Initially, I had proposed to prevent the adverse events associated with alarm fatigue by adjusting telemetry alarm threshold to help reduce false and clinically insignificant alerts as well. Adjusting telemetry alarm settings to increase the threshold helps to reduce the number of alerts. However, as the project progresses, I have changed my intervention to nurse education to prevent alarm fatigue because I learnt that the organization has implemented policies preventing the change of telemetry alarm setting. The change of intervention was therefore informed by existing organizational policies.

References

Hravnak, M., Pellathy, T., Chen, L., Dubrawski, A., Wertz, A., Clermont, G., & Pinsky, M. R. (2018). A call to alarms: Current state and future directions in the battle against alarm fatigue. Journal of electrocardiology51(6), S44-S48 https://doi.org/10.1016/j.jelectrocard.2018.07.024

Salous, M., Alkhawaldeh, J., Kewan, S., Aburashideh, H., Hani, D. B., & Alzayyat, A. (2017). Nurses’ attitudes related to alarm fatigue in critical care units: a systematic review. IOSR Journal of Nursing and Health Science6(2), 62-66 https://www.researchgate.net/profile/Hafez-Aburashideh/publication/316330429_Nurses‘_Attitudes_Related_To_Alarm_Fatigue_in_Critical_Care_Units_A_Systematic_Review/links/5b307103aca2720785e3b249/Nurses-Attitudes-Related-To-Alarm-Fatigue-in-Critical-Care-Units-A-Systematic-Review.pdf