NUR 590 Evidence-Based Practice Project Assignments

NUR 590 Evidence-Based Practice Project Assignments

Week 2 Assignment NUR 590 Evidence-Based Practice Project Assignments

Evidence-Based Practice Proposal – Section A: Organizational Culture and Readiness Assessment and Section B: Proposal/Problem Statement and Literature Review

In order to formulate your evidence-based practice (EBP), you need to assess your organization. In this assignment, you will be responsible for setting the stage for EBP. This assignment is conducted in two parts: an organizational culture and readiness assessment and the proposal/problem statement and literature review, which you completed in NUR-550. NUR 590 Evidence-Based Practice Project Assignments

Section A: Organizational Culture and Readiness Assessment

It is essential to understand the culture of the organization in order to begin assessing its readiness for EBP implementation. Select an appropriate organizational culture survey tool and use this instrument to assess the organization’s readiness. NUR 590 Evidence-Based Practice Project Assignments

Develop an analysis of 250 words from the results of the survey, addressing your organization’s readiness level, possible project barriers, and facilitators, and how to integrate clinical inquiry, providing strategies that strengthen the organization’s weaker areas.

Include the rationale for the survey category scores that were significantly high and low, incorporating details or examples. Explain how to integrate clinical inquiry into the organization. NUR 590 Evidence-Based Practice Project Assignments

Submit a summary of your results. The actual survey results do not need to be included.

Section B: Proposal/Problem Statement and Literature Review

In NUR-550, you developed a PICOT statement and literature review for a population quality initiative. In 500-750 words, include the following:

Refine your PICOT into a proposal or problem statement.

Provide a summary of the research you conducted to support your PICOT, including subjects, methods, key findings, and limitations.

NUR 590 Evidence-Based Practice Project Assignments General Guidelines:

You are required to cite three to five sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content. NUR 590 Evidence-Based Practice Project Assignments

Prepare this assignment according to the guidelines in the APA Style Guide in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric before beginning the assignment to familiarize yourself with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center. NUR 590 Evidence-Based Practice Project Assignments

Note: After submitting the assignment, you will receive feedback from the instructor. Use this feedback to make revisions for your final paper submission. This will be a continuous process throughout the course for each section.

NUR 590 Evidence-Based Practice Project

Week 3 Assignment (NUR 590 Evidence-Based Practice Project Assignments)

Evidence-Based Practice Proposal – Section C: Solution Description

Write a paper of 500-750 words for your proposed evidence-based practice project solution. Address the following criteria:

• Proposed Solution: (a) Describe the proposed solution (or intervention) for the problem and the way(s) in which it is consistent with current evidence. NUR 590 Evidence-Based Practice Project Assignments
• Heavily reference and provide substantial evidence for your solution or intervention. (b) Consider if the intervention may be unrealistic in your setting, if it may be too costly, or if there is a lack of appropriate training available to deliver the intervention.
• If the intervention is unrealistic, you may need to go back and make changes to your problem statement before continuing. NUR 590 Evidence-Based Practice Project Assignments

Organization Culture: Explain how (s) the proposed solution is consistent with the organization or community culture and resources.

Expected Outcomes: Explain the expected outcomes of the project. The outcomes should flow from the problem statement.

Method to Achieve Outcomes: Develop an outline of how the outcomes will be achieved. List any specific barriers that will need to be assessed and eliminated. Make sure to mention any assumptions or limitations that may need to be addressed.

Outcome Impact: Describe the impact the outcomes will have on one or all of the following indicators: quality care improvement, patient-centered quality care, efficiency of processes, environmental changes, or professional expertise. NUR 590 Evidence-Based Practice Project Assignments

You are required to cite three to five sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Prepare this assignment according to the guidelines in the APA Style Guide in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric before beginning the assignment to familiarize yourself with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center. NUR 590 Evidence-Based Practice Project Assignments

Note: After submitting the assignment, you will receive feedback from the instructor. Use this feedback to make revisions for your final paper submission. This will be a continuous process throughout the course for each section.

NUR 590 Evidence-Based Practice Project Assignments Week 4 Assignment – Evidence-Based Practice Proposal – Section D: Change Model

Roger’s diffusion of innovation theory is a good theoretical framework for an EBP project. However, students may also choose to use change models, such as Duck’s change curve or the transtheoretical behavioral change model. NUR 590 Evidence-Based Practice Project Assignments

Other conceptual models, such as a utilization model (Stetler’s model) and EBP models (the Iowa model and ARCC model) can also be used to apply your evidence-based proposal in clinical practice. Apply one of the above models and carry your implementation through each stage, phase, or step identified in the chosen model. NUR 590 Evidence-Based Practice Project Assignments

In 500-750 words (not including the title page and references page), discuss applying one of the change models to the implementation plan:

• Identify the selected model or theoretical framework and discuss its relevance to your project.
• Discuss each of the stages in the change model/framework.
• Describe how you would apply each stage in your proposed implementation.

In addition, create a conceptual model of the project. Although you will not be submitting the conceptual model you design in Topic 4 with the narrative, you will include the conceptual model in the appendices for the final paper. NUR 590 Evidence-Based Practice Project Assignments

You are required to cite three to five sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content. NUR 590 Evidence-Based Practice Project Assignments

Prepare this assignment according to the guidelines in the APA Style Guide in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric before beginning the assignment to familiarize yourself with the expectations for successful completion. NUR 590 Evidence-Based Practice Project Assignments

You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

Note: After submitting the assignment, you will receive feedback from the instructor. Use this feedback to make revisions for your final paper submission. This will be a continuous process throughout the course for each section.

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NUR 590 Evidence-Based Practice Project Assignments – Week 5 Assignment

Evidence-Based Practice Proposal – Section E: Implementation Plan

In 1,000-1,500 words, provide a description of the methods to be used to implement the proposed solution. Include the following:

• Describe the setting and access to potential subjects. If there is a need for a consent or approval form, then one must be created. Although you will not be submitting the consent or approval forms in Topic 5 with the narrative, you will include the consent or approval forms in the appendices for the final paper.
• Describe the amount of time needed to complete this project. Create a timeline. Ensure the timeline is general enough to be implemented at any date. Although you will not be submitting the timeline in Topic 5 with the narrative, you will include the timeline in the appendices for the final paper. NUR 590 Evidence-Based Practice Project Assignments
• Describe the resources (human, fiscal, and other) or changes needed in the implementation of the solution. Consider the clinical tools or process changes that would need to take place. Provide a resource list. Although you will not be submitting the resource list in Topic 5 with the narrative, you will include the resource list in the appendices for the final paper.
• Describe the methods and instruments, such as a questionnaire, scale, or test to be used to monitor the proposed solution’s implementation. Develop the instruments. Although you will not be submitting the individual instruments in Topic 5 with the narrative, you will include the instruments in the appendices for the final paper. NUR 590 Evidence-Based Practice Project Assignments

Explain the process for delivering the (intervention) solution and indicate if any training will be needed.

Provide an outline of the data collection plan. Describe how data management will be maintained and by whom. Furthermore, explain how the data analysis and interpretation process will be conducted. Develop the data collection tools that will be needed.

Although you will not be submitting the data collection tools in Topic 5 with the narrative, you will include the data collection tools in the appendices for the final paper.

Describe the strategies to deal with the management of any barriers, facilitators, and challenges.

Establish the feasibility of the implementation plan. Address the costs for personnel, consumable supplies, equipment (if not provided by the institute), computer-related costs (librarian consultation, database access, etc.), and other costs (travel, presentation development). NUR 590 Evidence-Based Practice Project Assignments

Make sure to provide a brief rationale for each. Develop a budget plan. Although you will not be submitting the budget plan in Topic 5 with the narrative, you will include the budget plan in the appendices for the final paper.

Describe the plans to maintain, extend, revise, and discontinue a proposed solution after implementation.

You are required to cite five to 10 sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Prepare this assignment according to the guidelines in the APA Style Guide in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric before beginning the assignment to familiarize yourself with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center. NUR 590 Evidence-Based Practice Project Assignments

Note: After submitting the assignment, you will receive feedback from the instructor. Use this feedback to make revisions for your final paper submission. This will be a continuous process throughout the course for each section.

NUR 590 Evidence-Based Practice Project Assignments Week 6: Evidence-Based Practice Proposal – Section F: Evaluation of Process

In 500-750 words, develop an evaluation plan to be included in your final evidence-based practice project. Provide the following criteria in the evaluation, making sure it is comprehensive and concise:

• Describe the rationale for the methods used in collecting the outcome data.
• Describe the ways in which the outcome measures evaluate the extent to which the project objectives are achieved.
• Describe how the outcomes will be measured and evaluated based on the evidence. Address validity, reliability, and applicability. NUR 590 Evidence-Based Practice Project Assignments
• Describe strategies to take if outcomes do not provide positive results.
• Describe implications for practice and future research.

You are required to cite three to five sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Prepare this assignment according to the guidelines in the APA Style Guide in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric before beginning the assignment to familiarize yourself with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center. NUR 590 Evidence-Based Practice Project Assignments

Note: After submitting the assignment, you will receive feedback from the instructor. Use this feedback to make revisions for your final paper submission. This will be a continuous process throughout the course for each section.

NUR 590 Evidence-Based Practice Project Assignments: Week 7 Assignment Benchmark – Evidence-Based Practice Proposal Final Paper

Throughout this course, you have developed a formal, evidence-based practice proposal.

The proposal is the plan for an evidence-based practice project designed to address a problem, issue, or concern in the professional work setting. Although several types of evidence can be used to support a proposed solution, a sufficient and compelling base of support from valid research studies is required as the major component of that evidence.

Proposals must be submitted in a format suitable for obtaining formal approval in the work setting. Proposals will vary in length depending upon the problem or issue addressed (3,500 and 5,000 words). The cover sheet, abstract, references pages, and appendices are not included in the word count. NUR 590 Evidence-Based Practice Project Assignments

Section headings for each section component are required. Evaluation of the proposal in all sections will be based upon the extent to which the depth of content reflects graduate-level critical thinking skills.

This project contains seven formal sections:

• Section A: Organizational Culture and Readiness Assessment
• Section B: Proposal/Problem Statement and Literature Review
• Section C: Solution Description
• Section D: Change Model
• Section E: Implementation Plan
• Section F: Evaluation of Process

Each section (A-F) will be submitted as a separate assignment in Topics 1-6 so your instructor can provide feedback (refer to applicable topics for complete descriptions of each section).

The final paper submission in Topic 7 will consist of the completed project (with revisions to all sections), title page, abstract, compiled references list, and appendices. Appendices will include a conceptual model for the project, handouts, data and evaluation collection tools, a budget, a timeline, resource lists, and approval forms, as previously assigned in individual section assignments.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is required.

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

You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

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NUR 590 Evidence-Based Practice Project Assignments – Evidence-Based Practice Presentation

Develop a 10-15-slide presentation with comprehensive speaker’s notes that covers all of the major areas of your evidence-based practice proposal.

You will need to post a rough draft of your evidence-based practice presentation to the Main Forum in Topic 8 DQ 1 for peer feedback. NUR 590 Evidence-Based Practice Project Assignments

While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references compiled from the final project should be presented using APA documentation 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 before beginning the assignment to familiarize yourself with the expectations for successful completion. NUR 590 Evidence-Based Practice Project Assignments

You are not required to submit this assignment to LopesWrite.

NUR 590 Evidence-Based Practice Project Assignments : Benchmark – Evidence-Based Practice Project Proposal Final Paper Sample

Problem Statement

In recent years, inserting a central line has become routine for outpatient and inpatient settings. Central lines include administering medication, monitoring hemodynamic status, and providing nutritional assistance, among other things (Huybrechts et al., 2021). For the same reasons, patients in the intensive care unit (ICU) need central lines since they are in critical condition. A proper insertion process must be followed because central line insertion is typical for ICU patients. NUR 590 Evidence-Based Practice Project Assignments

Unfortunately, the central lines act as a passage of infective agents, including bacteria, viruses, and fungi. These infections are termed central-line-associated bloodstream infections (CLABSI).

This is attributed to either wrong insertion procedures, poor maintenance of catheters, and failure to monitor the central lines. Once an infective agent accesses the body, it spreads through the bloodstream to cause severe systemic infection. CLABSI leads to an increased hospital stay that in turn increases the cost of care with resultant reduced patient outcomes.

Notably, up to 41000 new CLABSI infections are reported in the United States, with an estimated annual expenditure of 2.68 billion dollars (Huybrechts et al., 2021).  Furthermore, despite the achievement in treating CLABSI with antibiotics, there has been a recent increase in antibiotic resistance. As a result, most healthcare institutions focus on preventive measures to reduce the rate of CLABSI and improve patient outcomes.

The proposed preventive measures include; aseptic insertion of a central catheter; proper maintenance by either dressing, cleaning, or bathing; appropriate hand hygiene, and removal of unnecessary catheters when not in use (Karagiannidou et al., 2019). NUR 590 Evidence-Based Practice Project Assignments

Chlorhexidine has been used for bathing the central line leading to a reduced CLABSI rate. Most healthcare providers understand the importance of chlorohexidine; however, few adhere to the guidelines. Therefore, this evidence-based proposal will discuss the effectiveness of chlorhexidine compared to normal saline in reducing the rates of CLABSI.

The project aims at increasing knowledge among healthcare providers to adhere to daily bathing of central line with chlorohexidine. The PICOT question is:  In patients admitted in ICU with a central line catheter (P), how does the use of chlorhexidine (I) compared with flushing central line using normal saline (C) lead to the reduced central line-associated bloodstream infection (O) over six months (T)?

Literature Review

CLABSI is defined as any infection that develops within 48 hours of central line insertion or after removal of the catheter and cannot be related to other factors apart from the central line. It is the most common form of hospital-acquired infection (HAI) among patients admitted to the ICU.

According to Haddadin et al. (2022), the annual incidence of CLABSI in the US is above 41000 cases, estimated as 0.8% per 1000 central line days. The same author states that the global incidence is estimated at 3.73% per 1000 central line days. The increasing incidences lead to an increased hospital stay, reduced quality of life, increased mortality and morbidity, and increased cost of care. NUR 590 Evidence-Based Practice Project Assignments

The estimated annual cost of care due to CLABSI has recently increased from 670 million dollars to 2.68 billion dollars (Karagiannidou et al., 2019). The increased expenditure strains the healthcare budget with an increased cost of care. However, untreated cases lead to mortality and morbidity. The global mortality rate is estimated at 12-25% (Payne et al., 2018). This rate is expected to rise if preventive measures are not adhered to.

Several microorganisms are known causes of CLABSI. They range from bacteria, viruses and fungi, with the commonest cause being bacteria. Staphylococci, including Staphylococci aureus and coagulase-negative staphylococci, are the leading causes of CLABSI.

Enterococci, aerobic gram-negative bacilli, and yeast follow in that order (Haddadin et al., 2022). Notably, infections of the hemodialysis catheter are caused disproportionately by staphylococcus aureus. On the other hand, infections among patients with cancer are caused mainly by gram-negative bacilli. Yeast and gram-negative bacilli are common in femoral veins catheters, while candida infections are common in central lines for parenteral nutrition.

Various risk factors exist that increase the likelihood of a certain population to develop CLABSI, unlike others. These factors are related to either patient, healthcare providers, and catheter-related.  CLABSI rate is increased among either immunocompromised patients, those with severe illness, granulocytopenia, or those with existing distant infections (Zerr et al.2020). NUR 590 Evidence-Based Practice Project Assignments

Likewise, failure to adhere to aseptic procedures during central line insertion and catheter maintenance while in place increases the risks of disease. In addition, failure to monitor catheters and prolonged use of central line catheters increase the risk of infection. Furthermore, the site of the central line also determines the risk of infection.

The rate of infection increases in the following sites in descending manner; femoral catheters more than the internal jugular vein and lowest in the subclavian vein catheters. Preventive measures are required to reduce the rate of CLABSI while eliminating risks. NUR 590 Evidence-Based Practice Project Assignments

Prevention of CLABSI requires the use of evidence-based practice (EBP). These practices have been used in various settings with a resultant decrease in the CLABSI rate. According to Urbancic et al. (2018), these measures include correct insertion practice, good maintenance, and monitoring for the need for a catheter. When inserting a catheter, aseptic techniques should be used.

This requires insertion by trained personnel, adhering to hand hygiene, preparation of insertion site skin with 0.5% chlorhexidine, and using sterile barrier precautions during insertion. Maintenance of the central line requires bathing and dressing of the central line, preferably with Chlorhexidine, to reduce infection rate and educate both patients, healthcare providers, and relatives about the importance of daily bathing and the technique of bathing. Finally, monitoring of the central line should be done by healthcare providers. NUR 590 Evidence-Based Practice Project Assignments

The caregivers should assess the need for central lines in every patient and promptly remove those not needed by the patients. Consequently, prolonged stay of the central line increases the likelihood of new CLABSI. None of the preventive measures of CLABSI is superior to either. However, the use of chlorhexidine has been used by various centers with a positive result achieved.

Chlorhexidine gluconate is a disinfectant and antiseptic agent with bactericidal properties against antimicrobial agents, including aerobic and anaerobic agents. When applied to the skin, Chlorhexidine prevents skin colonization with germs and disease-causing microorganisms, reducing the infection rate (Payne et al., 2018).

It is effective against broad-spectrum bacterium and has a fast onset of action after application. Notably, various studies have been done in multiple settings to assess the effectiveness of chlorhexidine in preventing CLABSI.

Several authors and researchers have done studies involving the use of Chlorhexidine to support its effectiveness and citing reasons why it should be used in clinical practice.

To begin with, a study by Reynolds et al. (2021) sought to evaluate the effectiveness of implementing the practice of daily bathing with chlorohexidine in combination with a multifaceted program to reduce CLABSI. A qualitative-clustered randomized study was done. The involved nurses were given training regarding the proper technique of bathing central lines with chlorohexidine, and they were encouraged to adhere to daily bathing.

The champion nurses then observed nurses as they bathed central lines. Findings from the study indicated a 24% reduction in the CLABSI rate among patients bathed daily. Likewise, another study conducted by Urbancic et al. (2018) in the Australian tertiary ICU showed a decrease in methicillin-resistant staphylococcus aureus (MRSA) and minimal CLABSI reduction.

Yet, in another study by Zerr et al. (2020), participants were grouped into cases and controls among pediatric patients undergoing hematopoietic stem cell transplantation. The cases or study groups received daily bathing with Chlorhexidine, unlike the controls who were not bathed.

Blood cultures were collected from the groups, and results were compared. The findings revealed an increased rate of CLABSI among the controls compared to the study group. Similarly, Giri et al. (2021) did another study at Duke University medical center.

They aimed at ascertaining the relevance of using chlorohexidine for allogeneic transplant patients. The results showed a decrease in CLABSI rate among the study group by 15.6%. These two studies are relevant in ensuring adherence to daily bathing is mandatory (Giri et al., 2021). NUR 590 Evidence-Based Practice Project Assignments

Furthermore, in a prospective crossover study by Lowe et al. (2017), the researchers aimed at comparing the effectiveness between soap and chlorohexidine in reducing CLABSI. While the study group received daily bathing with chlorhexidine, the controls were bathed with non-medicated water and soap.

After eight months of follow-up of the patients and comparison of laboratory culture, the study group had a 55% reduction in the rate of CLABSI. On the other hand, the control group had a reduced rate of 36%. The reduced CLABSI leads to improved patient outcomes and a reduction in the cost of care.

Nonetheless, it is estimated that effective preventive measures can save healthcare from losses. For instance, according to Reagan et al. (2019), proper use of chlorohexidine to bathe the central line leads to reduced HAI with resultant decreased cost of care. The same study revealed that up to $815,301 was saved. Therefore, reduction of the healthcare burden requires proper use of preventive measures.

Organizational Culture and Readiness.

Assessment of the organizational culture and readiness is an essential element before implementing a project. Organizational readiness assesses the commitment and the willingness of members of an organization to accept and implement change within an organization. In centers where the readiness is high, the implementation of the project will also be possible.

This is because members will be ready to use their resources, committing to ensure that change is achieved. In addition, members will likely cooperate, initiate change, and exert persistence resulting in effective implementation of the evidence-based project (EBP). Therefore, before implementing this project, I assessed Houston`s Methodist culture and readiness.

Like other best healthcare providers in the US and globally, Houston Methodist has a culture of incorporating EBP into the care of patients while improving interdisciplinary collaboration. The administration hires and retains healthcare providers with advanced skills and knowledge to provide cost-effective care while improving patient outcomes.

Furthermore, improved interprofessional collaboration through enhanced communication and consultation improves patient care. Therefore, guided by the advanced culture and eagerness to improve, there is a need for periodic knowledge advancement regarding current issues and coming up with better strategies to enhance care while improving patient satisfaction.

In addition, the leadership of the facility is also commendable. Decentralized leadership of the organization involves employers in daily activities to ensure that patients receive the best care. As a result, Staff members are involved in various researches to come up with new innovative techniques that improve patient care.

According to Puchalski Ritchie & Straus (2019), leadership that appreciates the contribution of other employers is likely to succeed because every member will be dedicated with improved satisfaction and are likely to offer positive contributions.  Furthermore, the organization is guided by Christian principles and teachings that emphasize protecting human life.

This culture encourages members to provide quality care while improving patient outcomes and their quality of life. NUR 590 Evidence-Based Practice Project Assignments

Apart from good leadership, the organization is guided by its mission, values, and beliefs. The organization’s mission states its commitment to provide high-quality, cost-effective health care that delivers the best value to the people they serve in a spiritual environment of caring in association with internationally recognized teaching and research.

Best value and quality care can be achieved by implementing evidence-based practice (EBP). EBP aims at improving clinical decision-making while ensuring that best practice is provided to patients.  Guided by the mission, the organization is likely to accept the implementation of an EBP process that improves patient care, improves the quality of care, enhances the patients` experience, reduces the burden of care through cost reduction, and reduces mortality rate.

The beliefs of Houston Methodist are grounded on Christian teachings as guided by the Texas Annual Conference of the United Methodist Church. It strives to provide quality healthcare services. The organization believes that God provides life and can heal humans through the actions, lives, and words of others. As a result, everyone is considered sacred and should be treated with utmost care and love. This belief makes it relevant to implement an EBP that will improve the quality of care.

In addition, the organizational values also dictate its commitment to quality care. The guiding values include integrity, compassion, accountability, respect, and excellence. The organization strives for excellence by incorporating EBP and retaining highly skilled healthcare providers who provide the best care with integrity and compassion.

Furthermore, interprofessional collaboration enhances the quality of care through improved communication. The use of the TeamSTEPPS assessment tool further affirmed the findings of the organizational culture ad readiness for change.

Team Strategy and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is a proven tool for assessing the level of organizational readiness for change. The tool assesses an organization’s weaknesses and strengths while determining the skills, attitudes, and knowledge toward change (Payne et al., 2018).

Using the tool, it is possible to evaluate various parameters, including identified need, readiness about time, resources, and personnel, as well as change sustainability through review and measurement. Measuring motivation and willingness to embrace change are also part of organizational preparedness. According to the evaluation instrument, Houston Methodist is ready to undertake change thanks to well-organized leadership and a strong organizational culture shaped by the mission, beliefs, and values.

Furthermore, the company has a high level of team spirit, mutual support, and information flow, all of which contribute to change preparedness and change implementation. NUR 590 Evidence-Based Practice Project Assignments

Furthermore, Houston Methodist has various strengths, including but not limited to the following:

• Encouraging and supporting research, innovation, improved interpersonal teamwork, resource availability, effective leadership, strong stakeholder relationships, and skilled specialists dedicated to personalized patient-centered care.
• Most of the experienced people in the organization will be part of the stakeholders for this project.
• Stakeholders will be required to take an active part in ensuring that the healthcare providers well understand the project to enhance its implementation.

Knowledge will be guided towards training other nurses and encouraging them to adhere to bathe central lines with chlorohexidine.

Stakeholders will include senior nurses in the ICU, nurse managers, informaticians, and physicians. Senior nurses will form part of champion nurses who will actively educate others through active demonstrations and videos about effective bathing procedures for central lines.

The correct bathing procedure requires observing hand hygiene and using a washcloth infused with chlorohexidine. They will also monitor the nurses as they take part in bathing patients.

On the other hand, physicians will be involved in demonstrating the correct insertion technique for central lines while enlightening about symptoms of infections. The earliest sign of CLABSI is temperature abnormalities, either high or low. Finally, nursing informatics will monitor new incidences of infection and report data on the same.

Change Model or Frameworks

Implementation of EBP requires the adoption of an appropriate change model or framework. These frameworks or models will help quickly incorporate various research findings into an EBP to improve healthcare delivery and decision-making (van der Steen et al., 2019). Furthermore, the change model will guide the decision regarding data analysis, interpretation, and research perception. As a result, an appropriate change model must be chosen to ensure the project’s success.

Adopting the wrong model may hinder the implementation of an EBP and increase error incidences. These errors develop due to skewing in the proposed process while deviating to processes aided by personal interests (van der Steen et al., 2019). NUR 590 Evidence-Based Practice Project Assignments

These interests cause bias. Bias can either be confounding, information-related, or selection bias. Furthermore, bias will likely cause errors that may impair the achievement of the research objectives. Therefore, various models exist, as discussed hereafter.

Various models were listed for consideration in this project to enhance the implementation of the EBP. They include the John Hopkins nursing EBP model, Lowa Model for EBP to promote quality care, advancing research and clinical practice through the close collaboration model (ARCC), and the promoting action on research implementation in health services (PARIHS) framework (Huybrechts et al., 2021).

These models have been tried in various settings resulting in remarkable results. However, for this project, the ARCC model was chosen. NUR 590 Evidence-Based Practice Project Assignments

The ARCC model adopts the use of mentors to help implement the EBP project in a step-wise manner. Mentors are chosen from the existing team members. However, they are provided with further roles making them superior. Furthermore, they are directly involved with the organization’s daily activities and occasionally communicate with other members regarding the EBP project.

They also improve organizational belief towards an EBP aided by the amount of knowledge and skills they depict during the implementation process. Notably, previous trials using the model resulted in improved patient outcomes and job satisfaction due to reduced burnout. NUR 590 Evidence-Based Practice Project Assignments

Similarly, I aspire to improve patient outcomes while advancing the quality of care and reducing the rates of CLABSI through bathing central lines with chlorohexidine. In addition, I believe that integrating nurse mentors will positively influence the other nurses to adopt the proposed practice. However, there is a need to adhere to all steps of the model to achieve positive outcomes.

The ARCC model has five major steps that describe the stepwise implementation process. These steps include; assessment of organizational culture and readiness; identification of barriers and strengths; identification and development of EBP mentors; implementation of the EBP, and outcomes evaluation (Huybrechts et al., 2021). Following these steps leads to the project’s success and improves healthcare services.

To begin with, assessment of the organizational culture and readiness is a vital part of the model. This is necessary to determine the preparedness of the organization for change. In this stage, various parameters are required for implementation, including personnel, time, resources, attitude, existing policies, and willingness to adopt change are assessed. Furthermore, both organizational strengths and weaknesses are identified in this stage.

In this project, I chose to use the TeamSTEPPS assessment tool for readiness evaluation. The tool identified various strengths and weaknesses.

The identified strengths were decentralized leadership, team spirit, interdisciplinary collaboration, availability of resources, and willingness of the organizational members to accept changes. In addition, the organizational mission, beliefs, and values favor the need for change and enhance implementation of the EBP.  Therefore, Houston Methodist has all that it takes to implement change.

Identifying facilitators and barriers to implementation is the second step of the model. Facilitators of implementation form the basis under which the whole process will be built, while barriers offer an opportunity for identifying better innovative ways.

The anticipated barriers for implementation include limited time, inadequate skills, negative attitude towards change, limited supply from the administration, limited mentors, and increased theoretical knowledge with limited practical knowledge on carrying out research.

These barriers may make it hard to implement change if they are not addressed and dealt with appropriately. On the other hand, facilitators include increased teamwork, interprofessional caregiving, ethical approval of the project, and the presence of EBP policies.

The next step of the model is the mentors’ identification and establishment. Mentors are essential for both educational and motivational factors. As educators, mentors will train other nurses using demonstrations on how to bathe lines effectively.

On the other hand, their presence will improve the beliefs and confidence of other nurses regarding the EBP process and hence will likely support the process. For this project, mentors will be picked among the clinical team. Thereafter, special training will be offered through meetings, simulations, demonstrations, tutorials, and workshops to increase EBP knowledge and skills. With better skills and expertise, they will provide excellent training to enhance project implementation.

The evidence is then put into effect in the fourth stage. The implementation guarantees that the most up-to-date clinical knowledge is integrated into the clinical perspective to make informed patient care decisions (Yoo et al., 2019).

Under the supervision of EBP mentors, nurses will participate in implementing the EBP practice. Research findings, the clinical skills of the attending healthcare practitioners, patient preference, as well as values and ethics, will all influence the practice.

In this study, all ICU nurses will be trained in safe central line bathing and urged to bathe central lines regularly to lower CLABSI rates. The correct bathing process involves using Chlorhexidine bathed washcloths to clean skin around the central line to kill germs and prevent infections.

The fifth and last step is to evaluate the results of the practice adjustment. Project evaluation is relevant in assessing the success made compared to the objectives.

Furthermore, it is necessary to establish the project’s relevance and the level of achievement in terms of efficiency, impact, effectiveness, project sustainability, and objectives attainment (Melnyk et al., 2017). Furthermore, review ensures that limited resources be used wisely to maximize impact. To improve an EBP, adjustments are performed during the evaluation.

These adjustments aim to fill the gaps identified in the whole process while improving the outlook of the project. Hence, in this project, the project’s expected outcomes include improved patient outcomes, enhanced patient and caregivers’ satisfaction, reduction in the cost of care, reduced readmission rate, improved cohesion, and patient turnover will be paramount during evaluation. Improved patient outcomes are projected due to the high-quality care provided guided by EBP knowledge and skills.

Implementation Plan

The actualization of the project ideas into practice is dependent on the implementation plan.  The implemented EBP aims to improve knowledge and decision-making to improve patient outcomes. Having a clear implementation plan will enhance the actualization of the project`s ideas into reality, where poor planning is likely to inhibit the integration of the project into practice. Therefore, for effective implementation, it is paramount to have a clear strategy of activities including stakeholders, setting, time, management of barriers and facilitators, resources, cost, and data collection plan.

The project will be implemented in the ICU. ICU is chosen because it receives several patients with reversible life-threatening conditions who require close monitoring and stabilization. As a result, patients will receive life-saving procedures such as central lines. These lines, in turn, act as conduits for germs that cause infection (McDougle et al., 2020). NUR 590 Evidence-Based Practice Project Assignments

The conditions are expensive to treat, negatively impacting a patient`s life, and probably leading to death. Therefore, the project will require efforts from every healthcare giver in the ICU settings for its success. As a result, the ICU team will be the major stakeholders for the project. EBP mentors will offer training involving the use of chlorhexidine-soaked washcloths to wipe the skin around the central lines to prevent germ infestation.

Nonetheless, patients too will be involved in the project. Application of the prospective cohort study will require grouping patients. These groups will either be study groups or controls. NUR 590 Evidence-Based Practice Project Assignments

Either group will sign a consent form to belong to the study and will be free to live the study anytime without objections. Study groups will receive daily bathing of central line with Chlorhexidine, while the controls will receive normal saline. Comparisons between the two groups will be made to determine the incidence rate among the two groups.

Yet another component of implementation is time management. Implementation of the project will require a minimum of ten weeks, with every activity given a stipulated time. The stakeholders of the project will be identified in week one. NUR 590 Evidence-Based Practice Project Assignments

The stakeholders will be required to ensure the project’s contents are shared among healthcare providers. Each individual will be given specific roles with instructions on how to accomplish them. This will enhance knowledge and facilitate cooperation leading to implementation. Resource identification will be happening in the second week. Training of staff will be accomplished in the third week.

Training will involve tutorials, demonstrations, and webinars to improve skills and knowledge about the project. From week four to the ninth week, the project will be implemented into practice. Nurses will be observed as they undertake the process, while any concerns raised will be addressed in this period. In week ten, modifications will be made in areas of concern to improve the EBP. Upon implementation, data will be collected to ascertain the project’s feasibility.

The project will be deemed feasible if its outcomes outweigh its cost. As a result, data will be collected to determine if there is a decrease in the rate of CLABSI. Questionnaires, surveys, and medical data from the laboratory will provide the required data. The data will be grouped, tested using the chi-square test, and analyzed by the Statistical Package for the Social Science (SPSS). Thereafter, an auditing tool will be used to compare the project’s outcomes versus the previous data to determine any change achieved.

Finally, the identification of barriers and addressing them must be considered. The potential barriers include limited time, insufficient EBP mentors, and resistance from some members. As a result, coming up with a straightforward implementation can help ensure that every activity is carried out within the stipulated time to avoid time limitations.

Mobilizing EBP mentors while explaining the importance and objectives of the plan in improving the quality of care will attract many mentors who will be involved in project implementation (McDougle et al., 2020). The EBP mentors will, in turn, transfer the EBP knowledge to other nurses to help in reducing resistance and encouraging them to participate in the project.

Evaluation Plan

The final part of the project is the evaluation after implementation. Evaluation is vital in identifying any gaps and the success of the project. Therefore, any gaps can be addressed in this phase with various adjustments to perfect the project. Outcomes of the project will also be evaluated.

For instance, in this project, I expect improved patient outcomes with reduced CLABSI rates like other studies done before. Likewise, according to Arunga et al.(2021), the correct implementation of daily bathing with chlorhexidine is intended to reduce the CLABSI  rate while improving outcomes, enhancing the quality of care, reducing mortality and morbidity, and reducing the cost of care. However, measurement of these outcomes is essential.

The project’s expected outcomes will be improved quality of care and nurses’ adherence to the bathing process. Quality of care will be measured in terms of patient satisfaction, patient turnover, reduction in rehospitalization, and prompt recovery without complications.

When patients and relatives are contented with the services, they will, in turn, encourage others to seek the same services, which increase patient turnover, improve income return, and attract more profit that can be used to improve other sectors of patient care (Frost et al., 2018 ). On the other hand, adherence to daily bathing will be measured in terms of nursing attitude and acceptance of the project.

Nurses with a positive attitude who understand the importance of the project will own patients and do daily bathing while encouraging others to do the same. As a result, the infection rate will reduce, thus limiting judicious use of antibiotics with a decrease in antibiotic resistance.

Furthermore, the outcomes observed from this project will impact one organization and the neighboring institutions. This is because nurses will share the knowledge with others to improve care. Also, continuous education will be provided to maintain and extend it to other facilities. Finally, a contingency plan is necessary in case the initial plan fails.

I am confident that my steps in this project will produce the desired results. However, if the predicted results are not met, I will be forced to re-evaluate the entire procedure. Assessing the availability of resources and employees used throughout the process and identifying deficiencies that could have led to deviations from the intended results would be part of the process review.

In addition, I’ll get more information about the implementation process from the champion nurses and their perspectives on the evidence-based project. Furthermore, I will strengthen my tactics for training nurses and encouraging them to follow the process. This can be achieved by carrying out more demonstrations, encouraging small groups participation, and installing reminders in the ICU.

These reminders can be in the form of charts and reminder notes to help nurses adhere to the practice. Finally, if none of the interventions provide the desired effects, I will consider restarting the entire process. More strategies, however, are required to address the gaps.

NUR 590 Evidence-Based Practice Project Assignments References

• Arunga, S., Mbarak, T., Ebong, A., Mwesigye, J., Kuguminkiriza, D., Mohamed-Ahmed, A. H. A., Hoffman, J. J., Leck, A., Hu, V., & Burton, M. (2021). Chlorhexidine gluconate 0.2% as a treatment for recalcitrant fungal keratitis in Uganda: a pilot study. BMJ Open Ophthalmology, 6(1), e000698. https://doi.org/10.1136/bmjophth-2020-000698
• Frost, S. A., Hou, Y. C., Lombardo, L., Metcalfe, L., Lynch, J. M., Hunt, L., Alexandrou, E., Brennan, K., Sanchez, D., Aneman, A., & Christensen, M. (2018). Evidence for the effectiveness of chlorhexidine bathing and healthcare-associated infections among adult intensive care patients: a trial sequential meta-analysis. BMC Infectious Diseases, 18(1), 679. https://doi.org/10.1186/s12879-018-3521-y
• Giri, V. K., Kegerreis, K. G., Ren, Y., Bohannon, L. M., Lobaugh-Jin, E., Messina, J. A., Matthews, A., Mowery, Y. M., Sito, E., Lassiter, M., Saulo, J. L., Jung, S.-H., Ma, L., Greenberg, M., Andermann, T. M., van den Brink, M. R. M., Peled, J. U., Gomes, A. L. C., Choi, T., … Sung, A. D. (2021). Chlorhexidine gluconate bathing reduces the incidence of bloodstream infections in adults undergoing inpatient hematopoietic cell transplantation. Transplantation and Cellular Therapy, 27(3), 262.e1-262.e11. https://doi.org/10.1016/j.jtct.2021.01.004
• Haddadin, Y., Annamaraju, P., & Regunath, H. (2022). Central line-associated bloodstream infections. https://pubmed.ncbi.nlm.nih.gov/28613641/
• Huybrechts, I., Declercq, A., Verté, E., Raeymaeckers, P., & Anthierens, S. (2021). The building blocks of implementation frameworks and models in primary care: A narrative review. Frontiers in Public Health, 9, 675171. https://doi.org/10.3389/fpubh.2021.675171
• Karagiannidou, S., Zaoutis, T., Maniadakis, N., Papaevangelou, V., & Kourlaba, G. (2019). Attributable length of stay and cost for pediatric and neonatal central line-associated bloodstream infections in Greece. Journal of Infection and Public Health, 12(3), 372–379. https://doi.org/10.1016/j.jiph.2018.12.004
• Lowe, C. F., Lloyd-Smith, E., Sidhu, B., Ritchie, G., Sharma, A., Jang, W., Wong, A., Bilawka, J., Richards, D., Kind, T., Puddicombe, D., Champagne, S., Leung, V., & Romney, M. G. (2017). Reduction in hospital-associated methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus with daily chlorhexidine gluconate bathing for medical inpatients. American Journal of Infection Control, 45(3), 255–259. https://doi.org/10.1016/j.ajic.2016.09.019
• McDougle, J., Sabirovic, M., Pietropaoli, S., & Hamilton, K. (2020). The gulf between emergency plans and the resources needed: a global review: -EN- -FR- Le fossé entre les plans d’urgence et les ressources nécessaires: un examen au niveau mondial -ES- El abismo que media entre los planes de emergencia y los recursos necesarios: panorámica mundial. Revue Scientifique et Technique (International Office of Epizootics), 39(2), 373–384. https://doi.org/10.20506/rst.39.2.3088
• Melnyk, B. M., Tan, A., Hsieh, A. P., & Gallagher-Ford, L. (2021). Evidence-based practice culture and mentorship predict EBP implementation, nurse job satisfaction, and intent to stay: Support for the ARCC© model. Worldviews on Evidence-Based Nursing, 18(4), 272–281. https://doi.org/10.1111/wvn.12524
• Payne, V., Hall, M., Prieto, J., & Johnson, M. (2018). Care bundles to reduce central line-associated bloodstream infections in the neonatal unit: a systematic review and meta-analysis. Archives of Disease in Childhood. Fetal and Neonatal Edition, 103(5), F422–F429. https://doi.org/10.1136/archdischild-2017-313362
• Puchalski Ritchie, L. M., & Straus, S. E. (2019). Assessing organizational readiness for change comment on “development and content validation of a transcultural instrument to assess organizational readiness for knowledge translation in healthcare organizations: The OR4KT.” International Journal of Health Policy and Management, 8(1), 55–57. https://doi.org/10.15171/ijhpm.2018.101
• Reagan, K. A., Chan, D. M., Vanhoozer, G., Stevens, M. P., Doll, M., Godbout, E. J., Cooper, K., Pryor, R. J., Hemphill, R. R., & Bearman, G. (2019). You get back what you give: Decreased hospital infections with improvement in CHG bathing, mathematical modeling, and cost analysis. American Journal of Infection Control, 47(12), 1471–1473. https://doi.org/10.1016/j.ajic.2019.07.003
• Reynolds, S. S., Woltz, P., Keating, E., Neff, J., Elliott, J., Hatch, D., Yang, Q., & Granger, B. B. (2021). Results of the Chlorhexidine Gluconate Bathing implementation intervention to improve evidence-based nursing practices for prevention of central line-associated bloodstream infections Study (CHanGing BathS): a stepped wedge cluster randomized trial. Implementation Science: IS, 16(1), 45. https://doi.org/10.1186/s13012-021-01112-4
• Urbancic, K. F., Mårtensson, J., Glassford, N., Eyeington, C., Robbins, R., Ward, P. B., Williams, D., Johnson, P. D., & Bellomo, R. (2018). Impact of unit-wide chlorhexidine bathing in intensive care on bloodstream infection and drug-resistant organism acquisition. Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine, 20(2), 109–116. https://pubmed.ncbi.nlm.nih.gov/29852849/
• van der Steen, J. T., ter Riet, G., van den Bogert, C. A., & Bouter, L. M. (2019). Causes of reporting bias: a theoretical framework. F1000Research, 8, 280. https://doi.org/10.12688/f1000research.18310.2
• Yoo, J. Y., Kim, J. H., Kim, J. S., Kim, H. L., & Ki, J. S. (2019). Clinical nurses’ beliefs, knowledge, organizational readiness and level of implementation of evidence-based practice: The first step to creating an evidence-based practice culture. PloS One, 14(12), e0226742. https://doi.org/10.1371/journal.pone.0226742
• Zerr, D. M., Milstone, A. M., Dvorak, C. C., Adler, A. L., Chen, L., Villaluna, D., Dang, H., Qin, X., Addetia, A., Yu, L. C., Conway Keller, M., Esbenshade, A. J., August, K. J., Fisher, B. T., & Sung, L. (2020). Chlorhexidine gluconate bathing in children with cancer or those undergoing hematopoietic stem cell transplantation: A double-blinded randomized controlled trial from the Children’s Oncology Group. Cancer, 127(1), 56–66. https://doi.org/10.1002/cncr.33271

Appendix

NUR 590 Evidence-Based Practice Project Assignments: Benchmark – Evidence-Based Practice Project Proposal: Organizational Culture and Readiness

Evidence-Based Practice Project Proposal: Organizational Culture and Readiness

Before putting into practice an evidence-based practice, it is vital to analyze the organizational culture and readiness (EBP). The assessment is crucial in figuring out whether the organization is prepared to accept change about the procedure, the people, the performance, and the system.

According to Abimbola et al. (2019), organizations that are open to change are more likely to adopt it and put it into practice. As a result, everyone in the organization will contribute their fair share of time and resources to making sure the change is accomplished.

Organizational Culture and Readiness

Houston Methodist has a decentralized leadership structure that appreciates the effort and role of all staff to provide quality care to patients. Staff members engage in innovative activities that improve the patient experience. Puchalski Ritchie & Straus. (2019) affirms that leadership that engages and appreciates the effort of the subordinate staff enhances satisfaction and improves work output. NUR 590 Evidence-Based Practice Project Assignments

Besides, the organization’s mission, beliefs, and values reaffirm continued support for quality care. The mission of Houston Methodist provided in the organization`s website is to provide high quality, cost-effective health care that delivers the best value to the people they serve in a spiritual environment of caring in association with internationally recognized teaching and research.

The organization`s mission is to provide high-quality, cost-effective care guided by research and education. Furthermore, the organization is guided by Christian teachings that God heals through human actions. As a result, the organization is likely to support the change that incorporating evidence-based practice into care will reduce human suffering and improve an individual`s health. The change aims to improve the quality of care, reduce the cost of care, improve patient experience, reduce suffering, and improve patient outcomes.

The values of Houston Methodist include integrity, compassion, accountability, respect, and excellence. The need for excellence in care incorporates an EBP, thus prompting the organization to embrace the proposed change.

Highly trained doctors are present and offer evidence-based medicine, ongoing research, several specialists, and incorporation of clinical guidelines by staff members ensure that members are in constant communication. As a result, inter-professional collaboration is enhanced.

TeamSTEPPS Assessment Tool- Assessing Readiness for Change

Team Strategy and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is a readiness assessment that helps identify strengths and weaknesses in the organization in the realms of skills, knowledge, and attitude (Kuriyan et al., 2021). NUR 590 Evidence-Based Practice Project Assignments

The tool assesses various parameters, including defined need, time, resources, and personnel readiness, and change sustainment through evaluation and measurement. Organizational readiness also entails measuring such aspects as motivation and willingness to accept change.

Based on the assessment tool, Houston Methodist is prepared to implement change aided by organized leadership and superb organizational culture attribute by the mission, belief, and values. NUR 590 Evidence-Based Practice Project Assignments

Positive team spirit, mutual support, and a high flow of information within the organization also supports readiness for change.

In addition, Houston Methodist holds various strengths, including encouraging research, innovation, enhanced interpersonal collaboration, availability of resources, strong leadership, a strong partnership of stakeholders, and experienced specialists committed to providing personalized patient-centered care.

The research center in the organization allows for carrying out research and implantation of the research findings into patient care.  However, frequent training and education needed to implement change pose a challenge to its implementation.

Healthcare Process and Systems Requiring Improved Quality, Safety, and Cost-Effectiveness.

Houston Methodist offers primary care and acute care led by highly trained physicians and specialists from various fields. Doctors are required to provide quality care while handling patients and reducing the cost of care. This is achieved through enhanced interprofessional collaboration, continuous communication, and involvement in research.

On the other hand, nurses collaborate with physicians and other healthcare providers to provide care and improve the patient experience. As a result, it is essential that training and education on safety care should be encouraged. Education about an EBP can be provided in small groups over time. This includes maintaining hand hygiene, cleaning the skin with a washcloth soaked in chlorhexidine, and monitoring central lines.

Quality improvement collaborations also use standardized methodologies for data collection, including questionnaires, surveys, and medical records. The collected data is analyzed and shared between members to ascertain the impact of change. Monitoring and continuous evaluation of the intervention are essential in offering feedback and identifying areas of improvement.

Strategies to Enhance Organizational Readiness.

Transtheoretical Model (TTM) is the strategy of choice in Houston Methodist for enhancing organizational readiness. TTM aligns a tailored approach for change to meet the organization’s needs (Hashemzadeh et al., 2019). It is completed in six stages: pre-contemplation, contemplation, preparation, implantation, sustainment, and relapse.

In the pre-contemplation stage, individuals are unaware of the negative behavior and hence do not understand the need for change. In addition, they are also defensive about their behavior despite gathering contradicting information from other sources such as media and close friends.

Whereas in the second stage, there is an acknowledgment of the need for change as people understand the negative consequences of their problem. However, they think having the change as the risk and cost outmatch the need for change is unnecessary. In the preparation stage, an individual starts taking steps to initiate change. They include reading, gathering information, and talking about the matter.

In the fourth phase, individuals use the acquired knowledge from the preparation stage to start new and healthy behavior. Support and motivation from others are essential in this stage to avoid slipping back to previous behaviors. In the sustainment phase, the new practice becomes part of the routine and comes up with strategies to prevent relapse.

Finally, the relapse stage involves going back to the previous behaviors, forming the normal pattern of change. However, it is necessary to identify the triggers for failure and develop better strategies to sustain the change.  Following all the steps will enhance organizational readiness and initiate change.

Stakeholders and Team Members in the Project.

The identified stakeholders in the EBP project of encouraging daily bathing of central line with chlorhexidine to prevent central line infections will include the Intensive care unit ICU nurses, physicians, and nursing informaticists. (ICU) nurses will act as champion nurses to educate, monitor others, and encourage other nurses and students to use chlorhexidine to prevent central line-associated bloodstream infections (CLABSI).

Furthermore, they will train other nurses about the correct bathing procedure.  On the other hand, physicians will be pioneers in training ICU nurses about the safe placement of central lines and how to identify early signs of infections. In case of infection, physicians will prescribe appropriate medications to prevent complications. Nursing informaticists will collect real-time data about incidences of CLABSI while comparing the trends against the proposed intervention.

Information and Communication Technologies

Use of electronic health records (EHR, clinical decision support system (CDSS), and Bar-Coded Medication Administration Systems (BCMAs).

EHR is essential in improving communication, data collection, and data retrieval. Communication between nurses will enhance the efficient passage of patient information from one caregiver to the other. In addition, nurses are likely to remind each other about bathing patients with chlorhexidine, resulting in compliance and improved patient outcome.  Including chlorhexidine in patients’ BCMAs will enhance compliance while reducing medical errors.

Musuuza et al. (2017) acknowledge that BCMAs increase efficiency in medication and hence can be integrated into ICU to remind nurses to carry out bathing. CDSS mitigates errors by directing practitioners towards solutions. Using CDSS reduces clinical errors through notifications leading to desired patient outcomes.

NUR 590 Evidence-Based Practice Project Assignments References

• Abimbola, S., Baatiema, L., & Bigdeli, M. (2019). The impacts of decentralization on health system equity, efficiency and resilience: a realist synthesis of the evidence. Health Policy and Planning, 34(8), 605–617. https://doi.org/10.1093/heapol/czz055
• Hashemzadeh, M., Rahimi, A., Zare-Farashbandi, F., Alavi-Naeini, A. M., & Daei, A. (2019). The transtheoretical model of health behavioral change: A systematic review. Iranian Journal of Nursing and Midwifery Research, 24(2), 83–90. https://doi.org/10.4103/ijnmr.IJNMR_94_17
• Kuriyan, A., Kinkler, G., Cidav, Z., Kang-Yi, C., Eiraldi, R., Salas, E., & Wolk, C. B. (2021). Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) to improve collaboration in school mental health: Protocol for a mixed-methods hybrid effectiveness-implementation study. JMIR Research Protocols, 10(2), e26567. https://doi.org/10.2196/26567
• Musuuza, J. S., Roberts, T. J., Carayon, P., & Safdar, N. (2017). Assessing the sustainability of daily chlorhexidine bathing in the intensive care unit of a Veteran’s Hospital by examining nurses’ perspectives and experiences. BMC Infectious Diseases, 17(1), 75. https://doi.org/10.1186/s12879-017-2180-8
• Puchalski Ritchie, L. M., & Straus, S. E. (2019). Assessing organizational readiness for change comment on “development and content validation of a transcultural instrument to assess organizational readiness for knowledge translation in healthcare organizations: The OR4KT.” International Journal of Health Policy and Management, 8(1), 55–57. https://doi.org/10.15171/ijhpm.2018.101