Patient Safety First

Details:

Using 800-1,000 words, discuss methods to evaluate the effectiveness of your proposed solution and variables to be assessed when evaluating project outcomes.

Example: If you are proposing a new staffing matrix that is intended to reduce nurse turnover, improve nursing staff satisfaction, and positively impact overall delivery of care, you may decide the following methods and variables are necessary to evaluate the effectiveness of your proposed solution:

Methods:

Survey of staff attitudes and contributors to job satisfaction and dissatisfaction before and after initiating change.

Obtain turnover rates before and after initiating change.

Compare patient discharge surveys before change and after initiation of change.

Variables:

Staff attitudes and perceptions.

Patient attitudes and perceptions.

Rate of nursing staff turnover.

Develop the tools necessary to educate project participants and to evaluate project outcomes (surveys, questionnaires, teaching materials, PowerPoint slides, etc.).

Refer to the “Topic 4: Checklist.”

Prepare this assignment according to the APA guidelines found in the APA Style Guide

My outline is:

Capstone “Topic 4“ Checklist

Methods used to evaluate program:

1. Comparison of Pre and Post quizzes on proper surgical wound classifications given to the OR Nurses.

2. Percentage of improper surgical wound classifications pre and post training.

3. Percentage of SSIs from patients that had improper wound classifications by Nurses in the OR.

Variables to be assessed when evaluating project outcomes:

1. Number and type of surgery where there was improper wound classifications.

2. Number and type of surgeries during the same time period.

3. Number of SSIs in patients that had improper wound classifications

4. Type of and number of surgical cases by specialty and type of surgery that had improper wound classifications

5. Hospital length of stay for those patients that had SSIs after improper wound classifications

6. Average length of hospital stay for surgical patients by specialty and type of surgery.

7. Random sampling of post operative huddle to confirm the inclusion of the surgical wound classification

Develop tools to educate project participants

1. Power point presentation used in training.

2. Badge buddies on proper surgical wound classifications

3. Badge buddies on information to cover in the post-op huddle.

4. Posters in the OR on wound classifications and about the steps in the post-op huddle.

5. Emails to Charge Nurses to conduct random reviews of post-op huddles to confirm the inclusion of the surgical wound class

Develop assessment tools to evaluate project outcomes:

1. The clinical systems analyst will develop a relational database to track improper surgical wound classifications. Some of the fields in this database will include: (Note: If all of this information can be pulled directly from the hospitals electronic chart, then detailed report will be ran instead of creating a separate database)

a. Type of surgery

b. Patient’s name

c. Surgeon’s name

d. Nurses name

e. Improper wound classification

f. Proper wound classification

g. Did wound class match surgeon’s operative dication? Y or N

h. SSI develop? Y or N

i. Length of hospital stay

j. Comments

2. Pull statistics from the hospital patient system on number of cases, by type, by time period, average length of stay by surgery, specialty and overall; did SSIs develop by type of surgery, specialty and overall; did SSIs develop by improper wound classifications by type of surgery, specialty and overall; historical statistics on improper would classifications and associated SSIs and length of hospital stay by type of surgery, specialty and overall. Also run statistics on improper wound classification by OR Nurse, type of surgery, specialty and overall.

Statistics will be displayed in chart form to highlight variations so the OR Leadership can focus on specific Nurses and Specialties.

Developing an Evaluation Plan

The level of staff attitudes and perceptions contribute to job satisfaction and dissatisfaction of surgical operators. Job satisfaction for these professionals also involves their contentment towards their continuing education and their working contract hours. Usually, for a productive and happy team, the goal of the organisation has to fit in perfect ways towards the career advancement goals of the individuals in the surgical team. (Van Wicklin, 2014). In the surgical playground, nurses play a central role, and as such, conditions favouring accreditation, continuing education, remuneration, and resolving conflicts of interest issues go a long way in reducing care personnel turnover rates before, during, and after initiating change.

The variables that need assessment when evaluating wound infection and surgical project outcomes include the attitudes and perceptions of both the patients and staff members, and the level of education and staff training. Staff attitudes and perceptions are also crucial in surgical theatre operations. For instance, the ritual of wearing scrub suits every time while in the process of undertaking surgery should be understood and thought positively by the nursing and surgical team. Bad perceptions of such rituals may provide an environment where microorganisms are shed to the patient from the hair and the skin leading to more risks of wound infection. The uniform barrier also helps protect the nurses from blood splashes, sprays, and other substances (Weaving, Cox, & Milton, 2008). Patients’ attitudes and perceptions are also helpful in ascertaining and assessing their relative surgical risks and health status. Their perceptions help an experienced nurse assess their morbidity, mortality rates, and their demographic characteristics to draw upon the best and most related recommended practises and healthcare trends in relation to individual patients (Zinn, 2012). Education of all stakeholders, especially surgical staff and patients, is also helpful in prevention and reduction of disease complications with treatment or rehabilitation.  The first two clauses in the implementation guidelines for SSI prevention by the joint commission recommend that providing education focussed on SSI prevention strategies to staff members and practitioners, coupled with focussing patient education on preoperative and postoperative infection prevention to them and their family members reduces the risk of infections and disease complications. The most effective tools used in educating participants include PowerPoint slides, the use of budge buddies, posters, internal memos, and emails. These efforts will usually include emphasis on hand hygiene, non-smoking, and proper care of postoperative dressing habits. Other variables that also need to be assessed when evaluating outcomes include the number and types of reclassifications, number of SSIs in patients that had reclassifications, the types of those that had reclassifications, and the patient’s length of stay at the hospital.

Surgical wound classification is the information that nurses taking rounds document on a patient’s record at the end of a surgical procedure. Wound classification is made accurately to reflect and record any events that might have occurred during a surgical procedure that would affect wound classification (Zinn, 2012). According to the National Surgical Quality Improvement program, wound classification and assessment can be done pre-operatively, before the surgical operation and post-operatively, after the surgical operation. Preoperative clinical data collected includes the patient’s history with regard to alcohol use, bleeding disorders, cardiac surgery, angina, central nervous system tumours, diabetes, functional health status, height and weight, open wounds, renal failure, vascular surgery, pulmonary disease, and ventilator status (Devaney & Rowell, 2004). Postoperative quiz data involves the collection of laboratory data such as the patient’s blood count, potassium and sodium levels, liver function tests, white blood cell and blood platelet counts. Other data that is collected in order to compare with preoperative data include bleeding, renal failure, cardiac arrest, deep wound infection, septic shock, urinary tract infection, and ventilator dependency.

The percentage of improper surgical wound classifications in quality improvement initiatives showed that there is a thirty percent chance of incorrect documentation of clinical documents (Zinn & Swofford, 2014). Through detailed analysis of the data review made by the surgical clinical nurse reviewers trained in data definitions and methodology of the National Surgical Quality Improvement Program revealed that wounds were classified manually by nurses on an operating room computer system. As a result, of the total number of clean cases, thirty two percent needed to be reclassified. Five percent of the clean but contaminated category needed to be classified, while fifteen percent of the contaminated cases needed reclassification bringing the total percentage of reclassifications to twenty percent. After the problem was identified by the SCNR, a multi-dimensional education program was developed in partnership with the OR nurses and departmental staff members. Standardised training on the classification system for all staff members involved resulted in a higher degree of accuracy in classification. Awareness, feedback and re-education were also important tools used in obtaining data accuracy. After training, a similar review was made where only seven percent of the three hundred and sixty six clean cases needed reclassification. Of the two hundred and three clean but contaminated wound misclassifications, twenty seven percent needed reclassification. Of the thirty one contaminated cases, thirteen percent needed reclassification, while fourteen percent of the dirty and infected category needed reclassification bringing the total cases of reclassifications to fourteen percent, a gross improvement of six percentage points (Devaney & Rowell, 2004).

A proper development of assessment tools to evaluate project outcomes is significant (Lauren, Sumanas, & Hanwright, 2013). It involves creating a database that includes the type of surgery, the patients, nurses and surgeon names, the wound classification details, the development of surgical infections, whether the wound class matched the surgeon’s operative directions and generally surgical comments.  

References

Devaney, L. R., & Rowell, K. S. (2004). Improving Surgical Wound Classification: Why it Matters. AORN Journal, 208.

Lauren, M. M., Sumanas, J. W., & Hanwright, P. J. (2013). The Relationship between      Preoperative Wound Classification and Postoperative Infection: A Multi-Institutional      of 15,289 Patients. Archives of Plastic Surgery, 522-529.

Van Wicklin, S. A. (2014). Clinical Issues. Continuing Education , 99, 320.

Weaving, P., Cox, F., & Milton, S. (2008). Reducing the risk of surgical site infections     (SSIs). Infection prevention and control in the operating theater, 201.

Zinn, J., & Swofford, V. (2014). Interprofessional collaboration promoted a successful     initiative to improve wound classification. Quality Improvement Initiative:          Classifying and Documenting Surgical Wounds, 1, 32-33.

Zinn, L. J. (2012). Surgical Wound Classification: Communication is Needed for Accuracy.         Patient Safety First, 95, 275.

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