Surgical Set infections (SSIs)

OUTLINE TO THE ASSIGNMENT.

Consider the population in which the solution is intended, the staff that will participate, and the key contributors that must provide approval and/or support for your project to be implemented. These stakeholders are considered your audience.

Develop an implementation plan (1,500 words). The elements that should be included in your plan are listed below:

1. Method of obtaining necessary approval(s) and securing support from your organization’s leadership and fellow staff.

2. Description of current problem, issue, or deficit requiring a change. Hint: If you are proposing a change in current policy, process, or procedure(s) when delivering patient care, describe first the current policy, process, or procedure as a baseline for comparison.

3. Detailed explanation of proposed solution (new policy, process, procedure, or education to address the problem/deficit).

4. Rationale for selecting proposed solution.

5. Evidence from your review of literature in Topic 2 to support your proposed solution and reason for change.

6. Description of implementation logistics (When and how will the change be integrated into the current organizational structure, culture, and workflow? Who will be responsible for initiating the change, educating staff, and overseeing the implementation process?)

7. Resources required for implementation: Staff; Educational Materials (pamphlets, handouts, posters, and PowerPoint presentations); Assessment Tools (questionnaires, surveys, pre- and post-tests to assess knowledge of participants at baseline and after intervention); Technology (technology or software needs); Funds (cost of educating staff, printing or producing educational materials, gathering and analyzing data before, during, and following implementation), and staff to initiate, oversee, and evaluate change.

SEE BELOW IS MY OUTLINE TO THE ASSIGNMENT. PLEASE REVIEW AND EXPAND WITHIN THE 1500 WORDS ALLOTTED.

1) Method (presentation of the report) of obtaining necessary approvals and securing support from your organization leadership and fellow staff.

1. CNO

2. CFO Productivity

3. Chief of Surgery

4. Chief of Anesthesia

5. Quality Management

6. Infection Control

7. Support from Charge RN

8. Staff RN by-in

2) Current problem (SSIs) is that the nurses appear to struggle with wound classification on some cases. Proper classification will lower the cost of care and decrease in hospital stays therefore lowering the cost. Currently Infection Control and Quality Management are sending the department reports with patients name and procedure with improper wound classification sent to them from the CDC. Assisting the nurses with the education to help them make the correct surgical wound classification is vital for the patient to receive the best practice.

3) Education is key to the solution of documentation of the correct surgical wound documentation, along with involving the surgeon during the post procedure huddle on what the correct surgical wound classification should be. Policy change?

4) The rationale for this being the proposed solution, its been noted that some of the surgical nurses appear to have difficulty selecting the correct wound classification. We are a level one-trauma center and see a lot of trauma patients with exploratory laparotomy procedures. The nurses seem to struggle with documenting the proper surgical wound classification. It has been noted they are not having the conversation with the surgeon on what the post procedure wound classification is or should be. The Charge RNs are being sent emails with wrong surgical wound classifications that have been audited and found to have wrong surgical wound classification. The Charge RNs spend hours researching why the nurse choose that classification. It has been noted that the majority of the time the nurse did not know what wound classification they should have documented. Therefore its been incorrect.

5) Evidence from your review of literature in Topic 2 to support your proposed solution and reason for change. Stats and studies from research articles. See attached.

6) The implementation will start within the next 60 days. When, how and who? The Director will be responsible (begin stats baselines) for the imitating the change. The education department (educator) will be the responsible party for instructing the staff during the staff in-services, emails and educational opportunities. The Infection Control nurses and Quality Management will monitor the success rate. They will provide data that will track the process of surgical wound classification. The Director will oversee the implementation along with the support of the Charge RNs, Infection Control RNs, Quality Management and Education RNs.

7) The resources needed with be one on one communication with each OR RN by the surgical services educator. The cost of education, educational materials, posters and signs (laminated) will need the support from the CFO for the funding of the education. The CNOs input will be necessary so that the CFO, Educational Director and CFO will support the implementation. The implementation does require financial support and funding for materials and productivity requirements.

8) Stakeholders – surgeons..Must have their by in.

9) Need to focus on proper wound class, which will lower SSIs, which will reduce hospital stays and will lower cost of care.

Developing an Implementation Plan for Surgical Wound Classification

Surgical Set infections (SSIs) have multiple etiologies and a wide range of associated co-morbidities ranging. Therefore, a wide range of healthcare professionals with varied ranges of knowledge regarding SSIs care treatment (Health Service Executive, 2009). Therefore, to seek support for the project implementation, an abstract shall be prepared and issued to the hospital’s director, the Chief Nursing Officer (CNO), Chief of Surgery, Chief of Anesthesia, and Infection Control. This abstract will contain a clear explanation of the intended project and the outcomes to be expected by its implementation (Houser & Oman, 2011). This group comprises of the leadership team of the hospital, therefore, their support will in turn lead to support from of other nursing staff. The other staff will be issued with the abstract to gain their approval and support before implementation. Approval for the project implementation will be obtained from the hospital director through a written formal request.

According to Murphy (2006), a Surgical Site Infection (SSI) is a wound infection that follows invasive surgical procedures. Infection here develops when the numbers and activity bacteria contained in the wounds overcome the immune system of the patient that results into tissue breakdown hence delayed healing. These have posed one of the greatest challenges for surgeons since the beginning of surgery (Gould, 2012).

For example in the United Kingdom according to Emmerson et al. (1996), SSIs comprised of 10.7% of all HCAI. In 2006, a similar survey was conducted by the society of nurses involved hospital infection and infection control established that SSI comprised of 13.8% of HCAI in acute hospitals. In the 2008 study, the National Institute for Health and Clinical Excellence (NICE) revealed that 5% of all procedures in surgery resulted into SSI which accounted for 1 in every 7 HCAI cases a figure that is perceived to be underestimated as most SSI present after patient discharge (Gould, 2012).

Several factors have been linked to the rapid increase in SSIs within the hospital setting with the most prominent ones being poor knowledge in wound classification. Classification of surgical wounds affects the surgical analyses and outcomes and a predictor of postoperative infections and its associated risks (Devaney & Rowell, 2004). The classification the extent of infection in the surgical site during surgery is essential for the prediction of risks of infection in surgical wounds and is based on the surgical wound’s bacterial load or contamination (Devaney & Rowell, 2004).

In addition, to the above, studies done on the factors such as time of preoperative antibiotic administration, length of anesthesia and surgery, and new surgical instruments all take into consideration the classification of the wound. For example, according to the Study on the Efficacy of Nosocomical Infection Control done in 1985, researchers involved in the study developed a multivariate index for classifying wounds that were based on the degree of contamination and status oh host resistance (Devaney & Rowell, 2004). The study revealed that the index included other risk factors and had a better wound infection risk prediction rate than the traditional system. This index has been modified by the Center for Disease Control and Prevention (CDC) and its success indicate the need to incorporate such classification in every surgical setting (Devaney & Rowell, 2004).

However, currently the nurses are struggling with the classification of wounds in some cases. As illustrated above, improves treatment outcomes and, in addition, lowers the treatment costs by lowering the length of hospital stay. Currently, Infection Control and Quality Management are sending department reports with patients’ name and procedure with improper with improper classification of wounds as sent from the CDC. This indicates a lack of mastering of the wound classification by the nursing staff hence the need to provide education and training to help the nurses correct and improve their skills in surgical wound classification. This will in turn promote the provision of quality care and reduce the hospital stay for these patients hence reduce the cost of care.

Therefore, this program intends to introduce nursing education to help the nurses become conversant with the classification of wounds hence reduce the incidence of SSIs. Therefore, the program Quality education provides Provision of education to the nursing staff especially in Infection Control and Quality Management on the correct wound classification and documentation and this education especially. When this education is provided using nursing processes ensures that all aspects of documentation are considered, addressed, and well written in a uniform manner as per the classification criteria. Education here plays a central role in documentation of the proper classification of wounds by the nursing staff including involvement of the surgeon during post procedure in determining the correct surgical wound classification. This program was collaboratively developed with and close monitoring of the hospital director, CNO, Quality Management, Infection Control, Chief of Surgery, and Chief of Anesthesia.

The rationale for the need of education and training is that it has been noted that a considerable number of nurses in the surgical field experience difficulties in correctly classifying surgical wound. In exploratory laparotomy correct wound classification is critical due to the important role the procedures involved patient care and care costs. Nurses in the centre have had problems documenting post procedure wound classification and are not communicating this to the surgeons. The RN in charge, therefore, receives emails containing wrong surgical wound classifications that have been audited and found to have wrong surgical wound classification. The researcher conducted further research on why nurses used this form of classification and the RN in charge found out that these nurses did not know the type of wound classification they should use.

SSIs’ incidence is influenced by the type of surgical procedure and whether the wound is contaminated or clean. Therefore, an education program to train the nurses in support of all the involved parties would play an important role in improving the classification and documentation processes for wound. For example, in the second review from the educational program established by SCNR reviewing wound classification process use the documenting methodology and rates of incorrectly classified procedures using a relational database. Three months after provision of in-service programs the rate of misclassification reduced to 14% that was a 26% improvement (Devaney & Rowell, 2004).

The follow-up studies that incorporated other areas that initially did not have a lot of success through a retrospective random sampling completed by NSQIP indicated a 26% improvement incorrect wound classification. These significant improvements indicate the importance of education and training programs and feedback from clinicians (Devaney & Rowell, 2004).

            Implementation of the education program will commence in the next 60 days. On the first week of implementation, the center’s director will intimate the program to allow formal acceptability of the program by every staff member. After initiation, the educator who will come from CDC the developers of the wound classification will begin instructing the nursing staff during both in-service and out- of service, emails and other educational activities. This will begin a week after initiation of the program (Mather, 2013). The Infection Control and Quality Management will conduct continuous monitoring for the success rate of the program. This will be from initiation to completion of the program. They will be involved in tracking the surgical wound classification. With support from the Charge RN, Infection Control, Quality Management, and the CDC educationalist the director will oversee the implementation process of the program (Mather, 2013).

The resources required to implement this will include interviews that will provide one on one communication between the educator and staff involved in surgery from the surgeon to the RN. For the educational classes, PowerPoint presentations will be required to provide summarized information (Pankake, 2013). At the initial stages, questionnaires will be required to provide one on one communication between the educator and the staff involved in the program. A relational database will be required to compare and track data improvements. Several copies of the abstract initially prepared will also be required that will act as the guidelines to be followed during the program. Apart, from the interviews, questionnaires will be required that will be issued to determine why clients filled the forms wrongly in order to diagnose the problem’s origin. Funding will be required from the CFO to provide the above stated materials and support the implementation of the program. (Pankake, 2013).

References

Devaney, L., & Rowell, K. S. (2004). Improving Surgical Wound Classification – Why it                          Matters. Association of periOperative Registered Nurses Journal, 80 (2), 208-223.

Gould, D. (2012). Causes, Prevention and Management of Surgical Site Infection. Nursing                       Standard, 26 (47), 47-56.

Health Service Executive. (2009). National Best Practice and Evidence Based Guidelines for                   Wound Management. 1-92.

Houser, J., & Oman, K. S. (2011). Evidenece-Based Practice: An Implementation Guide for                     Health Cre Organizations. Sudbury, MA: Jones & Bartlett Learning, LLC.

Mather, D. (2013). CMMS: A Timesaving Implementation Process. CRC Press,.

Pankake, A. (2013). Implementation. New York, N.Y: Routledge.

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