Surgical Site Infections as Nursing Practice Issue

Discovery: topic and practice issue

The topic and the nursing practice issue related to this topic

Reducing the risk of surgical site infections (SSIs) has been chosen as the topic for this task. Nurses play a critical role in the care of patients after surgery, and thus they contribute significantly to care outcomes. Therefore, the involvement of nurses in ensuring the wellbeing of patients after surgery underscores the nursing practice issue as related to this topic.

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The rationale for the topic selection. The scope of the issue/problem

SSI is one of the hospital-acquired infections (HIAs) leading causes of mortality and morbidity among hospitalized patients (Anderson et al., 2014; Gillespie et al., 2015). After surgery, patients are placed under the care of nurses, and thus this problem could be addressed by training nurses on how to prevent such infections, which underscores the scope of this issue.

Summary: evidence to support the need for a change

The practice problem and the PICOT question

SSIs are common occurrences, and they are associated with increased cases of patient mortality and morbidity and other consequences such as increased cost of care (de Oliveira & Sarmento Gama, 2017). However, nurses could minimize SSIs by adhering to best practices during care provision. Using a standardized sepsis bundle would prevent SSIs significantly. Therefore, the PICOT question for this task is: – In patients that have undergone surgery (P), how does the use of a standardized sepsis bundle (I), as compared to general care practices (C), affect patient outcomes (O) in five months (T).

The main findings from the systematic review and the strength of the evidence

Patient-centered interventions, such as using a standardized sepsis bundle, would play an important role in the prevention and minimization of SSIs. The evidence presented in the article is strong because an exhaustive search of the literature was conducted using major healthcare databases, including CINAHL, Medline, and Cochrane Library databases, PubMed, and ProQuest. Twenty-three articles were selected from 559 articles, which means they were relevant to the study objective, hence the strength of the evidence.

Evidence-based solutions for the trial project

The introduction of a standardized sepsis bundle would be considered as an evidence-based solution to the problem of SSIs.

Translation: Action Plan

Care standards, practice guidelines, or protocols to support the intervention planning

Post-operative care protocols require strict adherence to best practices to improve quality of care, patient outcomes and decrease the length of stay (Cataife, Weinberg, Wong, & Kahn, 2014). This practice guideline and protocol will be used in the introduction of the proposed change in post-operative care.

Stakeholders and their roles and responsibilities in the change process

Hospital management

The management will be used to approve and support the implementation of the standardized sepsis bundle in post-operative care.

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Nurses

Nurses are in direct contact with patients, and thus they will be the key players in this change process because they will be the implementers.

The nursing role in the change process

My nursing role in the change process is to drive the process from the beginning to completion. As an advocate, I will educate my colleagues on the need for using the proposed intervention plan.

Stakeholders by position titles

Nurse Manager (1)

The nurse manager will be in charge of supervising the implementation of the change process.

Chief nursing executive (CNE) (1)

A CNE will act as a link between the management and the team implementing the change process. The nurse manager will report directly to him or her.

Staff nurses (8)

Staff nurses will drive the change process by implementing the use of a standardized sepsis bundle in post-operative care.

Type of cost analysis needed prior to a trial

Cost analysis before a trial will consider that the eight staff nurses will require training. Training materials such as videos, charts, and booklets will be bought. Allowances will also be paid to the participants. All these factors will be considered in the cost analysis.

Implementation

The process for gaining permission to plan and begin a trial

The nurse manager will write to the CNE on the proposed change detailing all involved aspects together with the expected care benefits to patients. The CNE will contact the management for approval to initiate the change process.

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The plan for educating the staff about the change process trial

The participating nurses will be sensitized on the need to use the proposed intervention plan as a way of preventing and minimizing SSIs. After creating awareness, training will be conducted to show the involved nurses how to use the sepsis bundle.

The implementation timeline for the change process

15.09.2019 – 22.09.2019 Creating awareness among participating nurses

23.09.2019 – 30.09.2019 Training the participants on how to use the sepsis bundle

07.10.2019 – 07.02.2020 Implementation of the change process (monitoring and evaluation)

08.02.2020 – 15.02.2020 Evaluating the entire process to draw conclusions

The measurable outcomes based on the PICOT

Intervention (I) – Adherence to using the standardized sepsis bundle by the participating nurses will be monitored

Outcome (O) – patient outcomes, such as the length of stay, occurrence of SSIs, and patient satisfaction, will be noted.

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Time (T) – The process will run for five months after the implementation date

Recording during the pilot change process

Cases involving the use of the sepsis bundle will be noted on papers and backed with soft copies. Excel sheet forms will be ideal for this task.

Resources available to staff during the change pilot

The standardized sepsis bundle will be available to the participating nurses

Meetings of certain stakeholders throughout the trial

The team will meet once per week to assess the progress and make changes where necessary.

Evaluation

Reporting the outcomes of the trial

Frequency tables will be used to compare patient outcomes among nurses using the intervention and the control group using the normal hospital guidelines.

The next steps for the use of the change process information

After showing that a standardized sepsis bundle improves care outcomes by preventing and minimizing SSIs, a proposal will be made to the management to consider adopting the change process in the hospital.

References

Anderson, D. J., Podgorny, K., Berrios-Torres, S. I., Bratzler, D. W., Dellinger, E. P., Greene, L.,… & Kaye, K. S. (2014). Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35(2), 66-88.

Cataife, G., Weinberg, D. A., Wong, H. H., & Kahn, K. L. (2014). The effect of Surgical Care Improvement Project (SCIP) compliance on surgical site infections (SSI). Medical Care, 52(2), 66-73.

de Oliveira, A. C., & Sarmento Gama, C. (2017). Surgical site infection prevention: An analysis of compliance with good practice in a teaching hospital. Journal of Infection Prevention, 18(6), 301-306.

Gillespie, B. M., Kang, E., Roberts, S., Lin, F., Morley, N., Finigan, T., … Chaboyer, W. (2015). Reducing the risk of surgical site infection using a multidisciplinary approach: An integrative review. Journal of Multidisciplinary Healthcare, 8, 473-487.

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