Name
Capella University
NURS-FPX6201
Instructor’s Name
October, 2024
Strategic Plan for Change
In hospitals, patient safety is a major component that defines the quality of care,e and among the components of patient safety is the prevention of Hospital Acquired Infections. Hospital-acquired infections, (HAIs) including VAP, UTIs, and BSIs have negative consequences on patient outcomes, increased costs, longer lengths of stay, and worse morbidity and mortality (Mastroianni et al., 2023). These matters call for multifaceted, blueprints that include empirical-based strategies and innovation of a culture of improvement. The following is a broader plan on how to cut down on HAIs but this strategy will apply to the ICU because it poses the most risk to the patient.
Problem Statement
Current data from our ICU shows that VAP rates rose by 17% compared to the previous quarter, which is very dangerous to the safety of the patients and the overall costs incurred in healthcare (Mastroianni et al., 2023). The root cause of VAP as derived from observational audits and interviews with the staff is equally attributed to suboptimal compliance with VAP preventive measures, especially HOB.
Strategic Objectives
The primary objectives of this strategic plan are to:
- Prevent the development of VAP by at least 30% within the next six months among ICU patients.
- Enhance compliance with the currently implemented VAP prevention bundle.
- Strengthen staff to increase their knowledge about infection control measures and ensure self-and-other accountability.
- Organizational culture that enhances patient safety and within which change is a continuous process.
Literature Review
It is essential to use research-based interventions while preventing HAIs because it is challenging in high-risk patient populations such as those in the ICU. A centerpiece of these complications is ventilator-associated pneumonia which is a major complication to patients on mechanical ventilation (Chapman et al., 2021). Limited evidence has persistently pointed to the importance of delivering care bundles, which are defined as ‘‘coordinated sets of interventions that have been demonstrated to be effective’’’. Research also shows that these care bundles decrease VAP occurrence by 50 percent if barriers to proper implementation of the care bundles are observed.
Key components of successful VAP prevention strategies include:
- Head-of-Bed (HOB) Elevation: Raising the HOB to 30 – 45 degrees has been proven to reduce the incidence of aspiration, a major cause of pneumonia (Güner et al., 2022).
- Daily Sedation Breaks and Extubation Readiness Assessments: Sedation interruptions allow the multi-professional team to assess the patient’s respiratory status and thus avoid extended and potentially harmful periods of mechanical ventilation.
- Oral Hygiene Protocols: Chlorhexidine oral care effectively removed the bacteria from the mouth reducing their invasion in the lungs.
- Subglottic Secretion Drainage: Subglottic secretion drainage endotracheal tubes facilitate the prevention of the formation of secretions which help bacteria to grow.
These strategies became more important during the COVID-19 pandemic as more respondents sought to work from home. In a survey carried out by (Baccolini et al., 2021) it was reported that the pandemic led to increased HAIs inICUsU,s, especially through increased bed turnover, longer mechanical ventilation times,s and burnout among the staff. The number of critically ill patients also increased like any other indicator of patient severity, which taxed the existing resources particularly as infection control also became a major issue (Maes et al., 2021) share the same argument, arguing that it is crucial to perform VAP prevention protocols and especially in a situation like the pandemic, the infection rate is higher. Both works urge for better infection prevention frameworks in healthcare organizations to address new issues including pandemics without elevating the risk to patients.
The research shows that although the central principles of infection prevention and control continue to be effective, increased flexibility and funding are needed during emergencies. To strengthen all these evidence-based interventions, hospitals need to consider the following additional measures for implementing care bundles: Rotational work, appropriate and continuous training, and surge capacity planning.
Strategy for Change
To effectively reduce VAP rates and improve patient outcomes, the following strategic plan will be implemented, focusing on three core areas: education training, Adherence reporting/monitoring,g and System changes.
Education and Training
A comprehensive training program will be developed and rolled out to all ICU staff, focusing on the following:
Refresher Training
It will be required that all nurses, respiratory therapists, and aides who work in the unit will undergo training on the unit VAP prevention bundle with specific attention being paid to the correct HOB elevation and the correct methods of performing oral care (Chapman et al., 2021).
Simulation-Based Learning
To enhance practical competencies in the subject matter of the present study, hands-on simulation sessions will be arranged, focusing on extubation readiness assessment, and sedation vacation together with the remaining component of the VAP bundle (Chapman et al., 2021).
Family Engagement
ICU patient families will be informed of the possibility of spreading infections to the patients they visit and will be encouraged to embrace the measures by reminding the staff of the need to keep the HOB elevated in addition to upholding hygiene to the patients (Zhang et al., 2023).
Monitoring and Compliance
Ensuring adherence to the VAP prevention bundle requires continuous monitoring and accountability:
- Daily Rounds Checklist: It is going to be mandatory for all the practitioners on daily rounds to use the VAP checklist to identify all essential components of the VAP prevention bundle (Isibel et al., 2020).
- Audit and Feedback: Verification with guidelines of VAP prevention will be done through an audit on a monthly basis (Zhang et al., 2023). The results will be reported to staff and the departments, which show maximum progress, will be rewarded.
- Real-Time Feedback: Using EHR for administration to prompt reminders to both the nurses and respiratory therapists regarding vital IPC practices (Mastroianni et al., 2023). For instance, if the HOB is not raised to the indicated level, an alarm is produced.
System and Environmental Improvements
Structural and process improvements are critical to support staff in preventing VAP and other infections:
- Adjustable Bed Alarms: More specifically, beds with adjustable alarms will be incorporated so as to maintain the HOB at the correct angle at all times (Li et al., 2020). They are too sound to notify personnel when the HOB is less than 30 degrees.
- Oral Care Kits: This approach will entail the provision of readily accessible and easy-to-use chlorhexidine oral care kits to patients at the hospital and particularly individual patients’ bedside (Li et al., 2020). These kits will be refilled daily during rounds with necessary articles as prescribed by a doctor.
- Subglottic Secretion Drainage Systems: The use of endotracheal tubes with subglottic secretion drainage will be implemented in patients who require intubation with a specific focus to avoid VAP.
Leadership and Communication Plan
The role of leadership in the change management process, cannot be overemphasized because of its significance in the implementation process. Nurse managers will be responsible for their training, enforcement of compliance as well as handling of all the challenges that may be experienced during implementation (Pozuelo et al., 2022). Nonetheless, to facilitate open communication there will be weekly management/worker meetings at least twice per week where progress, issues, and solutions will be addressed.
Employees’ comments will be sought, and ideas for additional enhancement of the plan will be considered (Isibel, 2020). In order to encourage all subordinates to take responsibility, the goals that are aimed at by means of this strategic change, as well as the significance of the change, will be described as transparently as possible.
Evaluation and Metrics
The assessment of the strategy will done based on not only outcomes but also process measures of the strategic plan. Key performance indicators (KPIs) include:
- Reduction in VAP Cases: An improvement of patient record and infection surveillance data by achieving a 30% reduction within the next months in case of VAP.
- Compliance Rates: A goal of having 95% strict adherence to the use of the VAP prevention bundle, using daily observation checklists, and monthly assessments (Choi et al., 2022).
- Staff Knowledge and Confidence: An evaluation of changes in educational needs, self-efficacy to apply VAP prevention measures, and perceived barriers to compliance before and after implementation (Xia et al., 2023).
NURS FPX 6201 Assessment 2 Conclusion
The proposed strategic plan for change for implementation in the context of our ICU is aimed at reducing the rates of VAP through education, strict adherence monitoring,g and system alterations (Yin et al., 2022). Our goal of decreasing VAP rates, helping the patients, and increasing the organization’s performance will be achieved by implementing an organizational culture that encourages answers for performances, learning from daily practice, and patient safety. This change initiative is work-related, supports the staff to be responsible for infection control practices, and leads to the improvement of quality patient care.
NURS FPX 6201 Assessment 2 References
Baccolini, V., Migliara, G., Isonne, C., Dorelli, B., Barone, L. C., Giannini, D., Marotta, D., Marte, M., Mazzalai, E., Alessandri, F., Pugliese, F., Ceccarelli, G., De Vito, C., Marzuillo, C., De Giusti, M., & Villari, P. (2021). The impact of the COVID-19 pandemic on healthcare-associated infections in intensive care unit patients: a retrospective cohort study. Antimicrobial Resistance and Infection Control, 10(1), 87. https://doi.org/10.1186/s13756-021-00959-y
Chapman, L., Hargett, L., Anderson, T., Galluzzo, J., & Zimand, P. (2021). Chlorhexidine gluconate bathing program to reduce healthcare-associated infections in both critically ill and non-critically ill patients. Critical Care Nurse, 41(5), e1–e8. https://doi.org/10.4037/ccn2021340
Choi, M. I., Han, S. Y., Jeon, H. S., Choi, E. S., Won, S. E., Lee, Y. J., Yang, J. H., Baek, C. Y., Shim, H., & Mun, S. J. (2022). The influence of professional oral hygiene care on reducing ventilator-associated pneumonia in trauma intensive care unit patients. British Dental Journal, 232(4), 253–259. https://doi.org/10.1038/s41415-022-3986-3
Güner, C. K., & Kutlutürkan, S. (2022). Role of head-of-bed elevation in preventing ventilator-associated pneumonia bed elevation and pneumonia. Nursing in Critical Care, 27(5), 635–645. https://doi.org/10.1111/nicc.12633
Isibel D. (2020). Improving health literacy at the organizational level. Journal of Doctoral Nursing Practice, 13(1), 79–83. https://doi.org/10.1891/2380-9418.JDNP-D-19-00028
Li, Y., Liu, C., Xiao, W., Song, T., & Wang, S. (2020). Incidence, risk factors, and outcomes of ventilator-associated pneumonia in traumatic brain injury: a meta-analysis. Neurocritical Care, 32(1), 272–285. https://doi.org/10.1007/s12028-019-00773-w
Mastroianni, M., Katsoulas, T., Galanis, P., Korompeli, A., & Myrianthefs, P. (2023). The impact of care bundles on ventilator-associated pneumonia (VAP) prevention in adults: a systematic review. Antibiotics (Basel, Switzerland), 12(2), 227. https://doi.org/10.3390/antibiotics12020227
Maes, M., Higginson, E., Pereira-Dias, J., Curran, M. D., Parmar, S., Khokhar, F., Cuchet-Lourenço, D., Lux, J., Sharma-Hajela, S., Ravenhill, B., Hamed, I., Heales, L., Mahroof, R., Soderholm, A., Forrest, S., Sridhar, S., Brown, N. M., Baker, S., Navapurkar, V., Dougan, G., … Conway Morris, A. (2021). Ventilator-associated pneumonia in critically ill patients with COVID-19. Critical Care (London, England), 25(1), 25. https://doi.org/10.1186/s13054-021-03460-5
Pozuelo, D. P., Cobo, A. I., Carmona, J. M., Laredo, J. A., Santacruz, E., & Fernandez, R. (2022). Body position for preventing ventilator-associated pneumonia for critically ill patients: a systematic review and network meta-analysis. Journal of Intensive Care, 10(1), 9. https://doi.org/10.1186/s40560-022-00600-z
Xia, Y., Huang, H., Yu, Q., Halili, X., & Chen, Q. (2023). Academic-practice partnerships in evidence-based nursing education: A theory-guided scoping review. Nurse Education in Practice, 73, 103839. https://doi.org/10.1016/j.nepr.2023.103839
Yin, Y., Sun, M., Li, Z., Bu, J., Chen, Y., Zhang, K., & Hu, Z. (2022). Exploring the nursing factors related to ventilator-associated pneumonia in the intensive care unit. Frontiers in Public Health, 10, 715566. https://doi.org/10.3389/fpubh.2022.715566
Zhang, W. Q., Tang, W., Hu, F. H., Jia, Y. J., Ge, M. W., Zhao, D. Y., Shen, W. Q., Zha, M. L., & Chen, H. L. (2023). Impact of the national nursing development plan on nursing human resources in China: an interrupted time series analysis for 1978-2021. International Journal of Nursing Studies, 148, 104612. https://doi.org/10.1016/j.ijnurstu.2023.104612
