Discovery: topic and practice issue
The topic and the nursing practice issue related to this topic
The topic chosen for this task is promoting patient safety within hospital set-ups. Errors are common occurrences in nursing practice, and they come with adverse effects by affecting patient safety and health outcomes (Lawati, Dennis, Short, & Abdulhadi, 2018). Nurses could play a central role in addressing this problem by promoting a culture of safety.
The rationale for the topic selection. The scope of the issue/problem
The rationale behind selecting this topic is that errors are common in hospital settings with far-reaching outcomes, but they are preventable. In most cases, errors occur due to nurses’ failure to do what they are supposed to do at the appropriate time based on care protocols (Cloete, 2015). Therefore, the scope of this issue would require nurses to promote a culture of patient safety to address this issue satisfactorily and avoid the associated damages and costs to the involved parties.
Summary: evidence to support the need for a change
The practice problem and the PICOT question
Nurses may be prone to making errors in their practice due to different factors such as excessive workload and long shifts. Common errors in nursing practice include medication errors, patient falls, hospital-acquired infections (HAIs), and missed care (Gaffney, Hatcher, Milligan, & Trickey, 2016; Motamedzadeh, Mahmodi, Nehri, & Ebadi, 2017 ). Therefore, there is a need to develop a strategy on how to address this problem for improved health outcomes.
PICOT: In hospitalized patients (P), how does promoting patient safety using standardized handover checklists (I), as compared to not using checklists (C), affect mortality rates (O) within six months (T)?
The main findings from the systematic review and the strength of the evidence
Patient safety is a major health care problem in both developed and developing countries. In the nursing practice, this problem is mainly caused by errors by nurses due to several reasons, including burnout due to excessive workload and understaffing. The evidence provided in this article is strong because 3072 papers were screened and 28 of them included for the review. In addition, the selected articles contained research from different countries, including the Netherlands, the United States, Germany, the United Kingdom, Canada, Australia, and Brazil. As such, the sample size and diversity of the research in the articles provided a way for generalizing the results in other set-ups.
Evidence-based solutions for the trial project
One of the solutions that would be considered for this trial project would be the introduction of standardized checklists for nurses to use during shift handover.
Translation: Action Plan
Care standards, practice guidelines, or protocols to support the intervention planning
Nursing practice guidelines require patient safety to be made a priority in the process of care provision. Therefore, this requirement will provide the basis for the introduction of the proposed intervention plan of using standardized checklists when handing over after shifts.
Stakeholders and their roles and responsibilities in the change process
- Nurses
Nurses will be required to implement the intervention plan when handing it over to their colleagues after their shifts.
- Management
The management will be required to provide the necessary support in terms of finances and structures for the successful implementation of the proposed plan. As key stakeholders in policy-making, the management’s directive for nurses to comply with the proposed plan would go a long way in ensuring its success.
The nursing role in the change process
My nursing role in the change process would be to ensure that the intervention plan is implemented successfully. As a nurse, I am required to use the standardized handover checklists and sensitize other nurses on the importance of doing the same. I am an advocate of change.
Stakeholders by position titles
- Nurse leader (1)
Nurse leaders play an important role in ensuring that change processes are implemented successfully through supervision and advocacy. These members are important to this project because they will offer the required guidance and leadership for the implementation of the intervention plan.
- Chief nursing officer (CNO)
A CNO will be required to give directions and authorize administrative changes needed for the successful implementation of the proposed intervention plan.
- Bedside nurses (7)
Bedside nurses will offer direct care to the patients, and thus they will be responsible for the ultimate implementation of the intervention plan. They will use standardized checklists.
Type of cost analysis needed prior to a trial
The cost analysis will involve estimating the money needed for training the selected nurse leader and the seven staff nurses, printing learning materials and notices. Additionally, training videos will be created, and all these aspects will be involved in the cost analysis before the start of the trial.
Implementation
The process for gaining permission to plan and begin a trial
The involved nurse leader will write to the CNO seeking official permission to implement the proposed intervention plan. In the letter, the need for patient safety will be highlighted as the major problem facing the facility and the proposed intervention. The expected care outcomes (benefits) will also be listed.
The plan for educating the staff about the change process trial
The selected staff nurses will be educated on the need to use standardized handover checklists as a way of improving patient safety. They will be trained on how to use the checklists effectively through videos and printed materials.
The implementation timeline for the change process
02/09/2019 to 13/09/2019 Creating awareness among the selected staff nurse on the need for the change process
16/09/2019 to 27/09/2019 Training the selected participants on how to use standardized checklists
1/10/2019 to 31/03/2020 Implementation of the intervention
1/04/2020 to 8/04/2020 Assessing the results of the results
The measurable outcomes based on the PICOT
I – Use of checklists – The effectiveness of using checklists will be determined
O – Mortality rates – number of deaths among hospitalized patients
Recording during the pilot change process
Standardized checklists will be used to record the handover procedure. Information gathered from the process will be entered into an excel sheet for the generation of final results.
Resources available to staff during the change pilot
Standardized handover checklists.
Meetings of certain stakeholders throughout the trial
The nurse leader will meet all participating staff nurses weekly to assess the progress.
Evaluation
Reporting the outcomes of the trial
Using frequency tables to compare the difference between the intervention and compare a group of nurses.
The next steps for the use of the change process information
If standardized checklists prove to be effective in enhancing patient safety, a proposal will be made to adopt the practice across the entire healthcare facility.
References
Cloete, L. (2015). Reducing medication errors in nursing practice. Cancer Nursing Practice, 14(1), 50-59.
Gaffney, T. A., Hatcher, B. J., Milligan, R., & Trickey, A. (2016). Enhancing patient safety: Factors influencing medical error recovery among medical-surgical nurses. OJIN, 21(3), 6-14.
Lawati, M., Dennis, S., Short, S. D., & Abdulhadi, N. N. (2018). Patient safety and safety culture in
primary health care: A systematic review. BMC Family Practice, 19(1), 104-116.
Motamedzadeh, M., Mahmodi, H., Nehri, B., & Ebadi, A. (2017). Patient safety in nursing: A systematic review. International Journal of Medical Reviews, 4(2), 52-57.