Change Proposal
Sandhya Varughese
Southern New Hampshire University: NUR 490
July 24, 2022
Section 1
Identified Issue
Several issues can be addressed in the hospital setting. There is an alarming increase in post-operation infections in the post-anesthesia care unit (PACU). This change proposal aims to address the problem. The first step is to begin a program called nose to toes. When the patient arrives in the morning for pre-operation, the nurse will give them a packet that includes wipes to clean their body, chlorhexidine solution to clean their mouth, and iodine swabs to clean their nose. Preoperative skin antisepsis is imperative for disinfecting the skin before the operation. The skin hosts many types of bacteria, which may compromise the safety of the operative room. The skin is the perfect home for various types of growing bacteria (Reichman & Greenberg, 2009). These germs may increase the risk of infection in the operation room. This would ensure that they are clean from top to bottom and will not bring any germs from their house into the operating room.
The rationale for Selecting the Issue
Surgical site infections (SSIs) are the second most common nosocomial (hospital-acquired) infections after urinary tract infections (Sattar et al., 2019). SSIs are very dangerous. It can lead to death. The patient might recover from the surgery but will have lifelong problems from the infection. This issue greatly impacts nursing practice because it affects the type of care that will be required for patients if they get a surgical site infection. This proposal is expected to reduce the rate of post-operation infections in hospitals.
Section II
Justification of need
Implementing this innovative treatment can significantly reduce or eliminate pain after surgery. However, surgical experts have argued that there is less focus on the post-anesthetic care unit (PACU), especially regarding surgical site infection in the facility (Siddharthan et al., 2018). Essentially, patients have complained that hospitals do not have an appropriate procedure to handle surgical site infections.
Patients end up having delayed healing of their wounds after surgery. In essence, patients may have surgical site infection such as superficial incision SSI, which occurs in the skin where the incision was done (Yao et al., 2018). Such infection mainly occurs if preoperative skin antisepsis is not used prior to surgery. Patients end up having complications on their skin due to bacterial infections after the surgery (Yao et al., 2018). The organization should have a clear plan to avoid these SSIs and reduce patient complaints. Therefore, the proposal to give patients preoperative skin antisepsis is vital in improving patients’ care after surgery.
It is also crucial to have postoperative skin antisepsis after the surgery. This helps to reduce surgical site infections that may prolong healing after surgery (Alkaaki et al., 2019). Such a program ensures that wounds remain clean and that there is no inflammation or contamination of the wounds. Ideally, it involves wiping the wound with an antibacterial agent and iodine to facilitate faster wound healing (Alkaaki et al., 2019).
Section III
Pre-Implementation Plan
Change is essential in resolving identified problems in nursing. Roger’s change theory will be applied in implementing post-operative infections in the post-anesthetics care unit (PACU). The theory articulates five phases for implementing change (Borkowski & Meese, 2020). These stages include awareness, interest, evaluation, trial, and adoption of the change into the system. The paper will link the activities highlighted in this theory that will facilitate change implementation.
The activities needed before change implementation are awareness, interest development, evaluation of the change strategies, and trial before the change is absorbed into the facility. The first requirement is to create awareness among the care providers, patients, and the facility’s management on the increase in post-operation infections. This move will involve declaring the statistics of these infections and how they have increased with time. Similarly, outlining the incidences of post-operation infections creates interest among the care providers, management, and patients in the available nursing interventions to resolve them.
The next strategy is to outline the nursing interventions like using wipes to clean the body, chlorhexidine to clean the mouth, and iodine to clean the nose (Sattar et al., 2019). This activity will allow the care providers and management to evaluate the feasibility of these interventions. Management can estimate the costs of these interventions against patient outcomes. The change agents can also outline post-operation skin antisepsis activities like wiping wounds with antibacterial agents and iodine for accelerated healing (Alkaaki et al., 2019).
In the trial stage, these interventions can be tested, and the nurse informaticists should be called upon to document the outcomes of the activities. Management will also assess patient and nurse acceptance of the strategies to obtain feedback. This feedback will facilitate more research and consultation of health literature on the best post-operative skin antisepsis interventions. Similarly, the management can collaborate with the care providers to develop policies and ethical standards for adopting these interventions as standard operating procedures. The stakeholders involved in the above plan include the care facility management, nurses, physicians, informaticists, and patients.
Section IV
Implementation Plan
One of the factors with great potential to influence the implementation of the recommended intervention is the lack of appropriate and standard approaches for handling surgical site infections in care facilities. This aspect increases the risk of infection after an operation and delays wound healing. The organization must develop clear plans for avoiding surgical site infections. They should provide preoperative and postoperative antisepsis to prevent contamination and increase recovery.
Surgical site infections will be addressed by establishing a program to provide preoperative and postoperative antisepsis to effect surgical wound management. This approach is crucial as it keeps the wound clean, preventing contamination and inflammation (Kolasiński, 2019). The care plan will involve using an electronic recording system to ensure that all protocols and approaches are observed to ensure effective wound management. Multiple organizations in contemporary contexts have recognized the increased need to adopt new technologies to improve physician-patient interactions and relationships.
The intervention will be carefully developed and customized to alight with institutional structures and culture. This aspect would ensure effective wound management practices throughout the care organization. The intervention will require effective education and training of relevant individuals in the care organization to build buy-in among all stakeholders, such as nurses. The solution will help to reduce hospitalization costs by decreasing hospital stays and medications.
Government and hospital policies could significantly influence the implementation of the solution. Such laws would determine the availability of adequate structures and supports for implementing the intervention. The HIPAA standards should be observed when collecting patient data to ensure safety and confidentiality (Mbonihankuye et al., 2019). Care providers will strive to provide culturally sensitive care as they will serve clients from diverse backgrounds. All communication and interaction processes should be based on recognizing patient diversity.
References
Alkaaki, A., Al-Radi, O. O., Khoja, A., Alnawawi, A., Alnawawi, A., Maghrabi, A., & Aljiffry, M. (2019). Surgical site infection following abdominal surgery: a prospective cohort study. Canadian Journal of Surgery, 62(2), 111. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440888/
Borkowski, N., & Meese, K. A. (2020). Organizational behavior in health care. Jones & Bartlett Learning.
Kolasiński, W. (2019). Surgical site infections–review of current knowledge, methods of prevention. Polish Journal of Surgery, 91, 41-47. https://doi.org/10.5604/01.3001.0012.7253
Mbonihankuye, S., Nkunzimana, A., & Ndagijimana, A. (2019). Healthcare data security technology: HIPAA compliance. Wireless Communications and Mobile Computing, 2019. https://doi.org/10.1155/2019/1927495
Reichman, D. E., & Greenberg, J. A. (2009). Reducing surgical site infections: A Review. Reviews in obstetrics & gynecology. Retrieved July 5, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2812878/
Sattar, F., Sattar, Z., Zaman, M., & Akbar, S. (2019, March 12). Frequency of post-operative surgical site infections in a tertiary care hospital in Abbottabad, Pakistan. Cureus. Retrieved July 5, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6516612/
Siddharthan, R., Chapek, M., Warren, M., & Martindale, R. (2018). Probiotics in the prevention of surgical site infections. Surgical Infections, 19(8), 781-784. https://doi.org/10.1089/sur.2018.231
Yao, R., Zhou, H., Choma, T. J., Kwon, B. K., & Street, J. (2018). Surgical site infection in spine surgery: who is at risk?. Global spine journal, 8(4_suppl), 5S-30S. https://journals.sagepub.com/doi/abs/10.1177/2192568218799056