CLABSI” Change Project for the “PICU” (Essay Sample)

CLABSI" Change Project for the "PICU” Name Institution CLABSI" Change Project for the "PICU” The selected change management is the inclusion of dressing chances, sterile cap changes, and closed system medication administration as part of universal policy and procedure for central line care. The Need for Change Hospital acquired infections poses an unending challenge to most health systems globally. It is estimated that 0.7 million hospital-acquired infections (HAIs) are recorded in USA resulting in over 75,000 deaths and approximately $45 billion in extra health care costs. Central line-associated blood stream infections (CLABSIs) are identified as the commonest HIAs with a mortality rate of 12-25%. Approximately 41,000 patients in the USA report central line-associated infection annually. The risks of acquiring CLABSIs are increased by bacterial colonization at the insertion site, catheter placement in the arm or leg instead of the chest, catheterization longer than two days, and insertion with less stringent barriers precautions. However, CLABSIs are largely preventable with the necessary quality management policies and practices. IHI (2012) reported that approximately 90% of all CLABSI are as a result of CVC use, leading to increased length of stay, increased the cost of care, and high mortality rates. With evidence-based preventative guidelines, such as evidence-based central line insertion bundles, it is possible to prevent them. Selected Change Process The change process will be managed using Lewin’s change model. According to Marquis and Huston (2014) Lwein’s model of change involves the unfreezing, change, and refreezing phases. Each of the three phases involves different activities and different change agents who drive the change process. Freezing Processes The following change plan is designed to help the health facilities improve CLABSIs rate. Change management is a fundamental element that ought to be included to maintain improvement in the management of central line. Establishing a strategy for accountability and acceptance of the change strategy significantly increase the chances of succeeding and sustaining of improvements. According to Marquis and Huston (2014), the unfreezing phase entails gathering the necessary data, diagnosing the problem accurately, deciding the necessary change, and making the others aware of the need or change. Therefore, the unfreezing phase will involve pre-implementation initiatives that will focus on building a strong basis for the project by assessing the organization’s culture for change, projecting the intended change, establishing a comprehensive and practical solution, engaging the right stakeholders, and defining a common vision. The project team will solicit support and active involvement; obtain buy-in and accountability for the outcomes not only from nurses, but from the entire care team and health executives. It is also critical to understand any potential source of resistance for the plan and develop an action plan or strategy to overcome the resistance to change. The change process will be aligned with the overall business strategy and ensure that the organization has the capacity and ability to sustain the change process. The leader should be actively visible in the initiative and support frequent communication regarding all elements of the initiative. The freezing phase entails the process of overcoming the challenges and barriers to the change process and promoting the quality culture within the organization. It will involve staff training/ educating on the evidence. The greatest barrier to evidence-based practice is lack of employees’ knowledge of the existing evidence. Therefore, the first step will be to educate employees about the evidence-based practices and encourage them to implement these practices to overcome their current culture. Movement Phase In the movement phase, an implementing team will be established with the aim of developing the implementation plan, goals, and objectives and set the specific milestone dates. The team will also outline the various strategies, mainly training in this case, that will be used to change the current PICU CLABSIs protocols and procedures. Additionally, the phase will involve implementing the identified strategy and soliciting support from all the stakeholders and implement the strategies to overcome barriers or resistance to change. Refreezing Phase The refreezing phase will involve monitoring and evaluation process to ensure the goals and objectives are achieved. It entails ensuring long-term executive support for a quality culture and creating an effective feedback system that allow communication and learning from incidents. Additionally, the new procedures will be integrated in new employees’ orientation and structures established to ensure continued learning among all ICU staff. The refreezing phase will also entail celebrating the small milestones made by the department and establishing stable reward systems that encourage employees to observe the unit-based quality program. Steps of the Change Process The program will be composed of five core steps as outlined by AHQR (2011). 1. Education on the importance of embracing a culture of safety The education will emphasize the core principles of safety, the appreciation of culture as part of the hospital work system, and the role interdisciplinary approach. 2. Identifying the current defects and patient safety barriers in the unit. The participating team will be directed to identify, prioritize, and eliminate barriers to patient safety in ICU. They will brainstorm on how patients are harmed in the unit and how the team can overcome those barriers 3. Collaboration with the executive Hospital executives will review the identified barriers to implement the safety guidelines and ensure the team has the necessary resources and support to implement the improvement plan. 4. Learning from the defects The implementing team will use root cause analysis to learn from incidents and whether the intervention is yielding the expected outcomes 5. Implementing communication and teamwork tools. Change Agents and Their Role The implementing team will be unit-based for each participating ICU. It will be comprised of a team-leader, physician champion, executive champion, and bedside registered nurses from each scheduled shift. The team leader will be the ICU manager. He/she will be the primary contact within the team who will organize, articulate the objectives of the project, and define decisions using the collective contribution of the team, promote, and facilitate good teamwork, and disseminate information to team members. The suggested physician champion will be the designated ICU medical director who will be in charge of advancing the project, bridging communication gaps and securing buy-in from other physicians and staff to participate in the project.Therefore, the physician champion will possesses three fundamental skills that include team leadership, communication skills planning, and evaluating skills. The executive champion will be the hospital chief nursing officer (CNO) due to the organizational reporting structure, the critical relationship between the role of CNOS, quality initiatives, and outcomes. The executive representative is a senior leader who works with the quality team and assumes an active role in the planned process. The direct connection of this senior leadership with other health executives will help guarantee the initiative is embraced hospital-wide, and the program remains an organization-wide project. Involving staff registered nurses from every shift will provide the necessary expertise and patient care knowledge to maintain and sustain the effects and success of the project (McMullan et al., 2013). Fundamental skills for the executive champion include taking responsibility, mobilizing the efforts of others, and Critical members to be included, such as quality and safety specialists, pharmacists, RTs and IPs Internal and External Forces that Relates to the Change Process As a quality improvement initiative, the change process is influenced by the Joint Commission principles, agency for healthcare research and quality (AHRQ), and institute for healthcare improvement. These are some of the external organizations and agencies that support and promote quality improvement initiatives in healthcare organizations and they provide guidelines and resources to support the development and maintenance of a quality culture. The current change initiatives are also influenced by CDC guidelines on the management of CLBSIs in pediatric ICUs. The change process integrates a safety culture planned to train and improve staff responsiveness to safety and care quality, empowering staff to assume responsibility and improve safety in their units, creating a partnership between hospital executives and departments to improve hospital culture and providing improvement facilities, and providing tools for measuring outcomes. It will integrate collaboration, communication, and leadership efforts to establish and support a safety culture (Kim, Holtom,&Vigen, 2011). The initiative will use a collaborative framework in which the frontline stakeholders include interdisciplinary teams from the participating units and departments. It will be executed and monitored at the ICU unit level and will involve lead patient care providers and quality management personnel within the facility. Rationale for Change The CDC recommends five evidence-based procedures which are identified as lowest implementation barriers and the greatest effects of rates on CLABSI. They include: hand hygiene before catheter insertion, application of maximum sterile barrier precautions, use of chlorhexidine to treat antisepsis, avoi...