NURS FPX 6021 Assessment 3 Quality Improvement Presentation Poster

Name

Capella university

NURS-FPX 6021 Biopsychosocial Concepts for Advanced Nursing Practice 1

Prof. Name

Date

Abstract

This quality improvement presentation discussed the alarming concern of secondary infections among patients with acute kidney injury at MedStar Washington Hospital. The quality improvement method selected for this presentation is the PDSA cycle. This continuous improvement cycle comprised the plan, do, study, and act stages. This initiative has implemented the Antimicrobial Stewardship Program and Infection Control Practices (ICP) change strategies to minimize the risk of infections among AKI patients.

The ASP aimed to optimize the use of antibiotics by ensuring safe and proper antimicrobial prescribing and reducing antibiotic resistance. Moreover, ICP addressed the environmental risks of causing infections by implementing hand hygiene and environmental hygiene practices. However, the challenges still persist in effective implementation of this PDSA cycle.The interprofessional team members have been gathered to perform this task and practice infection control strategies. These efforts eventually result in project’s overall success and improve care quality by delivering care treatments in infection-free environment for all patients. 

Quality Improvement Methods

• The quality improvement method that will be utilized to implement the proposed change strategies is the PDSA QI model. It stands for Plan, Do, Study, and Act. The following steps will be established to implement the plan eventually:
• Plan: The team leader, with an interprofessional team and administrator, will address the issue of systemic infections among AKI patients and create the required plan to prevent them.
• Do: This stage will be the implementation phase , where the proposed planning will be executed.
• Study: The data are collected after the pilot-scale implementation of the hand hygiene and ASP program to evaluate the success of the proposed plan.
• Act: After evaluation and further refinement in the plan, the final proposed plan is implemented in hospital to reduced the risk of infections among AKI patients. (McNicholas et al., 2019) 

Challenges of QI Improvement Methods

While the PDSA cycle has the potential to improve quality improvement within healthcare organizations, several challenges are encountered in the practical implementation of this initiative. Healthcare systems are intricate, and multiple interconnections are present. Implementing this cycle in such a complex environment will be challenging, requiring coordinated efforts from a diverse healthcare workforce. This coordination of interprofessional team members can be challenging due to hectic work schedules and resistance to change,

Another challenge is collecting data on systemic infections after implementing the plan initially. There are chances of gathering incorrect assessments of the impact of interventions. There is a strong need for robust data collection mechanisms and accurate metrics to measure infection rates.

Sustaining the improvements in the long run can be difficult. Without ongoing monitoring, reinforcement, and a culture of continuous improvement, there is a risk of gaining systemic infections at the same rate as acquired before the PDSA cycle (McNicholas et al., 2019). 

Evidence Supporting QI Methods

• Various evidence-based studies have used The PDSA cycle as a QI method. 
• According to Eboreime et al. (2020), the PDSA cycle has effectively improved healthcare performance in Nigeria after successfully adapting and implementing this method.
• Another evidence-based article utilizes this approach in maintaining care treatments for pediatrics with Cystic Fibrosis (CF) while minimizing the risk of COVID-19 by implementing a change strategy of routine monitoring of pulmonary microbes among patients through CF culture sputum test. This cycle helped achieve the goal of minimizing the infection rate among pediatric patients of CF (Hamilton et al., 2021).

Knowledge Gaps and Unknowns

The knowledge gaps and unknowns are related to the data collection phase , where inaccuracies may be related to ambiguity about the specific type of infection occurring, factors leading to mortality rates, and patterns of antibiotic resistance, and secondary factors impacting the data collection, such as length of hospital stay and patient satisfaction factors (Chen et al., 2020).

Change Strategy Foundation

Acute kidney injury (AKI) is a common healthcare issue among hospitalized patients with a frequent complaint of secondary infections due to reduced immunity (Chen et al., 2020). Secondary infections due to AKI are the leading cause of death among affected patients (Poston & Koyner, 2019). Patients with AKI are at substantial risk of microbial infections as a result of their immunocompromised state. This calls for a change strategy within MedStar Washington Hospital to minimize secondary infections. The change strategies utilized to prevent the onset of secondary infections due to AKI are the Antimicrobial Stewardship Program (ASP) and the implementation of Infection Control Practices (ICP). The ASP promotes meaningful and optimized use of antibiotics by selecting an appropriate drug with a precise dose and carefully monitoring the complete course of medication (Al-Omari et al., 2020).

The ASP program will involve developing guidelines for the judicious use of antibiotics, establishing interprofessional training sessions, and integrating them into current workflows to facilitate seamless work schedules (Ababneh et al., 2021). Furthermore, the surveillance system will be established to monitor the patterns relevant to resistance and ensure evidence-based antibiotic prescribing is conducted. This will improve patient safety quality and reduce antibiotic resistance (Hwang & Kwon, 2021). The ICP program, as a change strategy, will reduce the environmental risk of causing infections to AKI patients as hand and environmental hygiene is practiced. This program will involve developing standardized protocols for infection prevention and educating healthcare professionals and patients, along with their family members, on preventing infections through educational materials. ICP can lead to equitable care as healthcare professionals aim to deliver safe care treatments in an infection-free (Wilson, 2019).

Potential Challenges

Implementing ASP and ICP can lead to various challenges in the healthcare setup. These challenges include resistance to change and practice, poor support from the administration, the need for extra working hours to perform these initiatives, and lack of adequate financial resources (Ababneh et al., 2021). 

These challenges can be addressed by raising awareness o f the significance of infection control programs and their long-term benefits for organizations and patients. Moreover, collaborating with stakeholders that show similar concern s can enhance buy-in and result in better performance. Healthcare professionals can receive additional incentives and rewards to spur job satisfaction. Lastly, the resources must be effectively utilized in case of no funding to ensure budgeting is conducted correctly.

Interprofessional Team Benefits

• Implementing this change strategy will require a joint effort of nurses, physicians, clinical pharmacists, microbiologists, healthcare administrators, and infection control specialists.
• The team will collaborate, design guidelines and educational content, regularly review antibiotic prescribing and administration behaviors, and foster a concept of shared responsibilities of expected goals (Sheikh et al., 2019).
• The team will also ensure the development of effective communication channels like regular meetings or online portals to streamline the implementation of the change strategy and avoid issues related to the communication gap.
• The assumption on which this analysis is based is that team members can prevent infection control when they share similar goals and insights and collaborate together for the shared goal of minimizing secondary infections among AKI patients.  

Overall Project Benefits

• With the thorough discussion of evidence-based QI methods and change strategies, it is clear that ASP and ICP are great tools for minimizing secondary infections among patients with AKI.
• The PDSA model is easy to design, adapt, and implement for improving healthcare performance in our organization as it enhances performance in evidence-based literature.
• This initiative will utilize the valuable participation of healthcare professionals and promote continuous quality improvement. 

References

Ababneh, M. A., Nasser, S. A., & Rababa’h, A. M. (2021). A systematic review of antimicrobial stewardship program implementation in middle eastern countries. International Journal of Infectious Diseases, 105, 746–752. https://doi.org/10.1016/j.ijid.2021.03.035 

Al-Omari, A., Al Mutair, A., Alhumaid, S., Salih, S., Alanazi, A., Albarsan, H., Abourayan, M., & Al Subaie, M. (2020). The impact of antimicrobial stewardship program implementation at four tertiary private hospitals: Results of a five-years pre-post analysis. Antimicrobial Resistance & Infection Control, 9(1). https://doi.org/10.1186/s13756-020-00751-4 

Chen, Y.-T., Shao, S.-C., Hsu, C.-K., Wu, I-Wen., Hung, M.-J., & Chen, Y.-C. (2020). Incidence of acute kidney injury in COVID-19 infection: A systematic review and meta-analysis. Critical Care, 24(1). https://doi.org/10.1186/s13054-020-03009-y 

NURS FPX 6021 Assessment 3 Quality Improvement Presentation Poster

Eboreime, E. A., Olawepo, J. O., Banke-Thomas, A., & Ramaswamy, R. (2020). Evaluating the design and implementation fidelity of an adapted plan-do-study-act approach to improve health system performance in a nigerian state. Evaluation and Program Planning, 84, 101876. https://doi.org/10.1016/j.evalprogplan.2020.101876 

Hamilton, JenniferL., Stewart, J., Toledo, H., Snuggerud, A. E., & Meihls, S. M. (2021). Quality improvement and rapid PDSA cycles to maintain routine surveillance of pulmonary pathogens during the COVID-19 pandemic in a pediatric cystic fibrosis clinic. Journal of Pediatric Nursing, 63. https://doi.org/10.1016/j.pedn.2021.11.006 

Hwang, S., & Kwon, K. T. (2021). Core elements for successful implementation of antimicrobial stewardship programs. Infection & Chemotherapy, 53(3), 421–435. https://doi.org/10.3947/ic.2021.0093 

McNicholas, C., Lennox, L., Woodcock, T., Bell, D., & Reed, J. E. (2019). Evolving quality improvement support strategies to improve plan–do–study–act cycle fidelity: A retrospective mixed-methods study. BMJ Quality & Safety, 28(5), 356–365. https://doi.org/10.1136/bmjqs-2017-007605 

Poston, J. T., & Koyner, J. L. (2019). Sepsis associated acute kidney injury. BMJ, 364, k4891. https://doi.org/10.1136/bmj.k4891

NURS FPX 6021 Assessment 3 Quality Improvement Presentation Poster

Sheikh, F., Zarowitz, B. J., Sheikh, F., Naqvi, F. A., Heil, E., & Brandt, N. (2019). Interprofessional collaboration improves antibiotic stewardship. Journal of the American Medical Directors Association, 20(3), B22. https://doi.org/10.1016/j.jamda.2019.01.087 

Wilson, J. (2019). Infection control in clinical practice updated edition. In Google Books. Elsevier Health Sciences. https://books.google.com/books?hl=en&lr=&id=YTktpMWytE0C&oi=fnd&pg=PP7&dq=infection+control+practices+as+quality+improvement+plan&ots=2XpGjef835&sig=xZf-2ZkjO0zfok0FFfTmSiOe3mg