EVIDENCE-BASED PRACTICE PROJECT PROPOSAL FINAL PAPER NUR 590

The wellness of a population’s health using improved patient safety protocols implores healthcare workers (HCWs) especially nurses, to develop evidence-based practice interventions to reduce and prevent occurrence of adverse events like hospital acquired infections (HAIs) and medication administration errors (MAEs) among others. These adverse events lead to poor patient outcomes, increase the overall cost of care and disease burden, and lowers the quality of care delivered by healthcare professionals. Hospital acquired infections are some of the leading healthcare concerns that affect patient safety and quality of care. Many patients suffer from these infections that result into lengthened stays in hospitals, increased cost of care, and in extreme circumstances death.

Nurse practitioners and other healthcare professionals transmit infections to patients through poor hand hygiene measures and protocols (Alotaibi & Federico, 2017). As such, nurses and other providers should leverage evidence-based practice (EBP) interventions to reduce and prevent the occurrence of hospital acquired infections and guarantee quality care. The use of evidence-based practice interventions allows these providers to offer better services through increased quality, increased engagement of patients and their preferences, and leveraging clinical experience and expertise. The purpose of this evidence-based practice project proposal paper is to discuss how nurses in pediatric settings can integrate hand hygiene measures and protocols to reduce and prevent the occurrence of hospital acquired infections. These measures and protocols include handwashing using soap and water alongside hand sanitizers compared to handwashing with water and soap alone.

Problem Statement

Hospital acquired infections or nosocomial infections are newly acquired infections that patients contract during their stay in hospital settings or facilities. The transmission of the nosocomial infections happens through healthcare workers, patients, hospital equipment like catheters and interventional procedures that include catheterization. Studies demonstrate that healthcare workers who include nurse practitioners infect patients when they fail to adhere to effective hand hygiene measures like handwashing with soap or using alcohol-based sanitizers and hand rubs when handling and interacting with patient in the care process (Liana 2021). The use of evidence-based practice interventions using PICOT question is important in assisting nurses to implement better practices to reduce the susceptibility of patients acquiring nosocomial infections that have adverse effects on overall care delivery and quality. These infections lead to increased length of stay in hospitals, a rise in cost of healthcare and cause deaths, especially in critical care settings like pediatric units (Setty et al., 2019). Hand hygiene measures that include handwashing with soap and water alongside sanitizer will improve patient safety among healthcare workers. The implication is that healthcare workers will adhere to these measures in pediatric settings to reduce hospital acquired infections within six months’ period and improve quality outcomes.

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PICOT Statement

Population- Healthcare workers in pediatric settings

Intervention-Hand Hygiene using handwashing with soap and water and sanitizer

Comparison-Handwashing with soap and water alone

Outcome- Reduced Hospital acquired infections

Time- in Six months

Refined PICOT Question

The refined PICOT question for the EBP project is “Among healthcare workers in pediatric setting (P), does hand hygiene practices that include handwashing with soap and water alongside hand sanitizer (I) compared to handwashing with soap and water alone (C) reduce hospital acquired infections (O) within six months (T)?”

Organizational Culture and Readiness

The culture of an organization is essential in implementing changes and it impacts its overall vision, mission and values and employees’ perception in embracing new ways of executing tasks. A culture entails employees with strong norms and values, management and approaches to overall way of doing things.  A culture that involves employees, possesses strong values and norms, and encourages an open-door policy with decentralized approach is important in achieving set change objectives in an organization (Real et al., 2017). To effectively implement this EBP project proposal, pediatric healthcare settings and practitioners should use a decentralized organizational and leadership structure. The model is effective in enhancing motivation of subordinates and enhancing growth and increased diversification. Decentralization in healthcare organizations leads to better communication and adoption of innovative practices, ideas and strategies to improve quality of care. Through decentralization, the management leads a transformational approach to enhance agility and respond to new and best practices in care delivery.

The implementation of this EBP project proposal requires organizational culture that focuses on patient-centered care delivery. Through being patient-centered, an organization can support change programs to improve patient safety, quality and access while minimizing the occurrence of hospital acquired infections (HAIs). Increasing patient engagement and promoting inter-professional collaboration leads to a competitive advantage for healthcare organizations.

The evaluation of an organization’s readiness for change based on its culture is essential in implementing evidence-based practice projects. Readiness demonstrates the level to which organizational members are prepared to implement and embrace change, behaviorally and psychologically. Dearing (2018) opines that readiness is a psychological state of the mind that shows commitment to certain course of actions. As such, this EBP project proposal will leverage the Organizational Capacity Assessment Tool developed by the United Nations Development Program (UNDP) that assesses an organization’s readiness in promoting and enhancing the use of global health interventions. Through the tool, organizations identify substantive capacities and strengths that are present and the required one to attain their set objective. In this case, pediatric settings that aim to implement this EBP recommendations should demonstrate exemplary capacities in their attributes, have a superb and influential culture based on their missions, purposes and better values (De la Perrelle et al.., 2020). The capacity assessment tool looks at the various capabilities that include human resources, processes, financial resources, and systems as critical components of readiness for change implementation. Ready organizations possess sufficient strengths that include having the best skills, effective communication and adequate resources, availability of sufficient nurse workforce and effective engagement of their stakeholders.

The organizational readiness also evaluates the process and systems that require improvement to effectively implement the requisite changes (Vax et al., 2021). For instance, the improvement that pediatric care settings require include their patient handling process, the need for healthcare workers to adhere to hand hygiene measures and protocols, and delivery of patient-centered quality care. The organization will need quality improvement and collaborative approaches to enhance implementation. These organizations will also require quality data assessment tools for better and accurate analysis of their respective data (Dearing, 2018). The readiness will also include engagement of stakeholders and integration of information and communication technologies to ensure that all components to implement the project proposal are present. Using selected technologies, the project team and practitioners will pursue outcomes based on patient needs through enhanced alerts, reminders, and notifications on the need to comply with set hand hygiene protocols and measures that include effective handwashing and use of hand sanitizers to reduce hospital acquired infections in the pediatric settings.

Literature Review

Several studies and existing literature supports the incorporation of hand hygiene improvement measures to reduce hospital acquired infections. In their study, Ni et al. (2020) demonstrates that implementation of hand hygiene measures leads to a reduction in hospital acquired infections transmitted by healthcare workers. Using a qualitative design, the authors discuss the outcomes of a research in a large teaching hospital in China about the incorporation of hand hygiene measures to prevent infections and improve patient safety. The authors demonstrate that using handwashing has the potential to reduce HAIs in different care settings, including pediatric units. The article is emphatic that healthcare workers should embrace these interventions as best practices to enhance quality of care and patient outcomes. The study by Setty et al. (2019) implores organizations and healthcare providers to establish hand hygiene measures as one of the evidence-based practices in care management. Using a narrative approach, the authors implore on healthcare workers to disseminate best information to manage and reduce the ever-rising cases of medication errors and adverse events that lead to longer stays in healthcare facilities and increased cost of medication.

Nurses as part of the healthcare workforce should embrace hand hygiene measures to reduce infections and guarantee patient safety and quality care as well as better outcomes. However, many do not embrace these measures. Therefore, it is essential for health organizations and other stakeholders to make the hand hygiene interventions more attractive to nurses since they are frontline care providers and interact more with patients than any other health and medical professionals. Zhao et al. (2017) emphasize the need to make hand hygiene interventions more attractive to nurses and other healthcare workers for effective integration. The study demonstrates that with requisite training and awareness, nurses can implement better practices and make informed choices and decisions on the incorporation of hand hygiene measures to enhance patient safety.

In her study, Liana (2019) explores the effectiveness of hand hygiene practices with the aim of reducing hospital acquired infections. The author notes that all patients hospitalized are at risk of contracting nosocomial infections with certain categories being at the greater risk than others. The study observes that children, the elderly and individuals with compromised immunity are more likely to get an infection while in hospitals. Longer stays in hospitals, use of indwelling catheters, overuse of antibiotics, and the failure by healthcare workers to wash their hands increase the risk for getting nosocomial infections. According to Centers for Disease Control and Prevention (CDC) hospital acquired infections (HAIs) account for close to 1.7 million infections with close to 100,000 individuals dying each year due to associated complications (Liana, 2019). The implication is that healthcare workers should practice proper hand hygiene based on the World Health Organization’s recommendations. These include before touching a patient, after touching them patient, after getting into contact with inanimate surfaces and objects in the patient’s environment, and after having exposure to bodily fluids. They should also have proper hand hygiene before cleaning and aseptic procedures.

Hand hygiene lowers the transmission of pathogens in healthcare settings and healthcare providers need to encourage patients, their families and visitors to regularly decontaminate their hands to reduce infections. The implication is that establishment of proper hand hygiene measures and protocols help reduce nosocomial infections. The study by Staniford et al. (2020) is a systematic review of literature on hand hygiene and environmental disinfection strategies that enhances hygiene standards in pediatric settings. The study emphasizes the need for healthcare workers to change their behaviors with the aim of embracing best practices in handwashing like using soap and water as well as alcohol-based products. nurse practitioners and other healthcare workers should have positive attitude toward hand hygiene measures, have information on protocols and procedures to integrate these interventions with the aim of enhancing patient safety.

In their study, Hillier et al. (2020) explore correct procedures needed for effective hand hygiene. The authors emphasize the significance of nurses possessing relevant knowledge and understanding about evidence-based guidelines like increased use of sanitizers alongside handwashing with hands and water. The authors are categorical that healthcare workers need sufficient knowledge, information and awareness to enhance and integrate the use of these interventions to reduce hospital acquired infections. Using hand hygiene measures, healthcare workers can control and stop the spread of emerging and re-emerging disease’ epidemics and pandemics like the Coronavirus disease of 2019 (COVID-19) in different healthcare settings. The study implores these providers to leverage evidence-based interventions in their care practice and settings to mitigate infections’ transmission.

Clean hands protect individuals from serious infections when they are hospitalized in any facility. The Center for Disease Control and Prevention (CDC) asserts that hand hygiene is the best way to prevent infection. However, many healthcare workers are hesitant to clean their hand leading to healthcare associated infections. In their study Akanji et al. (2017) emphasize the need to institutionalize formal hand hygiene education and feedback compliance among nurses to mitigate and prevent hospital acquired infections. The study shows the need to increase engagement of nurses and other healthcare workers to offer feedback on the most effective interventions to improve patient safety through reduce rate of nosocomial infections. The implication is that organizations and healthcare providers should develop and implement evidence-based practice interventions to reduce different types of infections associated with healthcare settings like central line-associated bloodstream infections that are among the leading types of HAIs.

The study by Azar et al. (2017) shows the need to use agile implementation model to mitigate HAIs among healthcare workers to reduce nosocomial infections. The authors are categorical that nurses and other healthcare workers can deploy various interventions to prevent and reduce the possibility of infections like central line associated bloodstream infections (CLABIs) and catheter-line associated urinary tract infections (CAUTIs) as well as ventilator-associated pneumonia. These studies show that hospital acquired infections are a major healthcare challenge that requires effective evidence-based interventions and best practices as demonstrated in this research proposal. Healthcare workers in pediatric settings have an obligation to reduce and prevent these infections through effective hand hygiene protocols and measures that include handwashing with soap and water as well as using sanitizer.

Change Model or Framework

Evidence-based practice change models are essential as they offer guidelines on the implementation of effective interventions to enhance quality care and patient outcomes. The need to improve patient safety among healthcare workers in pediatric settings through interventions like hand hygiene measures that include washing hands with soap and water alongside sanitizers to prevent and reduce hospital acquired infections is essential. The selected model for this EBP project proposal is the Iowa model. The Iowa model is an effective EBP framework that focuses on the entire healthcare network that comprises of patients, practitioners, infrastructure and all stakeholders to enhance the application of best practices to improve care.

 The model helps and guides the project team to execute practice decisions using accessible research evidence (Collaborative et al., 2017). The Iowa model is suited for this project as it is detailed and applies a pragmatic problem-solving perspective in the implementation of EBP and takes an organizational system approach to generate the desired results to the clinical problem at hand. The Iowa model allows the staff to use the EBP process to question and critically evaluate current nursing practices and if they can enhance care provision by using current evidence.  The model suits this EBP project proposal as it is focused on promoting quality care among the target patient populations.

Stages of the Iowa Model

The Iowa Model of EBP has seven stages that focus on the problem at hand which to reduce the rate of hospital acquired infections (HAIs) in pediatric settings in six months. The first step is to identify the problem that required change. For example, the project team or organization should identify if the issue is problem-based or knowledge-focused trigger that can lead to the need for changes in the practice or nursing setting. In this case, the issue is to reduce the rate of HAIs among pediatric patients by instituting hand hygiene measures among healthcare workers. The second step in the Iowa Model is to demonstrate if there is a priority for the healthcare organization or facility to implement the new practice change. In this case, the level of priority for hand hygiene measures and protocols is high with the aim of reducing HAIs among the healthcare workers in the setting. Studies are categorical that HAIs threaten patient safety and quality care because of their adverse effects like longer stays in hospitals and complications.

The third step is to develop a team that will form, implement, evaluate and integrate the EBP change. The created team should include all interested stakeholders whose role would to appraise the project, synthesize existing literature and evidence, present the findings and implement recommendations to solve the problem at hand. The team should include nurse practitioners, project team manager, administrative representatives and other critical stakeholders to assist in designing the infrastructure for the project’s implementation.

The fourth stage of the change model is to gather and analyze research related to the desired change. The team should evaluate the level and merit of existing evidence. In case the evidence and its merit are not present, the team should conduct a fresh literature search. The team should also formulate and reframe the PICOT question and statement to effectively conduct evidence search for related studies through literature review. The fifth step of the Iowa Model is to review and analyze the obtained literature and ensure that the evidence supporting the EBP is scientifically sound. When the team ascertains the credibility and reliability of the available evidence, it can implement a pilot change to assess its effectively in addressing the practice issue, in this case, reducing HAIs among healthcare workers through hand hygiene measures. The sixth step is to appraise the pilot practice change based on its level of success in addressing the identified issue in the practice setting. The last step is to implement changes realized through the pilot program and evaluate the outcomes, whether they are cost-effective and should be sustained, or if factors requires more changes or should be canceled altogether.

The evaluation of the project’s implementation will demonstrate if the program will impact the target patient population and lead to behavioral change among the healthcare workers to reduce the rate of HAIs. The assessment will be based on real transformation as evidenced through reduced cases of infections and integration of hand hygiene protocols and measures. The implication is that the need to reduce the rate of HAIs is essential in healthcare settings, especially for pediatric care, and implementing interventions using the Iowa model will be important. The Iowa model is based on planning an action process and includes research evidence to translate it into bedside implementations. While there are other models and theoretical frameworks that can be used for this project, the Iowa model makes sense the most as it not only straight forwards to adopt but also the most appropriate for the practice setting.

Implementation Plan

Execution of any changes in an organization or facility comprises of different components that require a project team to develop a plan. Implementation entails the actualization of the ideas developed in the proposed EBP project that are divided into several identifiable steps. The implementation plan will entail integrating hand hygiene measures in pediatric setting among healthcare workers to mitigate hospital acquired infections. The implementation plan has several steps or components that include setting, timelines and resources, methods and instruments, intervention of delivery process and data collection model. The plan also entails management of various aspects of the project like challenges, facilitators and feasibility of the project.

Setting of the Project and Subjects

The setting for the project will be a pediatric hospital with the different cadres of healthcare workers (HCWs) being involved in service delivery to patient population that will be the primary subjects taking part in the proposed project. The chosen participants should have been in the unit for 12 months. The project will choose 20 healthcare workers to be part of the implementation process.  The second aspect of the project is attaining consent or approval from participants and the Institutional Review Board (IRB). Participants’ consent is important as it demonstrates their willingness to participate in the project willingly. The project will attain authorization from the review board and comply with ethical requirements to protect the subjects.

Timelines for the Implementation

The project’s implementation duration is six months when different activities will take place as indicated in the time schedule in appendix. The activities include establishing a multidisciplinary team in the first two weeks, and collection of resources and experts for the process in the last two weeks of the first month. The second month will have activities that include training of nursing staff for three weeks to ascertain that they have sufficient knowledge and skills based on available resources to execute hand hygiene measures aimed at reducing hospital acquired infections. In the first week of the third month, the project team and manager will identify possible barriers which may impact or influence implementation. The duration will also be leveraged to enhance stakeholder engagement and participation and gathering of their views and input for final implementation. The remaining duration will be used to implement the proposed with the pilot change initiative taking place in the first week of the period. The project team will conduct a review of the project in the fifth month to ascertain if there are any changes and modifications needed in the project. The evaluation of the project will occur simultaneously to ascertain its effectiveness to the target population and goals of reducing infections in pediatric settings.

Resources

Studies show that success of EBP projects mainly depend on the existence of required resources (DeNisco, 2019; Luciano et al., 2019). Implementing the project needs human resources that will consist of competent trainers who will impart the team with necessary skills and knowledge. The most appropriate resource for this EBP project proposal are nurse practitioners and clinical nurse leaders. Engagement of nurse practitioners and nurse leaders having the appropriate skills enhance the success of quality improvement projects. Apart from human resources, the project will need financial resources to fund its implementation. The financial resources as captured in the appendix will be used for compensating different stakeholders that include trainers and purchasing of the required stationeries like the training manuals. Changes needed in the implementation of the solution will entail more education and awareness among caregivers as most of pediatric patients do not understand protocols proposed to mitigate hospital acquired infections.

Design in Data Collection and Effectiveness

The EBP project proposal will use a qualitative design as it is effective in understanding thoughts, concepts and experiences of participants through techniques that include interviews, focus groups, and a literature review. The design is effective because it entails collecting opinions from healthcare workers on the need to improve hand hygiene measures to prevent and reduce the prevalence of hospital acquired infections (DeNisco, 2019). The design is effective as it encourages healthcare workers in the chosen settings to comply with hand hygiene measures for effective care delivery and quality patient outcomes.

Monitoring Methods and Instruments  

The implementation process will use an audit tool and satisfaction survey to assess the success of progress of the plan. The satisfaction survey will evaluate the effectiveness of the measured implemented to reduce the prevalence of HAIs in pediatric settings. The team will use the audit tool to complete the project audit process to ensure that all tasks and activities mentioned are implemented well. The tool will improve the auditing of collected data on certain hand hygiene interventions and their overall outcomes. The project will also use questionnaires to collect data from participating nurses as they will provide the requisite information on the effectiveness of hand hygiene measures and protocols.

Delivery of the Intervention

The delivery process will entail project team members consisting of nurse practitioners and leaders in different capacities who will develop and execute these interventions like setting hand sanitizer stations at various points of care. These points will include nursing stations and places within the pediatric wards and other key points to improve hand hygiene protocols. The participants will be trained to allow them execute their tasks and duties. Training will comprise of offering information to nurse leaders concerning aspects of the proposed solution to supervise the practitioners and ensure that they implement their mandate effectively.

Stakeholders to Implement the Plan

Stakeholders are important in implementing the EBP project as they offer resources, inputs, support, and execute the recommendations. The EBP project will involve several stakeholders that include clinical nurse leaders, nurse practitioners, organizations’ management, patients and their families, and suppliers who will ensure that all aspects of the EBP project are attained. The protect team and trainers will also be essential stakeholders as they will offer direction on the overall implementation of the interventions.

Components of the Implementation: Challenges, Barriers and Proposed Strategies

The overall success of this project will depend in the team’s management of various components that include facilitators, barriers and development of effective strategies to respond effectively to all circumstances that may hinder overall implementation (Melnyk & Fineout-Overholt, 2019). Organizational managers and leaders will play a critical role as they will offer the requisite support and allocate resources once they embrace the project and approve it. Critical challenges that may arise include time and resource limitations, insufficient knowledge and skills among healthcare workers, and negative attitude that may fuel resistance. These challenges will hamper effective implementation and should be addressed well by the concerned stakeholders. Again, mitigating these challenges and barriers will require use of effective strategies like sticking to the timelines to avoid scope creep, and engaging all stakeholders for resource allocation and deploying effective communication modalities.

A core aspect of the implementation plan is the feasibility of the project. In this case, the project manager and team will assess the feasibility using a cost-benefit analysis approach (Vandermause et al., 2017). The cost of implementing the project will be evaluated against the overall benefits that it shall have on the target population. The cost of the EBP will include funds to compensate different stakeholders like the trained and purchase of the required project implementation materials. The pediatric units of the organizations should implement the plan as its cost-benefit analysis will lead to a positive effect on the organization.

Evaluation Plan

Evaluation is a critical aspect of project management’s implementation as it assesses if the project’s execution is successful, what needs to be altered and if the work provide is sufficient to offer proof for funding and being supported by stakeholders (Albarqouni et al., 2018). In this case, the evaluation of the EBP project proposal to reduce HAIs in pediatric setting by healthcare workers, will entail assessing the expected outcomes, review of data collection tools, selection of an appropriate statistical test and methods to collect date and measure outcomes.

Expected Outcomes for the EBP Project Proposal

The EBP project is about improving outcomes that will lead to patient safety, quality of care and better intervention by healthcare workers in pediatric settings to reduce and prevent the occurrence of HAIs. The anticipated outcomes from the project comprise of dissemination of knowledge among healthcare workers to reduce HAIs, improvement of patient safety measures and establishing organizational frameworks and polices to integrate hand hygiene protocols and culture among healthcare workers. The proposals will reduce the prevalence of HAIs and expand the adoption of hand hygiene measures that include handwashing with soap and water alongside use of hand sanitizers and alcohol-based hand rubs.

Data Collection Tools Based on Research Design

The selected research design for the project is qualitative as it is an effective approach that leads to understanding of participants’ thoughts, idea and experiences in relation to the proposed interventions and its effectiveness to the selected population (Hunter, 2017). The project’s chosen data collection tool is institutional interviews where the participants will fill questionnaires to detail their experiences and thoughts on the topic. These will include views and opinions and best practices on hand hygiene to enhance quality care and patient safety in pediatric settings by the healthcare workers. Interviews are appropriate tools to collect data since they are flexible, and enhance validity and reliability. Collected data through interviews capture original sentiments, views, and opinions of healthcare workers in pediatric settings. Interviews improve confidentiality, accuracy and information precision as it comes from participants with experience based on t

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