Expert Answer to Benchmark Capstone Project Change Proposal NRS 493 Best Solution

The post has the instructions and complete paper for Benchmark Capstone Project Change Proposal NRS 493. This is a benchmark capstone project change proposal, gcu capstone project example and professional capstone and practicum reflective.

Benchmark Capstone Project Change Proposal

In this assignment, students will pull together the capstone project change proposal components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. For this project, the student will apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.

Develop a 1,250-1,500 written project that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the benchmark capstone project change proposal:

1.     Background

2.     Clinical problem statement.

3.     Purpose of the change proposal in relation to providing patient care in the changing health care system.

4.     PICOT question.

5.     Literature search strategy employed.

6.     Evaluation of the literature.

7.     Applicable change or nursing theory utilized.

8.     Proposed implementation plan with outcome measures.

9.     Discussion of how evidence-based practice was used in creating the intervention plan.

10.   Plan for evaluating the proposed nursing intervention.

11.   Identification of potential barriers to plan implementation, and a discussion of how these could be overcome.

12.   Appendix section, if tables, graphs, surveys, educational materials, etc. are created.

Review the feedback from your instructor on the Topic 3 assignment, PICOT Question Paper, and Topic 6 assignment, Literature Review and benchmark capstone project change proposal. Use this feedback to make appropriate revisions to these before submitting.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

benchmark capstone project change proposal fall prevention

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

RN to BSN

1.1:     Exemplify professionalism in diverse health care settings.

2.2:     Comprehend nursing concepts and health theories.

3.2:     Implement patient care decisions based on evidence-based practice.

Expert Solution to Benchmark Capstone Project Change Proposal

Introduction to benchmark capstone project change proposal

All papers require an introduction and thesis statement. There is a difference between the introduction and background.

Background

Banner Heart Hospital has a problem with nonfunctional Peripheral IVs (PIVs) coming to the Cardiac Cath Lab (CCL) for procedures. Some PIVs are on the wrong arm for the procedure, and some are compromised or occluded. Compromised PIVs are a cause of potential harm to patients and negatively impact the flow of the CCL. Changing this weak area of the institution can result in more positive patient outcomes and reduce costs for the hospital. Patient satisfaction improves when PIVs are not a source of pain, infection, or harm. Patient safety is improved when PIVs are properly working and maintained (Garrett et al., 2017).

Clinical Problem Statement

Nonworking IVs delay cases in the CCL, which causes staff to stay late to finish cases, increasing hospital costs. Compromised PIVs can cause patient harm through infiltration, phlebitis, and extravasation. This is painful for the patient, it can cause serious harm. Extravasation causes tissue damage when vesicant medications infiltrate tissue from the PIV catheter displaced from the vein. Infiltration is when IV fluids running through a displaced IV spread into the nearby tissue. These issues cause patients to stay longer in the hospital and increase costs (Keogh et al., 2016).

Expert answer to benchmark capstone project change proposal nrs 493 best solution
Expert Answer to Benchmark Capstone Project Change Proposal NRS 493 Best Solution

Purpose of Change Proposal

The change project aims to reduce the number of patients entering the CCL with nonworking PIVs. The proposed solution is to establish a pre-operative checklist for the perioperative nurses. The checklist will include criteria that need to be addressed by the pre-op nurse before allowing the patient to leave the floor. The checklist also needs to be communicated in the report between the CCL nurse and pre-op nurse. This solution requires education to be disseminated to all nurses involved regarding the standards of practice for PIV maintenance, the significance of maintaining a working PIV, and how to implement and communicate the checklist (Yagnik et al., 2017).

PICOT Question

PICOT question: Does developing a standardized pre-procedure checklist for PIV standard of practice improve patient outcomes? The development of a pre-procedure checklist would ensure the decreased risk of extravasation, improve procedure times and decrease infection rates. gcu capstone project examples

Literature Search

The GCU library to find all eight research articles. To gather the necessary evidence to support the change proposal, various search engines were used within the database. For instance, databases such as CINAHL, PubMed, and academic search completed helped. Within those databases, filters were used to obtain only the necessary articles that would help the project. Inputting extravasation prevention protocols, and PIV maintenance were the words searched predominantly. The search engines provided valuable supporting evidence.

Benchmark capstone project change proposal
benchmark capstone project change proposal

Evaluation of Literature

Two of my articles were studies performed to decrease the dwell-time of pre-hospital PIVs. Garrett et al. (2017) research studied trauma patients and evaluated the reduction in pre-hospital PIV complications post-intervention. The Ruegg et al. (2018) study followed all patients admitted to a medical centre and evaluated the number of pre-hospital PIVs that remained in place over 24 hours. The interventions used in both studies involved education for staff and a small practice change, placing an identifying sticker on each field stick site. Both studies had positive clinical outcomes, which helped support my PICOT question of implementing education and a small practice change, in my case a checklist, to improve patient PIV outcomes.

The Yagnik et al. (2017) study found that using inexpensive, simple interventions resulted in nurse practice improvement and increased adherence to PIV guidelines (Capps, 2020d). Another article explored the positive impact of dressing integrity on reducing PIV complications (Corley et al., 2019). Part of the low-cost education piece for my intervention will include EBP on dressings and securement practices; dressing assessments will be an item on the pre-procedure checklist as well. Keogh et al. (2016) explored the effects of different flushing methods on PIV failure. No conclusive findings were discovered that proved any one method better than another. Flushing PIVs per policy will be included in the PIV maintenance education and on the checklist. Two of my articles, Salgueiro et al. (2019) and Brady et al. (2016) showed that nurses often do not follow policy on PIV maintenance and that quality improvement projects and education can increase nursing compliance. This supports both my issue and my intervention. My final article, by Willassen et al. 2018, supports the idea that a checklist improves patient safety when adhered to by all team members. All of my articles lend support to my PICOT question.

Change or Nursing Theory

Lewin’s three-part Theory of Planned Change supports my research proposal. In the first phase of my project, data will be gathered on the number of nonworking PIVs arriving at CCL. This gives evidence and understanding that change is needed, which is Lewin’s first phase. During the second phase, education will be implemented utilizing the pre-procedure checklist. The final phase is to establish a new normal. During this phase, continued assessment of PIVs working or nonworking will be evaluated entering the CCL (Barrow et al., 2020).

Implementation Plan and Outcome Measures

My plan is to re-educate nursing staff who send patients to the CCL regarding EBP for PIV maintenance and to introduce a pre-procedure checklist to be communicated in report between the pre-op and CCL nurses. Education will be given verbally in pre-shift over a 4-week period before use of the checklist begins. A read-and-sign document with the written education and example of the checklist will be in the breakroom of each unit involved. Handouts of the education and checklist will be there for staff to take. Emails will be sent to all staff with the same information. A poster will be hung in each breakroom as a visual reminder (Yagnik et al., 2017). All staff must participate in the read-and-sign by the appointed date, at which time the checklist will be live for all nurses sending patients for a CCL procedure.

My project has three anticipated outcomes. First, a reduction in the number of compromised PIVs sent to the CCL. Secondly, the implementation of a pre-procedure checklist that is discussed in the report prior to procedures. This practice change must occur in order to achieve the first outcome. Finally, the nursing staff will incorporate practice changes and maintain PIVs according to EBP and hospital policy. When nurses are maintaining PIVs according to EBP and hospital policy, complications will be fewer and caught sooner (Salgueiro et al., 2019). This overall better PIV health for the hospital will roll over into better PIVs entering the CCL.

Use of Evidence-Based Practice in Intervention Plan

Many studies have shown that nursing practice varies when it comes to PIV maintenance. The education portion of my intervention will use EBP for proper PIV care and maintenance. This will include the type of dressing and securement, dating it, and when to change it. Dressings need to be changed every 5-7 days or when wet, soiled, or loose. EBP will also include flushing PIVs according to hospital policy. Also, reminders for documentation of the PIV insertion date and any complications will be included. Placement of PIVs will be addressed, as EBP has shown that insertion of PIVs at the antecubital fossa has a high rate of occlusion and accidental removal (Brady et al., 2016).

Plan for Evaluating Proposed Nursing Intervention

Evaluation will compare the number of nonfunctional PIVs entering the CCL before the intervention with the number of nonfunctional PIVs after the intervention. Data will be collected on the past 6 weeks of nonworking PIVs to use for a comparison. Each procedure room will be given a checklist to document, “Compromised IV / Incorrect Side.” I’ll number the list vertically and across the top will be the headings, “Date,” “Sending Department (i.e., ER, CVICU, 4th Floor, etc.),” and “Description of Problem (i.e., clotted, leaking, phlebitis, pain with flushing, wrong arm, etc.).” The CCL team will be presented with the plan prior to the 6-week assessment period and will be reminded each morning in huddle. Each time a problem PIV presents for procedure, the nurse can simply write the date, sending unit, and issue on the list. Lists will be collected at the end of 6 weeks. Following this, the 4-week intervention roll-out will take place, and the same evaluation will be performed again for 6 weeks (Garrett et al., 2017). At the end of the post-evaluation period, lists will be collected, and the numbers will be counted and compared.

Benchmark capstone project change proposal
benchmark capstone project change proposal

Potential Barriers and Plan to Overcome Barriers

Possible barriers for implementation of this project include lack of administrative support and staff resistance to change. A couple of years ago, the hospital did away with clinical managers for the inpatient units. This puts a big strain on the directors and senior clinical managers. Adding in another project that requires staff follow-up and consistent education may be impossible for them. Staff resistance may occur, and I would like to recruit peer support from specific floor nurses to speak positively of the project and to encourage others to make the change and better patient outcomes (Ginex, 2018).

Conclusion

Creating a patient experience free of unnecessary complications contributes to patient safety and increases patient satisfaction. Anticipation of CCL procedures can cause patients anxiety without the compounding effect of a nonworking PIV. Maintaining healthy PIVs and heeding the PIV checklist requirements contribute to positive patient outcomes.

References

Barrow, J. M., Annamaraju, P., & Toney-Butler, T. J. (2020). Change Management. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK459380/#article-89.s1

Brady, T., Bruno, F., Marchionni, C., & Paquet, F. (2016). Prevalence and maintenance practices of peripheral intravenous catheters. Vascular Access, 11–19. https://eds-b-ebscohost-com.lopes.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=80&sid=f8b8457c-a699-4b83-b17c-2f62928f4320%40pdc-v-sessmgr05

Corley, A., Ullman, A. J., Mihala, G., Ray-Barruel, G., Alexandrou, E., & Rickard, C. M. (2019). Peripheral intravenous catheter dressing and securement practice is associated with site complications and suboptimal dressing integrity: a secondary analysis of 40,637 catheters. International Journal of Nursing Studies, 100. https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S0020748919302160?via%3Dihub

Garrett, A., Drake, S. A., & Holcomb, J. B. (2017). Process to decrease complications in trauma patients with prehospital peripheral intravenous access. Journal of Trauma Nursing, 24(4), 236–241. https://eds-a-ebscohost-com.lopes.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=16&sid=f65e61f5-8501-4bc4-9664-1a72f71b0af5%40sdc-v-sessmgr01

Ginex, P. K. (2018, May 30). Overcome barriers to applying an evidence-based process for practice change. ONS Voice. https://voice.ons.org/news-and-views/overcome-barriers-to-applying-an-evidence-based-process-for-practice-change

Grand Canyon University. (n.d.). Find Journal Articles. https://libguides.gcu.edu/az.php

Keogh, S., Flynn, J., Marsh, N., Mihala, G., Davies, K., & Rickard, C. (2016). Varied flushing frequency and volume to prevent peripheral intravenous catheter failure: a pilot, factorial randomized controlled trial in adult medical-surgical hospital patients. Trials, 1, 1–10. https://doi.org/10.1186/s13063-016-1470-6

Ruegg, L., Faucett, M., & Choong, K. (2018). Emergency inserted peripheral intravenous catheters: A quality improvement project. British Journal of Nursing, 27(14), S28–S30. https://eds-a-ebscohost-com.lopes.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=25&sid=f65e61f5-8501-4bc4-9664-1a72f71b0af5%40sdc-v-sessmgr01

Salgueiro, A. D., Costa, P. J., Graveto, J. M., Costa, F. J., Osorio, N. I., Cosme, A. S., & Parreira, P. M. (2019). Nurses’ peripheral intravenous catheter-related practices: A descriptive study. Revista de Enfermagem Referência, 4(21), 111–120. https://eds-a-ebscohost-com.lopes.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=21&sid=f65e61f5-8501-4bc4-9664-1a72f71b0af5%40sdc-v-sessmgr01

Vascular Access Policy Group. (2019). Peripheral intravenous therapy, adults (Number 687, Version 16). Banner Health Policy. benchmark capstone project change proposal

Willassen, E., Jacobsen, I., & Tveiten, S. (2018). Safe surgery checklist, patient safety, teamwork, and responsibility—coequal demands? A focus group study. Global Qualitative Nursing Research, 5, 233339361876407. https://doi.org/10.1177/2333393618764070

Yagnik, L., Graves, A., & Thong, K. (2017). Plastic in patient study: prospective audit of adherence to peripheral intravenous cannula monitoring and documentation guidelines, with the aim of reducing future rates of intravenous cannula-related complications. American Journal of Infection Control, 45(1), 34–38. https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S0196655316308628?via%3Dihub

 

                                                                            Appendix B

Pre-Procedure Checklist for Cath Lab

  • Is the procedure a pacemaker or ICD? IV must be on the same arm as the side the device being placed.
  • Does IV flush easily?
  • Does IV have blood return?
  • How many days has IV been in place?
  • Is the dressing clean, dry, and intact?
  • Is IV secured?
  • Are there any signs of redness, leaking, or infiltration? Does the patient have pain with flushing? If yes to any of these, discontinue IV and start a new IV. benchmark capstone project change proposal

For the community assessment and analysis presentation

Appendix C

PIV Eduation

  • Background: Complications from IVs cause harm to patients, extend hospital stays, and increase costs.
  • PIVs for Cath/EP Lab: Nonworking PIVs cause delays in cath lab cases and increase patient anxiety due to lying on a cold, hard table getting poked for a new PIV. Patients receive vesicant medications in the cath lab that require a patent, well-placed PIV.
  • Pacemakers/Defibrillators: Patients going for a pacemaker or defibrillator implant must have a PIV on the SAME arm as the side of the chest the device will be placed. This is typically the left side, but not always; check your orders or call the doctor if they did not specify. A CENTRAL LINE IS NOT ACCEPTABLE FOR DEVICE PROCEDURES. This is because IV contrast is pushed under fluoroscopy through the PIV so the cardiologist can visualize the vascular anatomy of the patient when they stick for access. Pushing through a central line does not highlight the needed area. benchmark capstone project change proposal gcu
  • EBP for PIV Maintenance:
    • Flushing: Hospital policy requires peripheral IVs (PIVs) to be flushed with a minimum of 3 ml every 12 hours to maintain catheter patency. PIVs should be flushed before and after medication administration
    • Dressings: Must be adherent at insertion site. Edges can be reinforced if insertion site is intact. Dressing must be changed every 5-7 days or if soiled, wet, or nonadherent.
    • Dwell time: Change PIV sites when clinically indicated—pain, phlebitis, infiltration, leaking, extravasation, or occluded. Exception – remove field sticks within 24 hours.
  • Benchmark capstone project change proposalDocumentation: Signs of pain, leaking, phlebitis, infiltration, occlusion, or extravasation must be documented. Document insertion and discontinuation times (Vascular Access Policy Group, 2019).
  • Hand-off Communication: Discuss the Pre-Procedure Checklist in report with the cath lab RN before the procedure. Inform them of any issues related to the PIV. Resolving issues before taking the patient down constitutes a better and safer experience for the patient. benchmark capstone project change proposal portfolio

benchmark capstone project change proposal

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