NR 554 Week 1 Discussion, Connecting Workplace Issues with Policy

Connecting Workplace Issues with Policy NAME Chamberlain College of Nursing NR 554: Nurse Leader and Healthcare Policy DATE New information based on policy decisions locally, regionally, and nationally is often presented to staff by nurse leaders. Identify a recent change at your current, or most recent, workplace that was policy based. Discuss the policy and how the change supported positive patient outcomes. Week 1: Connecting Workplace Issues with Policy Blood culture contamination is a common problem in the emergency department (ED) that leads to unnecessary patient morbidity and health care costs. False-positive results in blood cultures are primarily due to contaminants. These false-positive cultures, at the microbiological laboratory level, require significant additional resources for workup. Additionally, they result in unnecessary antibiotic treatment and hospitalization days, causing needless harm to patients. Various methods have been implemented in order to reduce blood culture contaminants including the use of 2% Chlorhexidine Gluconate (CHG) Cloths. In October 2017, the Emergency Services Institute had significantly higher baseline rates of blood culture contamination from peripheral sticks than any other department. The entire emergency department went through individual mandatory blood culture training with the departments Clinical Nurse Specialist and Nurse Educator. Even after proper training the Emergency Department still has the high blood culture contamination rates from peripheral sticks. The quality improvement (QI) intervention to use CHG cloths for reducing blood culture contamination in the ED was initiated. Numerous studies have shown that Chlorhexidine bathing is effective in reducing levels of pathogens on the skin. A 2% CHG impregnated alcohol-free no-rinse cloth used for presurgical skin preparation is associated with excellent rapid reductions of bacterial counts (Edmiston, Bruden, Rucinski, Henen, Graham, & Lewis, 2013). A practice change outlining the proper use of the CHG cloths and collection technique using required sterile kits has been implemented. The patient’s entire arm should be wiped using the CHG for 30 seconds, then allowed to dry completely. Next, the insertion site is scrubbed with Chloraprep for 30 seconds and allowed to dry completely. Finally, the blood cultures can be drawn per hospital policy using a sterile kit. Current monitoring of staff to assess compliance with regular feedback is an ongoing process. Frequent monitoring with regular feedback will improve the suboptimal use of the CHG cloths, thus decreasing the incidence of blood culture contamination. The initial results from this practice change have not been presented to the staff to assess the effect of using the cloths to prevent cross-contamination. References Edmiston, C. J., Bruden, B., Rucinski, M. C., Henen, C., Graham, M. B., & Lewis, B. L. (2013). Reducing the risk of surgical site infections: does chlorhexidine gluconate provide a risk reduction benefit?. American Journal Of Infection Control, 41(5 Suppl), S49-S55. doi:10.1016/.2012.10.030 Response to Peer: Bedside shift reporting system has proven to improve patient outcome and experienced. Sandra, I agree that inadequate hands-off communication can result in an increase in patient safety risk. Inadequate hand-off communication is a contributing factor to adverse events, including sentinel events (The Joint Commission, 2017). Approximately 80% of serious medical errors are believed to result from faults in communication between caregivers when transferring responsibility and accountability for patients (The Joint Commission, 2012). To improve information sharing during patient handoffs, nurses can assess patients and give report at shift change together at the bedside. Thus, bedside communication serves to advocate for a patient’s safety and promote team collaboration. According to Bu & Jezewski, bedside report can be viewed through the theoretical lens of the midrange theory of patient advocacy (2006). Mid-range theory of patient advocacy includes safeguarding patients’ autonomy, acting on behalf of patients when they are unable to act, and championing social justice in the provision of health care (Bu & Jezewski, 2006). Therefore, bedside report is an inclusive and important patient care practice that allows nurses to act on behalf of their patients. References Bu, X., & Jezewski, M.A. (2006). Developing a mid-range theory of patient advocacy through concept analysis. Journal of Advanced Nursing, 57(1), 101-110. The Joint Commission. (2017). Inadequate hand-off communication. Sentinel Event Alert, 58, 1-7. The Joint Commission. (2012). Center for transforming healthcare releases targeted solutions tool for hand-off communication. Joint Commission Perspectives, 32(8), 1-3. Response to Peer: Workplace violence and support from leadership Kerlande, Violence in the hospital setting can occur in various forms. Hospitals must adequately consider violence in all its forms and take the necessary steps to address the problem. Workplace violence has the potential to harm workers both physically and emotionally and makes it more difficult for employees to perform their jobs efficiently. In addition, workplace violence can lead to higher turnover and deterioration of productivity and morale. Thus, workplace violence prevention begins with a strong and stable leadership team. Studies show a direct connection between engaged leadership, workplace security, and organizational success. A strong commitment from nursing leadership is critical to the overall success of a workplace violence prevention program. Leadership needs to provide a clear statement of the organization’s position on workplace violence, explain the consequences for violation, and inform all stakeholders involved. When employees understand clearly defined policies and procedures and there is visible leadership involvement, employees are influenced to report violent occurrences or related concerns.