Leadership Learning Experience: Reinforcing Asepsis in the OR

Identification and Explanation of the Problem/Issue

One of the primary goals of the surgical team is to prevent surgical site infections in the operating room(OR). As such, there are many activities put in place to support this goal which includes sterilization and disinfection of instruments, antibiotic prophylaxis and environmental cleaning. Still, the operating roomactivities that involve aseptic practices plays the greatest role in helping the surgical team decrease the risk of surgical site infections. The main goal of asepsis is in preventing the contamination of the operative site and this is accomplished by maintaining a sterile field designed to prevent microorganisms from entering Leadership Learning Experience: Reinforcing Asepsis in the OR.

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Evidence-based practice supported by a wide body of research suggests that aseptic technique is successful at preventing infections in the operating room (Beldi, Bisch-Knaden, Banz, Mühlemann & Candinas, 2009; Adams, Korniewicz & El-Masri, 2011; Labrague, Arteche, Yboa& Pacolor, 2012), yet compliance with this preemptive measure has demonstrated opportunities for improvement within my organization.This is an important issue in healthcare as breaks in sterile technique is a significant contributing factor in surgical site infections which are the second most common hospital-acquired infection (HAI) in hospitalized patients(Safe Care Campaign, 2014). This often result in an increase in patient mortality, length of stay and readmission rates. What’s more is that it has been estimated that roughly 40% to 60% of these infections are preventable(Safe Care Campaign, 2014).In addition, according to the Centers for Disease Control and Prevention (2009), the cost associated with surgical site infections are astronomical and ranges from $28 billion to $45 billion annually Leadership Learning Experience: Reinforcing Asepsis in the OR.

The problem identified within my organization is related to the practice of aseptic technique in the operation room. A trend was noted in the readmission rates in patients who underwent various orthopedic surgeries. For example, the Clinical Documentation Specialists within the Quality Improvement department conducted a 6-monthretrospective review of the readmissions relating to surgical procedures and found a significant increase in the number of readmissions linked to surgical site infections. More specifically, a 2.5% increase over the course of this 6-month period was noted. Leadership Learning Experience: Reinforcing Asepsis in the OR  As an RN working in the operating room, this is an issue that requires an intervention as it is a threat to patient safety.

Analysis of the Situation

In analyzing areas that might be contributing to the problem, a survey of the operating room personnel revealed that many of the staff reported a common factor that contributed to breaks in sterile technique:the fast-paced nature of the OR. In addition, direct observations during invasive procedures (catheter insertions, intubations etc) performed after the trend was noted revealed in many instances, gloves took the place of hand disinfection and were often used for a number of tasks. The use of gloves in an unsystematic manner increases the risk of HAIs Leadership Learning Experience: Reinforcing Asepsis in the OR. In addition, a total of 30 missed opportunities for aseptic technique in a 1-hour period was also noted based on observation. A deeper analysis of the data revealed that breaks in sterile techniques fell into one of four categories. These included category 1 which consisted of breaks in asepsis that were immediately noticed; category 2 consisted of breaks in asepsis that are realized shortly after the occurrence; category 3 comprised of breaks that were later realized and category 4 consisted of breaks that went unnoticed.

Proposing a Solution

Given that there are recommended standards, practices and guidelines created by organizations such as the Association of periOperative Registered Nurses (AORN) to be utilized by surgical teams to achieve aseptic practice in the perioperative setting, a careful review of these protocols and subsequent inclusion into a plan of correction was implemented. Since the principles of aseptic technique plays a vital role in the goal of asepsis in the OR, it is essentially the responsibility of all staff members to mindfully incorporate these principles into their practice. As such, operating room personnel (i.e. nurses, scrub techs, surgeons, anesthesiologists, etc) will be required to attend a two-day educational in-service “Beat the Bugs: Infection Control Fair” that places emphasis on the importance of creating and maintaining asepsis technique as well as plans of action to implement when a break in sterile technique is noted. Day one of the in-service will focus on games and simulated scenarios that that involve breaks in asepsis and interventions that can be implemented to ameliorate the situation. These scenarios will be designed to help staff draw upon their critical thinking skills. Leadership Learning Experience: Reinforcing Asepsis in the OR. Day 2 will consist of reviewing the principles of asepsis where the following five AORN principles will be discussed:

The sterile field consists of only scrubbed personnel: Although the surgical team consists of sterile and non-sterile individuals, only individuals who are scrubbed or sterile should be directly located in the sterile field. In contrast, non-sterile members remain outside the periphery of the sterile field. More so, all sterile members must don scrub attire inclusive of surgical mask, gown and gloves. In addition, prior to donning gloves and surgical gown, the sterile staff must perform surgical hand scrub and thereafter recognize that boundaries of the sterile area (Association of periOperative Registered Nurses [AORN], 2017) Leadership Learning Experience: Reinforcing Asepsis in the OR.

Sterile field is created using sterile drapes: The use of sterile drapes establishes a barrier to decrease the passage of microorganisms into the sterile field. As such, drapes should cover the patient and any equipment and furniture that are a part of the sterile field with the site of incision left exposed. Once drapes have been placed, it should not be moved and only the top surface is considered sterile(AORN, 2017).

The sterile field should only contain sterile items: It is evident that sterilization ensures that all instruments are without microorganisms, however, fluid and air can contaminate the sterile field. As such, sterile and non-sterile items should never occupy the same space and if a container or package has been compromised, it should be thought of a contaminated and replaced(AORN, 2017).

Sterility should be maintained when items are opened and added to the sterile field:In an attempt to preserve the integrity of the items and sterile field, the circulating nurse should use caution when placing items on the sterile field by securely handing them off to the scrubbed member or by placing them securely on the sterile field.When opening the sterile package, the non-sterile person must present the item to the sterile person in such a way to prevent contamination. In the same breadth, when opening a sterile solution only the top rim of the bottle and the contents of the bottle are considered sterile once the cover has been removed(AORN, 2017).

Sterile field must be maintained: Maintaining sterility is one of the OR staffs’ main responsibilities by making every effort to reduce the possibility of contamination. As such, when a breach in sterility occurs, it is of the utmost importance to take actions that will serve to reduce the risk of contamination. If there is ever a doubt about whether an item is sterile, it is best to consider it contaminated and replace it(AORN, 2017).

Recommendation of Sources and Timeline for Implementation

Resources will include incorporating and reinforcing policies created to assist OR staff to promote patient safety by being compliant with asepsis. These resources will draw upon the AORN, the Institute for Hospital Improvement (IHI), the Agency for Healthcare Research and Quality (AHRQ) as well as Joint Commission standards. In terms of a cost-benefits analysis, the 2-day in-service can be carried out without the assistance of a third-party vendor/ facilitator as the infection control nurse within the Quality Management department has the expertise to oversee this event. Leadership Learning Experience: Reinforcing Asepsis in the OR. As a result, the organization can expect this event to be fairly inexpensive while still providing a well-organized infection control fair. In terms of a timeline, planning for the event is expected to be a 1 week while the fair itself will last over the course of 2 days.

Identification of Key Stakeholders

The success of the “Beat the Bugs: Infection Control Fair” and educational in-service will depend largely, in part, on the attendance of the operating room staff. As such, the Chief Medical Officer (CMO), Chief Nursing Officer (CNO), NurseManager of the OR, and OR supervisor are crucial key players that are needed to obtain “buy-in” from the OR staff. The CMO and CNO are leadership positions, that oversee the physicians and nursing staff, respectively. As a result, they are influential and will play a key role in not only gaining support from key operating room personnel but driving home the importance of this event in relation to promoting patient safety. A meeting with both the CMO and CNO revealed enthusiasm and a dedication to getting this initiative underway. Both individuals noted a steadfast commitment to this project and a desire to move the practices of the operating room in the right direction to become more aligned with the patient safety goals noted in the mission and vision of the organization as well as the National Patient Safety Goals established by the Joint Commission.In fact, both parties, suggested that perhaps this initiative can be conducted on an annual basis. The involvement of the infection control nurse is another key stakeholder that cannot be overlooked due to the expertise in which a person in this position possesses Leadership Learning Experience: Reinforcing Asepsis in the OR. Still perhaps, two of the more important players are that of the OR Nurse Manager and Supervisor as they are considered the middle managers with a direct relationship and sphere of influence with the nurses and scrub techs.

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In terms of achieving success, communication is the foundation of any successful partnership or project particularly one that is comprised of a multidisciplinary team such as this one. As such, it is important keep the communication channels open. This can be done through encouraging the key stakeholders to continue to provide input as it relates to their respective roles, encouraging all members to report any concerns as well as continuously reinforce the purpose and goals of this initiative Leadership Learning Experience: Reinforcing Asepsis in the OR.

Discussion of Implementation and Evaluation of the Solution

As previously noted, a 2 day “Beat the Bugs: Infection Control Fair and Educational In-service” will be carried out that places emphasis on the importance of creating and maintaining asepsis technique as well as actionplans to implement when a break in sterile technique is noted. Day one of the in-service will focus on games and simulated scenarios that that involve breaks in asepsis technique and interventions that can be implemented to ameliorate the situation. These scenarios will be designed to help staff hone in on their critical thinking skills. Day 2 will consist of reviewing the principles of asepsis Leadership Learning Experience: Reinforcing Asepsis in the OR. Evaluation of this solution can be carried out using several techniques. First, with my assistance, the infection control nurse can conduct unannounced observance of the operating room personnel. This observation would determine how well the surgical team adheres to the principles of asepsis. Second, the readmissions related to surgical site infections can be monitored over a period of 3 to 6 months after the staff participated and were re-educated in the principles of asepsis. Ideally, the goal is to show a decrease in the number and rate of surgical site infections that were related to breaks in asepsis. These results can be reported on a monthly basis at the Quality Improvement meeting.

 

Explanation of Roles

The role of scientist was fulfilled by gathering and analyzing the data regarding the readmissions that were linked to surgical site infections.  The increasing trend in the rate of surgical site infections and its association with the breaks in asepsis techniques presented as scientific evidence that served as a barrier to providing safe and quality care for patients. In the same breadth, the role of detective was carried out upon surveying the staff to determine what they perceived as reasons for the breaks in sterile technique Leadership Learning Experience: Reinforcing Asepsis in the OR. As such, a common thread among their responses revealed that the fast-paced nature of the OR to be challenging. Where manager of the healing environment is concerned, the solution consisted of the 2-day infection control fair. This was an appropriate intervention that was not only creative and flexible but considered the contribution of multiple stakeholders with the primary goal of reinforcing patient safety in mind.

 

References

Adams, J. S., Korniewicz, D. M., & El-Masri, M. M. (2011). A descriptive study exploring the principles of asepsis techniques among perioperative personnel during surgery. Canadian Operating Room Nursing Journal, 29(4), 6-8.

Association of periOperative Registered Nurses. (2017). Aseptic technique. Retrieved January 20th, 2017 from https://www.aorn.org/guidelines/guideline-implementation-topics/aseptic-technique

Beldi, G., Bisch-Knaden, S., Banz, V., Mühlemann, K., & Candinas, D. (2009). Impact of intraoperative behavior on surgical site infections. The American Journal of Surgery, 198(2), 157-162.

Centers for Disease Control and Prevention. (2009). Direct medical costs of healthcare-associated infections in U.S. hospitals and the benefits of prevention. Retrieved January 20th, 2017 fromhttp://www.cdc.gov/hai/pdfs/hai/scott_costpaper.pdf. Leadership Learning Experience: Reinforcing Asepsis in the OR

Labrague, L. J., Arteche, D. L., Yboa, B. C., & Pacolor, N. F. (2012). Operating room nurses’ knowledge and practice of sterile technique. Journal of Nursing Care, 1(4).

Safe Care Campaign. (2014). Preventing health care and community associated infections. Retrieved January 20th, 2017 from http://www.safecare campaign.org/ssi.html. Leadership Learning Experience: Reinforcing Asepsis in the OR

Health Information Management (HIM)

Question 1   Explain the purpose of an organization chart, and reference an organization chart related to health information management from the Internet.  Your response must be at least 200 words in length.

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Question 2   List the HIM functions in a paper processing department and compare them with the functions required for processing in an EHR environment.  Your response must be at least 200 words in length.

Question 3   List three circumstances that will require planning in the HIM department.  Your response must be at least 200 words in length.

Question 4   What is the purpose of performance standards?  Your response must be at least 200 words in length

Diabetes in Hispanic American Adolescent

Edit the following…

Researchers show that the rate of increase of both types of diabetes increased, especially in the Latino population. The Latino youth aged below 20 years is the word hit by this epidemic. This study analyses the PICOT statement on diabetes and the Hispanic population. The focus is on the youth who have the highest risk of contracting this infection; then we provide an evidence based solution, nursing intervention, patient care, healthcare agency, and nursing practice. The focus of the study question for this PICOT Staementis In Hispanic Americans Adolescents, ‘how does dietary, and lifestyles changes compared with no intervention reduce A1C levels in the first three months of diagnosis? Diabetes in Hispanic American Adolescent

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The PICOT Statement

The population under observation is the Hispanic American youth who have recently been diagnosed and found to be having more and larger increase in the rates of increase of cases of diabetes. This study examines both types of diabetes affecting the Hispanic youth aged below the age of twenty years. It has been identified in the past that the advent in which diabetes increase in the population of the Hispanic American is wanting and must be analyzed.

Without intervention, the first three months of diagnosis of a patient with diabetes leads to particular and healthy dietary pattern to help reduce the effect of diabetes. This means that the patient tries to focus on methods that can assist in treating diabetes by reducing their weight and A1C levels in the blood(Ackroyd & Wexler, 2014). However, it is clear that these people lack the knowledge to conduct a healthy lifestyle. Thus, there is always a need for clinical intervention.

With a clinical response in the diagnosis of diabetes, many patients have been identified to lose weight and maintain a health dietary as advice by the doctors and nurses. A mean weight loss for after intervention with the nurses and on the treatment of diabetes, study show that an average of 5-8.7% weight is lost before a person gets to a plateau and become reluctant in exercising.

On the other hand, patient care has also been noted to improve the healthcare for the individual with either type of diabetes. Patient care can be divided into categories such as self-centered management and quality improvement. A randomized test for 94 level patient care randomized test shows that strategies used in patient care reduce the levels of A1C by a sum of above 5%. In particular self-management reduced A1C by 0.21% patient education by 0.21%, and electronic patient registries (0.08%), and patient reminders (0.02%)(Davis et al., 2009).

The above metrics show that nursing practices improve the case of diabetes by a significant amount of A1C reduction rate. This means that the intervention of the clinical assistance, healthcare agents such as doctors, and nursing practice assist patients in achieving a healthy living. However, in of all the studies conducted, none of the third party can give a 100% management of A1C levels or weight loss(Ackroyd & Wexler, 2014). Weight is associated with chronic diabetes and lack of enough control of the sugar levels in the body. Diabetes in Hispanic American Adolescent

This means that effective management and prevention of diabetes in a patient, especially a study population of Hispanic American, he patients themselves must be willing to work extra hard. Weight loss can be achieved, for example, Mike Huckabee who is recorded to have lost 110 pounds and was able to cure diabetes. It is only lack of willingness that makes the patients live with diabetes and lose the fight.

Conclusion

This study identified that the Hispanic population is the most prone to diabetes. A PICO analysis was conducted to determine the effect of various methods in assisting deal with the issue. The study showed that the intervention and a patient care assistant in reducing weight and reporting low levels of A1C. Diabetes in Hispanic American Adolescent

Effective Communication in the Work place

Organizations work to improve overall written and verbal communication to encourage a win-win situation for improved patient or customer care, increased team motivation, and supportive management. Effective communication encourages active listening among people and improved understanding of a situation embracing both similarities and differences in each employee. Let’s read the following scenario to emphasize the importance of effective communication in a workplace. Effective Communication in the Work place

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You are the keynote speaker to improve overall communication effectiveness in your organization. Your presentation consists of 12–15 Microsoft PowerPoint slides (not including the title and reference slide) along with speaker notes. You are addressing an audience comprising all department heads and management staff.

Your overall focus is on common communication problems, various methods of learning, issues with feedback, and improving overall attitude through communication.

Address the following areas including detailed speaker notes. The speaker notes area is the white space below the slide where you can type information similar to a Microsoft Word document. Your Microsoft PowerPoint presentation consists of professional color slides, with detailed speaker notes to include examples to support each slide.

• Describe four forms of communication used in the work environment. Discuss the benefits and concerns with each communication method. For example, body language, written, oral, and e-mail.
• Describe four methods of learning and listening. How does a person learn (auditory, visual, etc.) if he or she has a preferred method? How can the person adjust to learning in ways not in his or her preferred method?
• What environmental and personal barriers hinder communication? Be specific and provide at least three examples.
• What impact can diversity in the work environment have on effective and ineffective communication according to age, gender, cultural, or religious diversity?
• What three errors do managers commit when providing ineffective feedback?
• Describe three issues managers and team members face if they are not prepared to provide instant communication? What negative result can occur if one is not prepared?
• Describe four methods to overcome communication barriers and provide detailed examples.
• Provide three key elements with specific examples on how effective communication can reduce errors, improve professional relationships, and assist staff with clear communication.

Effective Communication in the Work place

Transcultural Nursing Course Description

Transcultural Nursing explores cultural beliefs and practices as they apply to a population’s health and the development of illnesses, as well as similarities and differences among cultural groups. Course materials and resources allow students to explore appropriate communication, cultural needs within the nursing scope of practice, and patient-centered care based on cultural values and preferences. Students will also identify disparities in health and health care among cultural groups. Transcultural Nursing Course Description

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TRANSCULTURAL NURSING COURSE DESIGN

Transcultural nursing

applies knowledge of differences in cultural norms and best practices to the provision of care based on the history, religion, and traditions of the patient. Nurses can provide higher-quality care when they are well versed in patients’ cultural practices and belief systems. In this course, students will learn about diverse customs and methods of health care, including folk remedies and the use of complementary and alternative care options, as well as how to gather information from patients in order to provide the best possible care.

Throughout the course, the role of the nurse in the delivery of culturally competent care is examined. Students will participate in weekly discussions that focus on the foundations of transcultural care, the customs of individual cultures, and best-practice methodology. Quizzes and the Final Exam address terminology and definitions as well as concept comprehension. There are two written assignments in the course. The Week Two assignment allows students to analyze a medical case study to identify areas that can be the basis for bias and develop questions that enable practitioners to ascertain critical information from patients. This assignment also provides an opportunity to compare and contrast cultural norms. The Week Four assignment utilizes cultural case studies. Students learn to develop exploratory questions to determine patients’ cultural behaviors and evaluate community services in order to adapt nursing practices to achieve quality health outcomes for diverse populations.

TRANSCULTURAL NURSING COURSE LEARNING OUTCOMES

Upon successful completion of this course, students will be able to
1. Explain the importance of communication for diverse patient populations in nursing practice.
2. Synthesize nursing care based on unique cultural needs’ assessment(s) and nursing scope of practice.
3. Apply the concept of quality care for specific group(s) based on cultural preferences.
4. Articulate specific similarities and differences in nursing care amongst different cultural groups. Transcultural Nursing Course Description