¶ … Chang Proposal - Milestone #4
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NR 451- Capstone Project Milestone #4: Design for Change Proposal
Christopher D'Ambrose
NR 451 Capstone Course
Quality of patient care is a paramount concern of healthcare professionals. When nurses experience interruptions while they are working, the quality of care patients receive can be negatively impacted. Interruptions have been shown to disrupt working memory, disrupt on-duty focus, induce frustration and stress, contribute to accidents, and lead to patient care errors (Bennet, et al., 2010). Interruptions that occur when nurses administer medication to patients are a particular concern. The incidence of interruptions is higher than might be surmised; according to Day (2010), 19.8% of all procedures did not have any disruptions or clinical errors. Biron, et al. (2009) reviewed 14 observational studies of nurses providing patient care, in which they found that 6.7 interruptions occurred each hour during mediation administration. This data indicates that a majority of patient cases involve some type of mistakes from distracting interruptions (Day, 2010).
To address these issues, a new approach needs to be taken by introducing a nursing plan that emphasizes certain standard procedures and practices. The literature has shown that some of these procedures and practices are associated with a decrease in the frequency of interruptions to nurses during the administration of medication (Bennet, et al., 2010; Pape, et al., 2005; Relihan, et al., 2010). The interventions employed in these studies made error reduction salient in practice, made it easier for healthcare professionals to pay closer attention to the tasks of mediation administration, and functioned to reduce the chance of errors occurring.
Pape, et al. (2005) found that the challenge of reducing interruptions during medication administration can be addressed through the use of the following: a medication administrative checklist, no talk signage, interruption vests worn by nurses printed with the phrase "Do Not Disturb." Rathmann, et al. (2007) found that the incidence of interruptions was reduced by 89% by establishing patient quiet zones during medication administration. Moreover, Biron, et al. (2009) found that and informing staff about the non-interruption strategies also helped to reduce errors.
In the tradition of evidence-based nursing, the overall planning process for designing a change in practice or procedures may follow the Rosswurm and Larrabee's (1999) 6-step change plan model. Taken together, the proven strategies from the literature and the systematic framework for building a research utilization program will work to identify the value of the plan in the desired context, and how implementing the plan with fidelity can improve the quality of care patients are receiving (Pape, et al., 2005; Rosswurm & Larrabee, 1999).
Contribution to the Future of Healthcare
The change model developed by Rosswurm and Larrabee introduces nursing staff to the evidence-based nursing practice, evaluates the potential for clinical practice change, and focuses on incorporation of new ideas into the current practices approved by healthcare professionals. The basic idea is to utilize these theories to shift the procedures in addressing specific problems, which could have an impact on quality. The 6-step change plan model is both a theory-driven framework and a pragmatic approach that empowers nurses to solve the problem of interruptions during medication administration through their own independent nursing decisions and actions. The evidence-based change plan proposes to establish use of a standardized checklist to be used during the processes associated with the administration of medicine. The checklist includes implementation of a number of practices that have been shown to effectively reduce the incidence of interruptions during medicine administration. Use of the checklist is anticipated to decrease the chance of errors occurring and establish a new strategy for everyone to follow; the overarching benefit to the future of nursing is a clear path to practice that reduces medication administration errors. The key stakeholders in this proposed evidence-based change of practice include nursing staff, other staff on the floor during the administration of medication, and -- naturally -- the patients receiving medication and care.
Change Model Overview
The Rosswurm and Larrabee (1999) 6-step model is designed to provide a framework of reference for systematically bringing about modification of clinical practice to an evidence-based change. Substantive strengths of the model are the incorporation of change theory and a step-by-step guide to research utilization -- and a thorough grounding of clinical staff in the theoretical foundations and the pragmatic use of standardized nomenclature to communicate about and evaluate the change. The six steps of the model are as follows:
1. Assess the need for change in practice.
2. Link the problem with interventions and outcomes.
3. Synthesize the best evidence.
4. Design a change...
Medication Errors Since the research materials are provided to you by human beings, and may be based Medication errors pose a significant threat to patients. The results of medication errors vary from mild to deadly. No facility is immune from the possibility to drug errors, either through a fault of their own, or from suppliers or pharmacists that supply them. All medication errors must be reported to the Food and Drug Administration.
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