CAPSTONE PROJECT CHANGE PROPOSAL

Benchmark Capstone Project Change Proposal

Background

Monitored anesthesia care (MAC) has become more widely used to avoid the complications of general anesthesia (GA) (Sammour et al., 2021). Monitored anesthesia care (MAC) is a safer alternative to general anesthesia (GA) in some surgical procedures. Indeed, as Sammour et al., (2021) observe, utilizing MAC seems to be more efficient without compromising safety. Complications of MAC include airway obstruction, de-saturation, cardiovascular collapse, and aspiration (Sohn et al, 2016). Though the complications of MAC are comparable to GA, inpatients who have undergone MAC are kept unmonitored outside of the PACU for prolonged periods of time negating optimal patient care. This practice is deleterious to patient care and can cause substantial professional and institutional liability resulting in malpractice claims (Kellner et al, 2018). A gap in care, among inpatients who have undergone monitored anesthesia care (MAC) and are not admitted to the post anesthesia care unit (PACU) but are transferred to the surgical floors by non-clinical personnel, was identified.

Clinical Problem Statement

The clinical challenge at the heart of this study centers on the increased vulnerability of surgical patients who have undergone MAC to postoperative complications. The risks associated with insufficient postoperative nursing management extend beyond the immediate recovery, potentially leading to prolonged recuperation periods, heightened healthcare expenditures, and decreased patient satisfaction. Addressing this issue is imperative as it impacts the well-being of individual patients and carries broader implications for the healthcare system. The proposed solution, effective postoperative nursing management, is poised to yield a positive patient outcome by notably reducing postoperative complications during the critical 24 to 48-hour period post-surgery. This anticipated outcome carries multifaceted benefits, including enhanced patient recovery, shortened hospital stays, and an overall elevation in the caliber of healthcare delivery, aligning with the fundamental goals of patient-centered and cost-effective care.

Purpose of the Change Proposal

The omission of providing immediate postsurgical monitoring and management significantly amplifies the patients risk for these complications. By highlighting the incidence of these complications in patients who have received MAC, the implementation of this quality improvement initiative prioritizes postoperative patient safety through attempt to persuade policy change by admitting these patients to the PACU.

The following measurable outcomes were identified as being relevant in this particular context.

1. Staff will be knowledgeable about the complications associated with monitored anesthesia care (MAC) especially within the immediate postoperative period as exhibited by competence in acknowledging such complications.

Rationale: Staff having knowledge about complications associated with MAC will facilitate early detection of clinical decline and initiation of early treatment/ resuscitation. Staff members who are knowledgeable about MAC complications can also effectively communicate with other team members, fostering a collaborative and coordinated approach to patient care.

2. A post anesthesia care unit (PACU) admission protocol for postoperative inpatients who have undergone MAC will be developed.

Rationale: Development of an admission protocol for postoperative inpatients will ensure optimal, quality, culturally appropriate health care delivery which will improve health outcomes through utilization of the code of ethics that guide professional decisions and practices. The implementation of a defined protocol simplifies the admission procedure for MAC patients, allowing for more effective use of resources in the PACU. This involves improving personnel numbers, equipment, and monitoring capabilities to meet these patients' specific demands.

3. Organizational barriers that may interfere with implementation of an admission protocol for the admission of postoperative inpatients who have undergone monitored anesthesia care will be identified and perioperative staff will be compliant with the admission protocol.

Rationale: Strategies to address organizational barriers will be addressed resulting in staff compliance and implementation of the admission protocol into practice. Recognizing and overcoming organizational impediments...

3. Infrastructure of the current PACU must be modified for spacing with additional bed capacity to accommodate these patients and

4. Managerial support for sustenance of this change project.

Plan for Evaluating the Proposed Nursing Intervention

Evaluating the change proposal project of admission policy of surgical inpatients to the post anesthesia care unit (PACU) determines its efficacy in providing a safe, cost-effective solution to the current practice of omission of monitoring surgical inpatients who have undergone monitored anesthesia care (MAC). An audit and feedback method will be utilized to determine the efficacy of nursing interventions that incorporate monitoring surgical inpatients in the post anesthesia care unit. To ensure patient safety, nursing clinical practice will be reviewed based on the implemented standards of care. Nursing practice will be audited on parameters such as respiratory monitoring and hemodynamic stability. Feedback will then be provided to the perioperative nursing staff regarding their performance and the impact of that performance on the intended objective of ensuring optimal patient outcome. The change proposal will be evaluated six months after implementation and a comparison will be made against the current nursing practice through review of patient medical charts. Efficacy will be proven through nursing practice that demonstrates competence and vigilance in identifying signs of early postoperative complications and prevention of these complications.

Potential Barriers to Plan Implementation

Assessment of the organizations culture revealed that the perioperative nursing staffs hindrance to readily accept new changes was a potential barrier to incorporate the nursing practice intervention. Staff edification is a primary strategy to equip nurses with knowledge regarding current evidence-based practices. This can be achieved through educational workshops and staff training to maintain competencies in clinical practice and professionalism. Furthermore, fostering an organizational culture that…