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NURS FPX 6021 Assessment 2 Change Strategy and Implementation

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Capella University

NURS-FPX 6021 Biopsychosocial Concepts for Advanced Nursing Practice 1

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Date

Change Strategy and Implementation

This assessment proposes a change strategy to minimize secondary infections in Acute Kidney Injury (AKI) patients at my current workplace, MedStar Washington Hospital Center. AKI is a common disorder among hospitalized patients, and the leading cause of mortality among AKI patients is the development of secondary infections. AKI is known to have several harmful systemic effects, including the impact on immune function, leading to an immunocompromised state. Thus, patients with kidney dysfunction have a substantial risk of subsequent infections (Gist & Faubel, 2020). This paper presents a data table on the existing and desired states of sepsis among AKI patients. Based on this data, we proposed change strategies and elaborated on how these strategies enhance the quality of care and improve patient outcomes. 

 

Data Table of Current and Desired Clinical Outcomes 

The data table in the appendix depicts the current and desired states of various clinical outcomes in AKI-infected patients at MedStar Washington Hospital Center. The data is collected through the organization’s dashboard and patient surveys. Compliance with the Health Insurance Portability and Accountability Act (HIPAA) is prioritized to maintain patients’ privacy and confidentially and ensure robust security measures are applied to extract the data from the organization’s information management systems (Rosenbloom et al., 2019).

However, some areas of ambiguity in the data collection process required further information to improve the analysis. These include a lack of detailed data on specific infection types and sources, unanswered questions about the factors leading to mortality, knowledge gaps on antibiotic usage and patterns of resistance, lack of information on secondary factors increasing hospital stays, and minimal information on factors contributing to patient dissatisfaction. Further information on these areas will improve the analysis and direct the change implementation process, targeting particular concerns. 

Change Strategies to Achieve Desired States

Secondary infections are commonly found in AKI patients due to the disease’s impact on individuals’ immune systems. Patients with acute kidney injury admitted to intensive care settings are 40-50% prone to developing infectious states (Peerapornratana et al., 2019). Antibiotic resistance and patient dissatisfaction are primary clinical outcomes that require prompt action through various change strategies. The strategies include the Antimicrobial Stewardship Program (ASP) and infection control practices (hand hygiene and environmental hygiene). 

The proposed change strategy is implementing an antimicrobial stewardship program to address antibiotic resistance. This initiative involves optimizing antibiotic use through appropriate drug selection, precise dose setting, and monitoring the duration of antibiotic treatment to ensure the best possible clinical outcomes are achieved to treat and prevent infection without encountering toxicity or resistance (Alawi et al., 2022). In my current workplace, the implementation of ASP includes developing guidelines for appropriate antibiotic use, conducting interprofessional training sessions, and seamlessly integrating existing workflows. Moreover, we aim to implement surveillance systems to monitor resistance patterns and foster a culture of answerable antibiotic prescribing.  

NURS FPX 6021 Assessment 2 Change Strategy and Implementation

Similarly, we propose Infection Control Practices (ICPs) as an environmental change strategy to improve patient satisfaction with healthcare practices. These robust ICPs include hand hygiene protocols and ensuring a transparent and sanitary environment to minimize the risk of secondary infections in all hospitalized patients (Braun et al., 2020), especially AKI patients. The implementation plan for the current workplace includes creating standardized protocols for infection prevention, conducting frequent training sessions, and integrating infection control into daily routines. Moreover, educating patients and their family members through educational materials and awareness campaigns is imperative to foster a shared responsibility for infection prevention.

However, several challenges might be associated with implementing these strategies, including staff readiness to change and compliance with the plan, resource constraints, availability of technology, and adapting practices to diverse patient populations. These challenges can be mitigated using transparent and open communication channels, ongoing education and leadership support, effective resource optimization and budgeting, upgrading existing technological infrastructure, and tailoring change strategies according to patients’ preferences.

Moreover, monitoring Key Performance Indicators (KPIs) is essential to evaluate the proposal’s effectiveness. These include reduced inappropriate antibiotic prescriptions, decreased antibiotic resistance rates, reduced hospital-acquired secondary infections in AKI patients, improved patient satisfaction scores, and improved patient outcomes. Regular audits, feedback mechanisms, and continuous data analysis ensure ongoing refinement to maximize effectiveness.

Justification of the Change Strategies

The antimicrobial stewardship program is relevant for reducing antibiotic resistance by promoting judicious and evidence-based use of antibiotics. This change strategy is justified by a study that mentions that in the evolving state of AKI-infection patients, the significant challenge is balancing the safety and efficiency of antibiotic dosage and utilization. Such a situation requires effective ASP initiatives to address the overuse and misuse of antibiotics, mitigate antibiotic resistance, and achieve desired outcomes (Hughes et al., 2022). However, some conflicting perspectives in the literature include resource limitations and potential resistance from healthcare providers. These perspectives often underscore the need for resource optimization, effective communication channels, and ongoing education (Mathew et al., 2020).

Patients consider hygiene practices and environmental cleanliness as indicators of quality of care. Thus, implementing rigorous infection control practices is crucial for enhancing patient satisfaction as it directly contributes to a safe and positive healthcare experience. Effective ICPs are essential to preserve patient safety by reducing hospital-acquired infections and improving patient outcomes (Gordon, 2021). However, the challenge of limited availability of Personal Protective Equipment (PPE) and staff compliance are conflicting perspectives for this measure. In-service training, staff recognition and rewards, and attracting external funding are practical strategies to mitigate these challenges (Lowe et al., 2021). 

Quality Improvement by Change Strategies 

The change strategies of ASP and ICPs contribute significantly to improving the quality of care regarding patient safety and equitable care by reducing the risk of antibiotic resistance and healthcare-associated infections. The antimicrobial stewardship program is more likely to improve patient safety quality. This program directly addresses safety concerns related to the potential failure of antibiotic therapy, which may subsequently risk patient health outcomes (Hughes et al., 2022). It mitigates the emergence of multidrug-resistant organisms, fostering a safer patient environment.

On the other hand, infection control practices are more likely to lead to equitable care. These practices ensure that all patients, regardless of socioeconomic background, receive care in a safe and infection-free environment. Moreover, these practices promote interprofessional collaboration, including diverse perspectives in care. This strategy reduces disparities in the likelihood of acquiring healthcare-associated infections across diverse patient populations (Khan, 2022). 

Both change strategies promote Quadruple Aim through enhancing patient outcomes by reducing the incidence of infections and antibiotic resistance. Furthermore, they improve the patient experience by fostering a safe environment. Lastly, by promoting prudent resource use, these strategies aid in cost-effectiveness, as per the goal of the Quadruple Aim. The analysis assumes that standardized protocols will ensure patient safety and equitable care. Moreover, ongoing monitoring of drugs and adherence to these change strategies will reduce care disparities and enhance safety outcomes. 

Interprofessional Perspectives of Change Strategies

Both change strategies use interprofessional considerations where physicians, nurses, pharmacists, infection control specialists, and administrators collaborate for successful implementation. These teams work together to develop and execute the strategies, ensuring a comprehensive approach that addresses diverse perspectives and expertise. Antimicrobial stewardship best utilizes interprofessional collaboration by establishing a multidisciplinary team comprising pharmacists, microbiologists, and frontline healthcare providers (Sheikh et al., 2019). This team collaborates to develop and implement guidelines, conduct educational sessions, and regularly review antibiotic prescriptions.

To ensure successful implementation, organizations must develop effective communication channels such as online portals and regular meetings to update and address ongoing concerns. The program’s success relies on the active engagement of all team members, recognizing their unique contributions to patient care. However, both the change strategies prioritize the well-being of healthcare professionals by incorporating actions to reduce their workload burden. In the case of ASP, this involves providing educational materials, clear antibiotic usage protocols, and decision-support tools to streamline the antibiotic prescription and administration process. For infection control practices, a safe working environment through proper training, access to PPE, and supportive policies contributes to the well-being of healthcare professionals.

References

Alawi, M. M., Tashkandi, W. A., Basheikh, M. A., Warshan, F. M., Ghobara, H. A., Ramos, R. B., Guiriba, M. L., Ayob, O., Janah, S. S., Sindi, A. A., Abdulhamid Ahmed, S. A., Dammnan, S., Azhar, E. I., Rabaan, A. A., Alnahdi, S., & Bamahakesh, M. M. (2022). Effectiveness of antimicrobial stewardship program in long-term care: A five-year prospective single-center study. Interdisciplinary Perspectives on Infectious Diseases2022, 8140429. https://doi.org/10.1155/2022/8140429

Braun, B. I., Chitavi, S. O., Suzuki, H., Soyemi, C. A., & Puig-Asensio, M. (2020). Culture of safety: Impact on improvement in infection prevention process and outcomes. Current Infectious Disease Reports22(12), 34. https://doi.org/10.1007/s11908-020-00741-y 

Gist, K. M., & Faubel, S. (2020). Infection post-aki: Should we worry? Nephron144(12), 673–676. https://doi.org/10.1159/000508101

NURS FPX 6021 Assessment 2 Change Strategy and Implementation

Gordon, N. C. (2021). Infection control for safety and quality. Community Eye Health34(111), 5–7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8528059/ 

Hughes, S., Heard, K. L., Mughal, N., & Moore, L. S. P. (2022). Optimization of antimicrobial dosing in patients with acute kidney injury: A single-centre observational study. JAC-Antimicrobial Resistance4(4), dlac080. https://doi.org/10.1093/jacamr/dlac080 

Khan, I. (2022). Navigating health inequities and health disparities in infection control: A research fellow perspective. American Journal of Infection Control50(4), 367–368. https://doi.org/10.1016/j.ajic.2022.01.017 

Lowe, H., Woodd, S., Lange, I. L., Janjanin, S., Barnet, J., & Graham, W. (2021). Challenges and opportunities for infection prevention and control in hospitals in conflict-affected settings: A qualitative study. Conflict and Health15(1), 94. https://doi.org/10.1186/s13031-021-00428-8 

Mathew, P., Ranjalkar, J., & Chandy, S. J. (2020). Challenges in implementing antimicrobial stewardship programmes at secondary level hospitals in India: An exploratory study. Frontiers in Public Health8, 493904. https://doi.org/10.3389/fpubh.2020.493904 

Peerapornratana, S., Manrique-Caballero, C. L., Gómez, H., & Kellum, J. A. (2019). Acute kidney injury from sepsis: Current concepts, epidemiology, pathophysiology, prevention and treatment. Kidney International96(5), 1083–1099. https://doi.org/10.1016/j.kint.2019.05.026 

NURS FPX 6021 Assessment 2 Change Strategy and Implementation

Rosenbloom, S. T., Smith, J. R. L., Bowen, R., Burns, J., Riplinger, L., & Payne, T. H. (2019). Updating HIPAA for the electronic medical record era. Journal of the American Medical Informatics Association : JAMIA26(10), 1115–1119. https://doi.org/10.1093/jamia/ocz090 

Sheikh, F., Zarowitz, B. J., Sheikh, F., Naqvi, F. A., Heil, E., & Brandt, N. (2019). Interprofessional collaboration improves antibiotic stewardship. Journal of the American Medical Directors Association20(3), B22. https://doi.org/10.1016/j.jamda.2019.01.087 

Appendix

Table 1

Current and Desired States of Multiple Clinical Outcomes in AKI patients 

Clinical Outcome
Current State
Desired State

Prevalence of AKI-related Infections

20% of AKI patients develop secondary sepsis during the hospital stay. 

The prevalence of AKI-related infections is reduced to 10% within a year. 

Mortality Rate

The death rate lies at 15% among AKI-infected patients. 

Reduce the mortality rate to 5% after the implementation of change strategies. 

Antibiotic Resistance

Patients are demonstrating increased resistance to commonly used antibiotics. 

Prevent antibiotic resistance through antimicrobial stewardship programs (Alawi et al., 2022). 

Length of Hospital Stay (LOHS)

AKI-infected patients currently stay two weeks longer than usual.  

The aim is to minimize the length of hospital stay to a maximum of 7 days, gradually reducing to the average LOHS only. 

Patient Satisfaction 

Around 75% of AKI patients expressed dissatisfaction with hospital care, especially concerning infection control practices.  

Increase patient satisfaction rate to 90% using effective infection prevention and control measures (Braun et al., 2020). 





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