Safety Performance Improvement Introduction

Nurs490W- Nursing Leadership

Safety Performance Improvement

Purpose of Assignment
To identify a safety issue within a health care organization that needs to change in
order to promote better delivery of patient care; to demonstrate an ability to
collaboratively problem-solve in an interdisciplinary environment while working towards
resolution of a common problem.
Approach to Assignment
Our group had to first identify a Joint Commission safety goal that was relevant to
an area of concern at our place of employment or clinical rotation. We also had to
describe a situation in our workplace or nursing practice that needed change. As a group,
we chose to do our paper from my submission on central line (CVL) infections. Our
paper was on the prevention of central line associated blood stream infections (CLABSI)
through evidence based practice (EBP) and education. We elected a group leader, divided
the rubric amongst the group and through email and text; submitted our paper on time.
Reason for Inclusion
Working on a hematology/oncology unit, I found great worth in completing this
paper. I was able to educate the nurses in my group on CVL care and safety as well as
learning evidence-based practice that I could bring back to my unit and share with my
educators.
Critical Thinking
o Uses nursing and other appropriate theories and models to guide professional
practice

We used Lewins change theory along with noting his force field
model. The force field model defined how the change could be
facilitated while the change theory reflected how to change the
behavior. Through Lewins three-part process of unfreezing, moving
and refreezing, our group devised a plan to facilitate CVL compliance
of care.
In using Lewins theory, to implement change, the NormativeReeducative strategy was used.

o Evaluates nursing care outcomes through the acquisition of data and the

questioning of inconsistencies

Our research and paper reflected proven outcomes and strategies from
the TJC and the Center for Disease Control and Prevention (CDC) in
the prevention of CLABIs.
CLABSIs are reportable to the National Healthcare Safety Network
(NHSN). The NHSN is a public health surveillance system that the
CDC maintains and supports as a mainstay of its healthcare-associated
infection prevention program. This transparency of CLABSI is an
additional motivator to eradicate line infections. Within twenty-four
hours of a CLABSI, an infection control nurse will meet with the
patients nurse to create a root cause analysis to determine if a cause is
identifiable. Nursing staff also fills out audit tools when caring for a
central line to evaluate the outcome through the collection of this data
to assess for inconsistencies.

o Revises actions and goals based on evidence rather than conjecture

As a group, we identified staff that would support our initiative and

those that would oppose this change in practice. This helped steer our
method of implementation and education. As newer staff joins my unit
at work, expert nurses have to teach the novices, the correct techniques
in line care. Our action plan for teaching was revised for those that
initially opposed the change we were implementing to include the
rationale and statistic as proof that EBP works. While the route in
which the teaching occurred was revisable, the goal has remained
constant as we attempt to eliminate CLABSIs.

o Engages in creative problem solving

This group worked closely together to collaborate and problem solve

on how to eradicate CLABSIs. We determined that education and
engaging nurses in the reporting of and prevention of line infections
was important. Our initiative for change was implemented in educating
the staff on EBP.

Nursing Practice
o Establishes and/or utilizes outcome measures to evaluate the effectiveness of
care

The measurable outcomes for this situation would be the amount of

CLABSIs reported monthly after the teaching has occurred with the
staff, patients, and families in comparison to the number of CLABSIs
prior to the implementation of the new protocol.

 Communication
o Expresses oneself and communicates effectively with diverse groups and
disciplines using a variety of media in a variety of contexts

The diverse group and disciplines within this paper consisted of the
different units in a health care setting along with the nurses, that have
varying years of experience. The spectrum ranged from novice to
expert nurse and from a general care floor to an intensive care unit.
Our paper devised a strategic plan to reach out to all of these nurses
and communicate the recommended guidelines in the prevention of
CLABSIs. Our group recommended yearly formal education on
guidelines and updates of central line care, poster presentations, along
with direct observation of staff during central line procedures to give
the nurses immediate feedback on their technique.

Teaching
o Provides relevant and sensitive health education information and counseling
to patients, and families, in a variety of situations and settings

It is important for families and patients to partner nursing in this

initiative to eradiate CLABSIs. Through modeling and education from
the nurses, patients have the knowledge to identify improper technique
and help stop central line infections through verbalizing their concern
to the nurse.

o Evaluates the efficacy of health promotion and education modalities for use in
a variety of settings with diverse populations

The evaluation of the educators teaching efforts on this initiative is in

the proof of eliminating CLABSIs. The CDC tracks and reports
CLABIs to the public. A decrease in line infections reported to the
CDC is proof this initiative is working through out the hospital, as
patients and nurses from all units partner together in the this endeavor.

Research
o Evaluates research that focuses on the efficacy and effectiveness of
interventions

nursing

Our paper detailed guidelines and recommendations set forth by the CDC
and TJC due to their continued efforts and research to eliminate
CLABSIs. Some of the guidelines include: sterile insertion, compliance
with hand hygiene requirements, scrub the access port or hub immediately
prior to each use with appropriate antiseptics (chlorhexidine, povidone

iodine, or 70% alcohol), and perform dressing changes under aseptic

technique (CDC, 2011). Capping all un-used ports with curos (alcohol
disinfectant caps), have been proven to also help decrease the potential for
infections. These EBP methods are effective in managing central lines. My
hospital follows these guidelines as well.
Leadership
o Assumes a leadership role within ones scope of practice as a designer,
manager, and coordinator of health care to meet the special needs of
vulnerable populations in a variety of practice settings

As a team project, we each took on a leadership role as we completed

our chosen sections, then reported back to the group. This role
continued as we each took ownership for the flow and context of the
paper. We identified the vulnerable population as the patients with
central lines due to the inherent risk of infection and death these lines
pose to those that have them. Our group then designed a plan to
implement the education necessary to prevent infections. Through
leadership, education and coordination of care, we were able to
achieve this goal throughout the multiple units within the hospital.

o Initiates community partnerships to establish health promotion goals and

implements strategies to meet those goals

The ultimate goal in our paper was to prevent CLABSIs through

education of proper techniques in central line care. Through the multi
step process we proposed to educate the staff, we felt confident that a
positive outcome was realistic. Community partnerships in this setting
can be identified as the many different units within the hosptial, as
well as outpatient clinics that come into contact with central lines.

o Organizes, manages, and evaluates the development of strategies to promote

healthy communities

The information within our paper was to provide nurses with updated
and current central line care in order to decrease the CLABSI
incidence and improve overall health in the community of those with
central lines. On the oncology unit, central lines are used more as a
long-term device, but throughout the hospital they may be placed for
temporary use. When the patient no longer needs their central lines,
the nurse should question the MD if the line is still medically
necessary or if the line can be removed. Through the process of
organizing, managing and evaluating the patients needs, a nurse can
help determine if lines should be removed. This is one strategy within

this paper, which promotes a healthy community.

o Articulates the values of the profession and the role of the nurse as member of
the interdisciplinary health care team

The role the nurse plays in the maintenance and prevention of central
line infections is multifaceted and valuable. Nurses are guardians over
their patients central lines as they are at the patients bedside the most
during the patients hospitalization. The nurse is able to protect their
patients from CLABIs by educating themselves in proper techniques
of line care. Nurses also protect their patients through advocating for
line removal when the line is no longer necessary. Nurses also play a
unique role in holding each other accountable when we observe a
breach in proper technique.

o Delegates and supervises the nursing care given by others while retaining the
accountability for the quality of care given to the patient

This can be achieved through direct observation of a nurses skill or

through an auditing tool. This self-reporting tool reflects the steps a
nurse takes in the care they provide for patients with central lines. It
encourages nurses to follow correct protocols and guidelines
established by the CDC or give explanation as to the deviation of the
normal protocol.

Professionalism
o Differentiates between general, institutional, and specialty-specific standards
of practice to guide nursing care

For this assignment our group had to review safety initiatives proposed
by the Joint Commission (TJC)s 2015 safety report. The prevention
of CLABSI is a goal all health care settings have undertaken to benefit
the outcomes of patients. Hospitals have many resources from which
to revise their policies in regards to central line care from the CDC and
TJC. It is imperative for staff to adhere to policies and procedures
within their institute to ensure safety of the patients.

o Understands the effect of legal and regulatory processes on nursing practice

and health care delivery, as well as limits to ones own scope of practice
It is important for nursing to remain up to date in their knowledge and
training in regards to central lines to protect their patients, themselves,
and their employer (the hospital) from harm and legal repercussions.
CLABSIs are not only dangerous and costly to the patients, but they
open the hospital up to lawsuits and denial of payment from insurance

companies.
o Demonstrates accountability for ones own professional practice.
As a leader and a mentor on my unit, I am responsible for staying
current and adhering to guidelines for line care set fourth by my
employer. I participate in monthly audits in regards to proper central
line care procedures through self-reporting.
o Applies an ethical decision-making framework and legal guidelines to clinical
situations that incorporate moral concepts, professional ethics, and advocacy
for patient well-being and preferences

Our goal as health care providers is to provide the best care for our
patients while keeping them safe and limiting their pain and suffering.
This goal can be achieved through keeping ourselves educated in our
field along with following policies and procedures within our
institutes. Nurses play a key role in advocating for their patients safety,
as nurses embrace change and keep their practice current through EBP.

o Advocates for professional standards of practice using organizational and

political processes.
As a nurse, we have a duty to advocate for the safety and well being of
the patients entrusted in our care. In this paper, my group addressed
this outcome through educating staff on current EBP related to the
prevention of CLABSIs in the hospital.

Reference
Centers for Disease Control and Prevention. (2011). Checklist for Prevention of
Central Line Associated Blood Stream Infections. Retrieved from:
http://www.cdc.gov/HAI/pdfs/bsi/checklist-for-CLABSI.pdf