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Homework answers / question archive / SECTION 1 BACKGROUND: IDENTIFYING A PROBLEM Eleanor is a 52-year-old patient who has had a hip replacement 1 day ago who is on your assigned patient care team

SECTION 1 BACKGROUND: IDENTIFYING A PROBLEM Eleanor is a 52-year-old patient who has had a hip replacement 1 day ago who is on your assigned patient care team

Health Science

SECTION 1 BACKGROUND: IDENTIFYING A PROBLEM Eleanor is a 52-year-old patient who has had a hip replacement 1 day ago who is on your assigned patient care team. You complete patient care rounds and assess Eleanor’s vital signs, comfort level, intravenous (IV) site and wound dressing. Eleanor has an IV for fluid replacement and medication administration. She also has an indwelling urinary catheter. She tells you that her pain level is a 4 out of 10 and she is reluctant to move around because of the pain. You know that the patient’s pain control is a high priority and that the physician ordered the indwelling urinary catheter until the patient is able to get out of bed easily and tolerate fluids. The urinary catheter is convenient in that the patient will not experience pain getting up to the bathroom and it provides an accurate measurement of output. On the other hand, you know that the longer the indwelling urinary catheter is in place, the higher the risk of an infection. You ask a trusted senior nurse when is the right time to remove the catheter since Eleanor is now tolerating ice chips. The senior nurse tells you that the catheter is usually kept until the patient is able to get up and ambulate independently. You wonder if there are any contraindications or problems with removing Eleanor’s indwelling catheter now. You decide to follow the senior nurse’s advice, leaving the indwelling urinary catheter in place and reevaluate for removal in the morning. SECTION II BACKGROUND: INTERPROFESSIONAL TEAMS AND STAKEHOLDER ENGAGEMENT This section is focused on the identification of a clinical problem and the steps of forming an interprofessional team to work on fixing the problem. The intent is to understand who are the stakeholders for this problem and the importance of engaging stakeholders in the quality improvement (QI) project. Examine the problem of CAUTIs holistically to identify stakeholders. You return to work the next day to learn that Eleanor has a low-grade fever of 99.8° F that was reported to the physician. The physician ordered an immediate urine culture and removal of the catheter the previous afternoon. The urine culture was positive for Escherichia coli, representing the presence of catheterassociated urinary tract infection (CAUTI). During the bedside report, you find that although Eleanor states she is tired, she is able to get up to the bathroom with a walker independently. She is also tolerating oral fluids and foods. The presence of the CAUTI bothered you enough that you spoke to your Unit Director about looking into evidence-based interventions to reduce CAUTIs. The Unit Director tells you that the rate of CAUTIs for the medical–surgical unit has steadily risen over the past year and the monthly total is twice the number from 2 years ago. You volunteer to convene a committee to work on the problem. Your first step is to identify others who should be on your team. You know that the stakeholders are individuals who influence or are influenced by the clinical problem under investigation. Review the discussion on stakeholders in Chapter 15 for guidance on selecting appropriate stakeholders. SECTION III BACKGROUND: LEADING A QI TEAM This section is focused on power gradients and leadership styles within an interprofessional team. Consider how to lead a team consisting of various healthcare professionals. You identified a variety of interprofessionals to include on your committee including two direct care nurses from the medical–surgical unit, one nurse from the operating room, two certified nurse assistants, a nurse supervisor, a physician, the medical–surgical clinical nurse specialist, a pharmacist, a laboratory representative, and a dietician. You feel that these individuals clearly represent all aspects of patient care. Review the information on communicating within a team and with different power gradients in Chapter 8. By working closely with the clinical nurse specialist (CNS), you are able to convene a meeting of the team. SECTION IV BACKGROUND: CLARIFYING THE PROBLEM The intent of this section is to work through the causative factors to fully understand the clinical problem. The focus is to use a root cause analysis approach to examine the big picture and pull out the factors that contribute to the problem. In this section, you will use information provided from previous sections of the case study and your research to create a root cause analysis. If needed, create scripts from the perspective of the various stakeholders who might be involved with the process being investigated to illustrate the various perspectives. Use the Healthcare Quality Improvement Partnership’s Root Cause Analysis for Clinical Audit guide (accessible at www.hqip.org.uk/resources/using-root-cause-analysis-techniques-in-clinical-audit/) to guide the students through a root cause analysis. Complete the cause–effect or fishbone diagram. A resource that includes a fillable template for creating a cause–effect diagram can be accessed through the Institute for Healthcare Improvement (a free account is required, accessible at www.ihi.org/resources/Pages/Tools/Quality-Improvement-Essentials-Toolkit.aspx). Chapter 12 Patient Safety includes an example of a root cause analysis. The clinical nurse specialist (CNS) decides to work through a root cause analysis and use a cause–effect diagram (fishbone diagram) with the team to identify potential causes for catheter-associated urinary tract infections (CAUTIs). You work with the CNS to complete this activity with the team. SECTION V BACKGROUND: PLANNING FOR CHANGE The intent of this section is to create a preliminary plan for action by using the PLAN-DO-STUDY-ACT model as outlined in chapter 13. The team decides to use the Plan-Do-Study-Act model to determine small tests of change that can be undertaken to improve CAUTI’s in the patients the team cares for. You work with the team to develop a map of the PDSA model. Case Study Part I Worksheet Section 1 Discussion Question: Use the information about “sacred cows” in Chapter 11 to consider the types of traditions found in patient care and why they are dangerous to patient outcomes. Discuss how this information may apply to removing indwelling urinary catheters. Section 1 Assignment: Research the background and significance of the clinical problem of CAUTIs. Include data on the national statistics that indicate that the problem is widespread (See websites in Chapter 13). Create a 1-page table to summarize your research and attach it to this worksheet. Include your resources in APA format Section 2 Discussion Question: How will you decide which stakeholders to include in the project? Section 2 Assignment: Complete Table 1 to identify potential stakeholders that should be included in the project, and include your rationale for inclusion TABLE 1 STAKEHOLDER INCLUSION AND ENGAGEMENT TABLE STAKEHOLDER NAME RATIONALE FOR INCLUSION INFLUENCE AND SUPPORT (HIGH, LOW) STRATEGIES FOR ENGAGING STAKEHOLDER Example: Direct care Medical– surgical nurse Example: Group has the biggest impact on CAUTIs based on direct patient care Example: High Influence Low Support Example: Involve nurses in the project Build relationships Section 3 Discussion Question: Review the leadership theories in Chapter 3. Which of the theories best fit with your leadership style and the type of project? Section 3 Discussion Question: How would you lead an interprofessional team with different perspectives and viewpoints? Case Study Part II Worksheet Section 4 Discussion Question: What are the primary causes for CAUTI’s based on your experience of working through a root cause analysis? Section 4 Assignment 1: Create a Root Cause Analysis as described in section IV and attach it to this worksheet Section 4 Assignment 2: Select one of the root causes identified in assignment 1. Select one small part of the cause that can be changed and map out a PDSA cycle for the change. Attach your map to this worksheet Section 4 Discussion Question: Consider barriers to the PDSA cycle that you have created. List at least one barrier and discuss a method that the team can use to overcome this barrier. i Printed by: denaroberts1@mydsn.net. Printing is for personal, private use only. No part of this book may be reproduced or transmitted without publisher's prior permission. Violators will be prosecuted. Printed by: denaroberts1@mydsn.net. Printing is for personal, private use only. No part of this book may be reproduced or transmitted without publisher's prior permission. Violators will be prosecuted. Printed by: denaroberts1@mydsn.net. Printing is for personal, private use only. No part of this book may be reproduced or transmitted without publisher's prior permission. Violators will be prosecuted. Printed by: denaroberts1@mydsn.net. Printing is for personal, private use only. No part of this book may be reproduced or transmitted without publisher's prior permission. Violators will be prosecuted. Printed by: denaroberts1@mydsn.net. Printing is for personal, private use only. No part of this book may be reproduced or transmitted without publisher's prior permission. Violators will be prosecuted.
 

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