NURS 2006 Assignment: Clinical Practice Improvement Project Report

NURS 2006 Assignment: Clinical Practice Improvement Project Report

NURS 2006 Assignment: Clinical Practice Improvement Project Report

Question:

Sample Draft Solution:

Introduction

Clinical governance is one of the most effective practice frameworks that can be used in the health care scenario to enhance the clinical safety of the care services that are being provided to patients and maintain the continuous improvement of the overall care services (Vordenberg et al. 2018). This systematic framework holds the each and every care provider accountable and responsible for the safety and efficacy of the care activities they are engaging in. This project has aimed to reduce the rate of falls in the health care facility by improving the awareness and knowledge of the bedside nurses regarding the fall prevention policies and practices, the project relates to a number of pillars of the clinical governance (Van Zwanenberg and Edwards 2018).

There are 7 pillars of clinical governance, which relates to different interconnected aspects of improvement of the clinical care services. The seven pillars of clinical governance in practice, they are clinical performance and evaluation, clinical risk management, patient experience and involvement or consumer value, resource effectiveness, communication, strategic effectiveness, and professional development and management. Among the seven pillars, there are four pillars or principles of clinical governance which relates intricately with the care services that are being provided to the health care professionals. First and foremost, the first pillar of clinical effectiveness and performance is associated with the implementing evidence based practice to ensure providing safe and effective care services to the patients (Vordenberg et al. 2018). This project aims to build on the knowledge and expertise among the nurses regarding fall prevention in the facility with respect to interventions that are derived from the best practice evidence available. Along with that, it has to be mentioned that health care associated falls are linked with many adversities and can even lead to fatal consequences for the critical care units. Hence, falls and the related injuries are a very important clinical risk which this project is aiming to address (Vlaeyen et al. 2017).

Similarly the pillar of professional development and management is the pillar which addresses the need for education and training among the existing staff. In this case as well, the intervention being proposed in this case refers to the training and educating the nurses regarding the fall prevention policies and practices, hence, the project is addressing the third pillar effectively as well. Lastly, the fourth and final pillar that the project is addressing is the consumer voice. Elaborating further, the project will involve the interventions that are going to  be implemented in the health care facility will also incorporate the consumer representatives to ensure their perception, wishes and grievances is taken into consideration regarding the implementation of the interventions (Van Zwanenberg and Edwards 2018). Hence, overall, it can be easily stated that the project that has been designed follows these 4 essential pillars of clinical governance effectively. NURS 2006 Assignment: Clinical Practice Improvement Project Report

Evidence that the issue / problem is worth solving:

Among the different health risks that cause a massive influx in thee mortality rates of the older adults or critically ill patients, falls account for a major portion of the clinical risk (Coppedge, Conner and Se 2016). The impact of a fall is multifactorial, the falls that the patients in the health acre facility not just leads to injuries, pain and suffering, but it also affects the emotional and psychosocial wellbeing of the patients altering the sense of safety and security while staying in the facility (Dykes et al. 2017). Hence, the impact of falls encompasses both physical and emotional wellbeing of the patients, and undoubtedly it is one of the greatest public health priorities for the health care professionals worldwide.

Discussing the prevalence and predominance of falls in the health care environment, falls has become a major contributor to the mortality and morbidity in the health care environment (Vlaeyen et al. 2015). Considering the data from the South Australia, in the year of 2017, the rate of hospitalization admission due to fall and related injuries had been 22576 people and among the alarming number of people, 400 had been dead due to fall related injuries (Aihw.gov.au 2018). As derived from the statistical data that had been gathered, there had been 34000 incidents of fall that had occurred in the health care facility which complicated the disease, enhanced the number of days of hospice care and also added to the cost of hospital based care. Hence, the fall and fall related injuries has become a grave concern, especially for the elderly patients and critically ill patients with mobility restrictions. Hence, the topic of concern for this project is relevant, and addresses one of the most impactful aspects associated with patient safety in the health care environment after health care associated infections (Matarese et al. 2015).

Nursing workforce:

The first internal stakeholder that is needed to be discussed in the context of fall prevention is the nurses elderly and critical care unit. Nurses are the primary point of contact for the patients and they carry out the most of the patient care as well. Hence, the most important stakeholder for this case will be nurses of the elderly or critical care units.

Nurse manager:

The nurse manager will be the leader of the intervention program, and will be supervising the entire program completion. The compliance of the selected staff and smooth operation of the educational intervention sessions will be monitored by the nurse manager.

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Consumer voice:

The consumer voice will be the representative of the patients and their family members and will be sharing their set of recommendations and suggestions along with any grievances or wishes.

Safety risk coordinator:

The safety risk coordinator will monitor that the educational intervention is not affecting the patient safety in the ward selected and whether the care services or programs are going smoothly.

CPI Tool:

CPI stands for clinical practice improvement which is a systematic project framework which can be easily employed to the care scenario to improve the current status of the care services or to minimize the incidence of any clinical risk (Taylor et al. 2014). Elaborating more, the CPI project can be defined as the framework that is utilized in planning, implementing and evaluating any change that has been introduced to the health care scenario. The CPI project format helps in introducing a format of continuous improvement cycle which is maintained throughout and can be integrated in the care practices of the facility on a large scale basis. The CPI project requires the implementation of any CPI tool which will help in the implementation of the project that has been designed. The CPI tool helps in the designing and successfully implementing the change into the target group successfully. In this case thee chosen CPI tool for this project is the PDSA cycle. PDSA cycle stands for Plan-do-study-act cycle which is also one of the most renowned change implementation tools used in the health care environment.

There are various benefits to using this cycle. First and foremost, the most important aspect for a pilot project is timely completion and minimal resource usage. In this case as well, the project will involve only 30 bedside nurses practicing in either elderly care units or critical care units. Hence, using the PDSA cycle will ensure that the project is completed in a timely manner utilizing as minimal resource as possible. Along with that, as mentioned by Rodda et al. (2017), the utilization of the PDSA cycle as a change implementation tool, also helps in better staff management, optimal resource utilization and also facilitating better teamwork approach to achieve better outcomes in the project. Hence, we have chosen the PDSA cycle as the choice of CPI tool for the project.

The PDSA cycle has four interconnected elements:

The first phase of the PDSA cycle is planning and will take the first and second month of the project. The preliminary step will be preparatory and will involve extensive research to gather data from the research that has been published in the past. The research will incorporate the incidences of falls, the contributing factors to falls, the innovative techniques for fall prevention, and the knowledge and awareness in the nurses regarding these techniques. Based on the research training and educational content will be prepared, which will contain both recent fall prevention policies and fall prevention practices such as fall prevention bundles, use of Morse fall scale, fall signage, and patient/family fall teaching contract (Pfortmueller, Lindner and Exadaktylos 2014). The training will be given by head intensive care nurses, nurse managers and leaders along with lead physiotherapists.

Do: The next phase is actual implementation of the intervention which will take up 5 months of the total allotted time of the project. In this case, the intervention will be designed in a twice a month pattern. The 30 bedside nurses from two wards, aged care ward and intensive care ward, randomly. The training will be provided after shifts so that the patient care is not affected in any manner. Each session will be of 45 minutes and after each activity the nurses will be given informative pamphlets for future reference. A demonstrative workshop of using Morse fall scale and fall signage will be conducted every two months during the project to help the nurses get a clear idea regarding the fall prevention.

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