WK4 Practice Discussion Responses Read and respond to two or more of

WK4 Practice Discussion Responses
Read and respond to two or more of your colleagues’ postings from the Discussion question. Provide feedback on potential challenges you see might compromise the improvement project and what other resources might be more cost effective. As a member of a community of practice, help each other refine and clarify the patient-centered Practice Experience Project.
Resp 1
L. Deacon 
RE: Group A Practice Experience Discussion – Week 4
COLLAPSE
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          In my action plan to reduce MRSA bloodstream infections in hospital inpatients, the costs associated with it will come from the education, training, testing, and medication used to reduce the number of infections.
           Looking at the cost associated with education and training for my proposed plan. It comes down to salary and materials. Education costs breakdown is time and participants. If you hold an in-service during business hours and you want staff not at work to attend, they must clock in to get paid for attending the in-service or call in over the phone, and the manager can pay them for their time by putting in later. The educator that will conduct this training will get their salary. Materials used or printed will come out of the unit’s budget for training.
Regarding testing, the swabs used for MRSA in the nares will reflect against the patient bill. For positive patients, mupirocin will also be charged to the patient. Mupirocin is used for decolonizing nasal MRSA and has been proven very effective (Eed2019). But prevention costs will be far less than the cost to the hospital when someone is positive for MRSA in the bloodstream with associated complications, i.e., endocarditis. In neonates, MRSA infection can cost the hospital 164 thousand dollars in care costs (Bharadwaj2019).
           The problem with the proposed plan is getting units on board to implement nasal swabs for patients when they get sent to the floor. The issues with arbitrary things are that they get passed on and sometimes missed. Resources for this project will be the swabs and manpower in the lab to complete all these tests. The one thing I did not find in my research is how long it takes to run this test or how difficult it is from a lab standpoint.
 
Eed, E. M., Ghonaim, M. M., Khalifa, A. S., Alzahrani, K. J., Alsharif, K. F., & Taha, A. A. (2019). Prevalence of mupirocin and chlorhexidine resistance among methicillin-resistant coagulase-negative staphylococci isolated during methicillin-resistant Staphylococcus aureus decolonization strategies. AJIC: American Journal of Infection Control, 47(11), 1319–1323. https://doi.org/10.1016/j.ajic.2019.05.004
Bharadwaj, S., Ho, S. K., Khong, K. C., Seet, A., Yeo, K. C., Chan, X. Y., Wong, L. L., Karlin, R. B., Chan, D. K., & Ling, M. L. (2019). Eliminating MRSA transmission in a tertiary neonatal unit–A quality improvement initiative. AJIC: American Journal of Infection Control, 47(11), 1329–1335. https://doi.org/10.1016/j.ajic.2019.06.001
Resp 2
N. Galloway 
RE: Group A Practice Experience Discussion – Week 4
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According to the council on accreditation there exist four common barriers to setting up a quality improvement system. One barrier is compliance versus quality improvement. Compliance-driven improvements are merely focused on regulations imposed by governmental agencies being met each year. They are only defined by the organization’s internal standards and do not rely on employees’ internal moral compasses to increase the quality of care (Micco, 2017). The second barrier is time. It is important to start explaining to everyone who will be involved what will be happening and the importance of the project. There is a planning phase and an implementation phase. Each phase may take a good portion of the time so it’s important to plan accordingly (Micco, 2017). The third barrier would be neglecting those who have formal or informal influence inside an organization. Influencers function on a successful team as metaphorical cheerleaders (Micco, 2017). The last barrier is not compartmentalizing each step of the project. Some will be eager, and others want to maintain their focus elsewhere. Compartmentalizing each step of the project will ensure understanding from all involved before moving on to each new step (Micco, 2017).
Implementing a new policy in the Department of Veteran’s Affairs (VA) has more barriers than just making sure others are on board. One of my supervisors explained that in our unit, one would need to meet with the unit manager along with the acting chief of the hospital. Once the acting chief signs off on the proposed policy, one would then need to coordinate with the administrative officer to have them ordered. Once they are ordered, there would need to be effort to implement regular staff training and competencies (S. Adamson, personal communication, August 2, 2022).
                Other considerations when writing a new policy for any hospital are making sure they are based on the most recent evidence-based practice (EBP) and clinician expertise and that they include patient values and preferences (Dols, 2017). EBP influences a unit’s nursing practice by increasing the nurses’ knowledge and changing nursing care through the development of new policies and procedures (Dols, 2017). This means that each new or updated policy must comply with EBP standards, policies, order sets, checklists, education content, patient education handouts, computerized documentation templates, and supplies needed for the policy (Dols, 2017). The failure to align these necessary tools with the most current evidence-based practice limits the success of its implementation (Dols, 2017).
 
               
 
References
Micco, M.D. (2017). 4Common Barriers to Setting up a Quality Improvement System. Council on Accreditation. https://coanet.org/2017/12/4-common-barriers-to-setting-up-a-quality-improvement-system/
S. Adamson (personal communication, August 2, 2018).
Dols, J. D., Munoz, L. R., Martinez, S. S., Mathers, N., Miller, P. S., Pomerleau, T. A., Timmons, A., & White, S. (2017). Developing Policies and Protocols in the Age of Evidence-Based Practice. JOURNAL OF CONTINUING EDUCATION IN NURSING, 48(2), 87–92. https://doi.org/10.3928/00220124-20170119-10
Name: NURS_4220_Week4_PracticeExperience_Rubric
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Excellent
Proficient
Basic
Needs Improvement
Required ContentDescribed the proposed action steps for implementing improved practice and explains where potential challenges might compromise the proposed improvement project. Described what resources are needed and explains whether or not those resources are cost-effective. Continues to collaborate with the selected individuals in the practice environment and shares this information with the group.
18 (36%) – 20 (40%)
Initial post is exceptional containing well developed and insightful analysis that brings connections to nursing practice into the discussion.
15 (30%) – 17 (34%)
Initial post contains reasonable analysis that brings insight into the discussion.
12 (24%) – 14 (28%)
Initial post contains minimal analysis that brings limited insight into the discussion.
0 (0%) – 11 (22%)
Initial post lacks analysis and/or that brings little or no insight into the discussion.
Response PostsEntered the discussion thread on 3 separate days. Wrote at least two posts to two separate peers.
Responses are appropriate to the topic, substantive, and promoted discussion by one or more of the following:• contributing insight to move the discussion forward.• offering substantial and/or different points of view and asks questions to add to discussion• including extra references or websites for peers to consider• relating discussion to different areas of practice and applying concepts to practice
**Additional points may be deducted for late posting per the University late policy.
14 (28%) – 15 (30%)
Response posts add substantial ideas and perspectives that invite further analysis and discussion. Participated 3 or more days in the classroom and responded to more than 2 classmates.
12 (24%) – 13 (26%)
Response posts are proficient and provide adequate analysis and discussion. Participated 3 days in the classroom and responds to at least two classmates.
11 (22%) – 11 (22%)
Response posts are limited and provide minimal analysis and discussion. Participated less than 3 days in the classroom and/or responds to less than two classmates.
0 (0%) – 10 (20%)
Response posts are inadequate and provide no analysis of discussion and/ or there is no participation in the classroom.
Professional Writing: Clarity, Flow, and Organization
4.5 (9%) – 5 (10%)
Content is free from spelling, punctuation, and grammar/syntax errors. Writing demonstrates very well-formed sentence and paragraph structure. Content presented is completely clear, logical, and well-organized.
4 (8%) – 4 (8%)
Content contains minor spelling, punctuation, and/or grammar/syntax errors. Writing demonstrates appropriate sentence and paragraph structure. Content presented is mostly clear, logical, and well-organized.
3.5 (7%) – 3.5 (7%)
Content contains moderate spelling, punctuation, and/or grammar/syntax errors. Writing demonstrates adequate sentence and paragraph structure and may require some editing. Content presented is adequately clear, logical, and/or organized, but could benefit from additional editing/revision.
0 (0%) – 3 (6%)
Content contains significant spelling, punctuation, and/or grammar/syntax errors. Writing does not demonstrate adequate sentence and paragraph structure and requires additional editing/proofreading. Key sections of presented content lack clarity, logical flow, and/or organization.
Professional Writing: Context, Audience, Purpose, and Tone
4.5 (9%) – 5 (10%)
Content clearly demonstrates awareness of context, audience, and purpose. Tone is highly professional, scholarly, and free from bias, and style is appropriate for the professional setting/workplace context.
4 (8%) – 4 (8%)
Content demonstrates satisfactory awareness of context, audience, and purpose. Tone is adequately professional, scholarly, and/or free from bias, and style is consistent with the professional setting/workplace context.
3.5 (7%) – 3.5 (7%)
Content demonstrates basic awareness of context, audience, and purpose. Tone is somewhat professional, scholarly, and/or free from bias, and style is mostly consistent with the professional setting/workplace context.
0 (0%) – 3 (6%)
Content minimally or does not demonstrate awareness of context, audience, and/or purpose. Writing is not reflective of professional/scholarly tone and/or is not free of bias. Style is inconsistent with the professional setting/workplace context and reflects the need for additional editing.
Professional Writing: Originality, Source Credibility, and Attribution of Ideas
4.5 (9%) – 5 (10%)
Content reflects original thought and writing and proper paraphrasing. Writing demonstrates full adherence to reference requirements, including the use of credible evidence to support a claim, with appropriate source attribution (when applicable) and references.
4 (8%) – 4 (8%)
Content adequately reflects original writing and paraphrasing. Writing demonstrates adequate adherence to reference requirements, including the use of credible evidence to support a claim, with appropriate source attribution (when applicable) and references.
3.5 (7%) – 3.5 (7%)
Content somewhat reflects original writing and paraphrasing. Writing somewhat demonstrates adherence to reference requirements, including the use of credible evidence to support a claim, with appropriate source attribution (when applicable) and references.
0 (0%) – 3 (6%)
Content does not adequately reflect original writing and/or paraphrasing. Writing demonstrates inconsistent adherence to reference requirements, including the use of credible evidence to support a claim, with appropriate source attribution (when applicable) and reference.
Total Points: 50
Name: NURS_4220_Week4_PracticeExperience_Rubric
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