Evidence-Based Practice Proposal Final Paper

Benchmark - Evidence-Based Practice Proposal Final Paper
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Abstract
Modernized surgical plume evacuation systems have shown to be critical in maintaining optimal safety of patients and health care organization staff, including critical care surgeons, general surgeons, anesthesiologists, perioperative nurses, critical care surgeons, colorectal surgeons, and urologists. Many studies have shown that extended exposure to surgical smoke affects patients such as increasing readmission rates and declining patient outcomes. Among health care workers, surgical smoke exposure reduces job satisfaction and increases job absenteeism. This evidence-based practice proposal provides a plan for an evidence-based practice project designed to address the problem of surgical smoke in operating rooms among patients and surgical specialists. While several types of evidence can be utilized to support a suggested solution, a compelling base and sufficient support from validly published research studies are needed as a major component of the evidence proposed. The plan will contain seven sections beginning with organizational culture and readiness assessment and concluding with the evaluation process. Other critical sections discussed in this plan include proposal/problem statement and literature review, solution description, change model, and the implementation plan.
Table of Contents TOC \o "1-3" \h \z \u 1.0 Section A: Organizational Culture and Readiness Assessment PAGEREF _Toc24467855 \h 42.0 Section B: Proposal/Problem Statement and Literature Review PAGEREF _Toc24467856 \h 53.0 Section C: Solution Description PAGEREF _Toc24467857 \h 74.0 Section D: Change Model PAGEREF _Toc24467858 \h 95.0 Section E: Implementation Plan PAGEREF _Toc24467859 \h 116.0 Section F: Evaluation of Process PAGEREF _Toc24467860 \h 13References PAGEREF _Toc24467861 \h 16
Benchmark - Evidence-Based Practice Proposal Final Paper
1.0 Section A: Organizational Culture and Readiness Assessment
Organizational culture facilitates the assessment of organizational readiness in the implementation of evidence-based practice (EBP). The main areas of such assessments for the proposed change would be staff beliefs, nursing leadership, continuous improvement, and awareness levels. Organizational Readiness to Change Assessment (ORCA) is the primary tool of choice for assessing the readiness of an organization (National Collaborating Center for Methods and Tools, 2019). The tool is mainly concerned with the amount of evidence for the proposed change, the organization's capacity to implement change and the context in which the suggested change will be implemented. Upon employing the survey tool, it was found that the nursing leadership at the organization often communicated the clinical significance of EBP to the staff. While nurse leaders sometimes engage the staff in discussing the importance of EBP in the organization, such involvements are irregular. To address these challenges, nurse leaders need to hold regular teaching sessions discussing the role of EBP as a way of promoting one vision and appreciating the desired outcomes. Wagner et al (2016) have acknowledged the importance of staff education in enhancing compliance with plume management. After the implementation of staff sessions, Wagner et al (2016) note that compliance levels can increase by 14.6 percent. Nevertheless, the staff is adequately informed and confident about the role of EBP in enhancing patient outcomes. For instance, survey questionnaires showed a mean of 90.11 (SD=10.99) in EBP beliefs. In regards to the concept of continuous improvement as part of the readiness assessment, the ORCA tool showed that the staff can do their best in reviewing patient progress and change the plans of service delivery in achieving positive change. Nevertheless, their efforts can be impeded by the lack of general understanding of the role of efficient smoke evacuation systems. Due to the lack of strong evidence among staff, there are areas of weakness in complying and adhering to the required standards of surgical plumes evacuation.
2.0 Section B: Proposal/Problem Statement and Literature Review
Among health workers in the organization, including critical care surgeons, general surgeons, anesthesiologists, perioperative nurses, critical care surgeons, urologists, and colorectal surgeons, there is a general accord that modernized surgical plume evacuation systems are a necessity for optimal safety of both patients and staff. Besides, some vast studies and publications show the adverse health impacts of extended exposure to surgical smoke. For instance, Katoch and Mysone (2019) have found that populations with increased risks of respiratory issues, eye irritation, and airborne infections in hospital environments are the surgical staff. Research attributes this risk to the lack of proper smoke evacuation systems, lack of awareness about the potential health dangers, irregular use of protective tools such as smoke masks, and poor approaches to management (Katoch & Mysore, 2019). Another important source of evidence in Sisler et al (2018) study that showed the presence of cytotoxicity in lung and skin cells following exposure to volatile organic compounds and particulate matter in surgical smoke. At the same time, Steege et al (2016) also found that 99.3 percent of the 4,533 surgical experts who reported exposure to surgical smoke got exposed while performing electrosurgery. These findings are in line with the problem at the organization where although the organization is a leader in technology and innovation, the majority of surgical experts are still uncertain about the health impact of surgical plumes inhalation since there is a lack of dedicated surgical plumes evacuation systems. In line with this problem statement, the PICO question will be: Among surgical specialists and patients in the operating room (P), are there evidence-based gains of installing modernized smoke evacuators (I) as verifiable from incidences of ocular irritations, respiratory complications, and referrals to SICU (O) compared to the present data (C) when evaluated 3 months, 1 year, and 3 years after implementation (T)?
Using interviews and survey questions, it was possible to generate results of the evidence-based implementation of the suggested change. The study was conducted using a sample of 100 patients and 20 surgical specialists and the questionnaires for the surgical staff demonstrated how their perception of safety had changed 3 months following the installation of a state-of-the-art smoke evacuation system. Results indicated that 50 percent (n-10) of the surgical staff were more motivated to work for longer hours since they perceived increased levels of safety. Survey also showed reported cases of respiratory complications eye irritation and ICU referrals that were associated with surgical smoke inhalation. Although the findings after the 3 months were inconclusive, 60 percent of the respondents reported that their breathing improved compared to the past. Besides the survey questionnaires, the interviews were administered among 15 surgical specialists. Among the common issues assessed during these interviews included how the intervention affected their overall job satisfaction and personal experiences about the air quality in the surgical department. Interview results indicated that 95 percent of the surgical team had significant improvement in job satisfaction levels following the installation of the modern smoke evacuation equipment. Survey also focused on the changes in the number and frequency of patient discharge from the surgical department. Due to the effect of complications such as respiratory issues and eye irritation on hospital stays, it is necessary to verify how the installation of the system affected patient stats. Results indicated that 3 months following the installation of the modern smoke evacuation equipment, there was a decline of the rates of readmission by 30 percent and a 10 percent increase in the rates of patient discharge from the surgical department. While these results were not conclusively connected to the reduction in the health dangers posed by the inhalation of surgical smoke, there was a high possibility that the installation of the new equipment played a critical role in achieving the results. Although this is preliminary research and only focuses on the changes within the 3 months of the new equipment installation, the data gives more insight into the changes expected 1-3 years from the installation date. This implies that the main limitation in this research is that it is not conclusive because the link between the installation of the new equipment and the outcomes is not well established.
3.0 Section C: Solution Description
The proposed solution is to install a modern surgical plume evacuation system which will comprise of a downward airflow system for filtering and redistributing filtered air to the operating theatres. Romano et al (2017) have found that ventilation systems with a unidirectional downward flow of surgical smoke eliminate contaminants more effectively than the upward smoke displacement system while measuring the particulate matter in operating rooms. The solution can also involve a wall suction with a particulate filter and a smoke evacuator. Schultz (20140 has found such a system to be effective in filtering almost 100 percent of all contaminants between 0.12 microns in diameter or higher. In another related study, the placement of a suction device next to the electrosurgical site reduces the number of viable bacteria in the diathermy plume (Shultz, 2015). This study recommends the use of suction devices in the reduction of infection cases at surgical sites. The qualification of the proposed change is supported by findings that health care workers in operating rooms are yet to understand the full spectrum of the risks involved following surgical smoke exposures. In one of the studies, a negative diagnosis for infectious diseases among patients made the surgical team feel comfortable not using a respirator. Besides, 48-56 percent of laser surgery and electrosurgical specialists claimed that they did not use respirators since it was not part of their protocol (Steege, Boinano & Sweeney, 2016). Results indicate that smoke evacuation systems reducing exposure to health risks of the surgical plume can be critical in bridging these gaps in the use of other alternative measures such as surgical masks and respirators.
The proposed system is realistic considering the fact the organization has had a culture of continuous improvement especially in areas of the work environment. At the same time, many professionals in operating rooms generally contend that time is ripe to change the work environment through the improvement of air safety after identifying weaknesses in the use of the existing techniques of preventing exposure to surgical smoke. Increased cases of ocular irritation, skin irritation, and asthma attacks among several surgical specialists have been associated with laxity in the use of precautionary measures during electrosurgical operations. Therefore, the proposed change in investing in modern smoke evacuation technology will be welcomed as the operating room staff has appreciated the health dangers of prolonged exposure to surgical smoke. Besides, the organizational culture and readiness assessment through the ORCA tool showed a significant level of confidence in EBP implementation. Nevertheless, this assessment identified areas that might require improvement, including frequent training sessions that will enhance a common vision of the expected results. Such sessions are in line with Wagner et al (2016) findings that EBP educational sessions lead to an increase in compliance levels by 14.6 percent in surgical smoke management practices in operating rooms. Many members in the surgical department at the organization have gradually familiarized themselves with reported evidence indicating that the operating room staff is at higher risks of airborne infections and eye irritations. Therefore, the anticipated outcomes following the implementation of change is a decline in the reported cases of asthma attacks and ocular irritations both among patients and the operating room staff members. Achieving the anticipated outcomes requires that the process commences with the consultation with key stakeholders, including the chief financial officer, hospital administration, chief surgical officer, and the nurse leaders. Afterward, a steering committee will provide guidelines on the implementation, including informing the key stakeholders about the progress at every stage. It might be necessary for the steering committee to conduct education sessions to reduce the chances of resistance from those who might have feelings of dissatisfaction with the existing interventions of plume management. The biggest impact of EBP will be on improving quality care. For instance, the implementation will see a reduction in hospital stays due to issues arising from exposure to surgical smoke. This will also reduce the costs associated with such conditions, and decline the absenteeism of staff due to illnesses.
4.0 Section D: Change ...