A1. Problem or Issue
This is where you state the problem or issue that you have identified collaboratively with your resource person related to practice, policy, population, or education that aligns with organizational priorities.
A1a. Explanation of Problem or Issue
Here explain the problem with substantial support and include why it is applicable to your chosen area of practice and healthcare environment.
Here discuss with detail “How” you investigated the problem. Use the COS to guide this discussion. Do an external investigation (Are there articles in professional journals about the topic? Are there recommendations from professional organizations about the topic? ) Do an organizational assessment (national source documents, evidence from a stakeholder or resource person).
A2a. Evidence of Problem
Here include your appropriate evidence (data) to substantiate the problem. According to Smith & Smith (2014), then state what the article reported. Your data from your resource person and other stakeholders goes here.
Here explain what the data from your investigation means and support the state of the situation with the current data reported above.
A3a. Areas Contributing to Problem or Issue
Here from the analysis above substantiate areas that might be contributing to the problem or issue. (Example: If the problem is inadequate pain control and your evidence and analysis substantiates that patients do not ask for pain medication because of fear of addiction this would be a contributing factor).
A4. Proposed Solution or Innovation
Here provide an explanation of your solution. What are you proposing to do about the problem?
A4a. Justification of Proposed Solution
Here use your results of your investigation and analysis to support why your solution is justified. Explain why your solution is a good idea.
A5. Implementation Resources
Here provide recommendations with sufficient detail of resources to implement the proposed solution. Example from COS. Time, Materials, Personnel, Money
A5a. Cost Benefit Analysis
Here provide a cost benefit analysis of the proposed solution
Equate cost and benefits into dollars. Time can be converted into dollars by using an average salary 25.00 X 1.5 hrs. = 37.50 Benefits can be equated as dollars or timeliness, efficiency, safety, saved revenue, improved health of population. Cost-Benefit Analysis
Here include a specific time frame from start to finish, step-by-step, needed to implement your proposal.
A7. Identification of Key Stakeholders or Partners
Here identify the Key Stakeholders that are important for the implementation of the solution. Do not use real names (titles OK) to maintain confidentially.
A7a. Importance of Key Stakeholders
Here discuss, with support, why each of the Key Stakeholders are important for the implementation of the solution.
A7b. Engagement with Key Stakeholders
Here discuss how you met with the Key Stakeholders. Include their input and feedback and how you intend to work with each of them.
Discuss with detail how you will work with the Key Stakeholders to achieve success. How will you get their buy-in to ensure success of the project?
Discuss with detail the how of solution implementation. Include a plan from start to finish
A8a. Evaluation for Success of Implementation
Provide a detailed discussion of your Evaluation Plan and how your plan will be evaluated for success.
Review Population Case Study Example in the COS Population Case Study Example
B1. Role of Scientist
Here discuss how you fulfilled the role of a Scientist during this project using the definition of the role and the case study as a guide.
B2. Role of Detective
Here discuss how you fulfilled the role of a Detective during this project using the definition of the role and the case study as a guide.
B3. Role of Manager of Healing Environment
Here discuss how you fulfilled the role of manager of the healing environment using the definition and the case study as a guide.
C. Verification Form
Attach a copy of your completed “Professional Verification Form” from the organizational leader advising you in the leadership experience.
Provide in-text citations and references in APA style.
Hand hygiene is seen as a primary measure in the reduction of the transmission of nosocomial pathogens. As such, the notion of non-compliance is an aspect of concern and remains a major problem in hospitals. Following the most recent improvements in the comprehension of the epidemiology of hand hygiene, it has become important to implement stringent approaches towards the emphasis on hand hygiene. The prospect of new approaches, guidelines for hand hygiene and setting up of standards in practice in the healthcare environment are some of the approaches implemented. Therefore, this paper will examine hand hygiene as a pertinent issue in the emergency department.
Current State of ER
Presently, monitoring of hand hygiene has become a facet of concern with the implementation of monthly basis for monitoring evident aspects. As such, the monitoring comprises of at least 100 observations that entails an analysis of Registered Nurses (RN) Medical Doctors (MD), Nursing Assistants and any other ancillary staff. through the implementation of a standardized noting audit sheet, there is a firsthand access to information about the individual seen leaving or entering patient care without conducting hand hygiene. From the analyses of Staats, et al., (2016), proper hand hygiene entails cleaning of hands using alcohol containing hand sanitizer or the use of the sink to wash coupled with dry the hands completely. Nonetheless, the main problem emanates from lack of communication among the individuals involved. The audits in most instances are left to the volunteers at the hospice who possess minimal knowledge about the appropriate ways of hand hygiene. As a clear example in the instance that an individual has Clostridium Difficile (C-Diff), they are required to wash their hands using soap and water but not incorporate hand sanitizer. Ensuring that appropriate ways were used to wash the hands is unclear due to the inadequate knowledge among the auditors. Further, in conversation with the diverse volunteers it became evident that resistance to conversing with the staff about their observations was a daunting prospect. Hence, in the last twelve months, the compliance rates have been at 83 with levels reducing to 76% in certain months. The main concern is the inefficiency in handling hand hygiene. Accordingly, hand hygiene should be imperative to curbing the emergence of Hospital Acquired Infections (HAI)). Therefore, the need for changes towards improving hand hygiene compliance is essential for successful outcomes in the healthcare organization.
Problem and Explanation of the Problem
Terms incorporated and reviewed towards the explanation of hand hygiene have been diverse. Nonetheless, the general agreement is the notion that hand hygiene is a term that denotes the process of washing hands through antiseptics or the implementation of surgical hand antisepsis. From the analysis of the emergency department, hand hygiene has been a major problem. Hand contamination has become a facet of concern emanating from non-emphasis on hand hygiene among the department workers. The ever increasing cases of hand contamination have been as a result of reduced empowerment of the healthcare staff on the need for hand hygiene. From the analysis of Liu, et al. (2015), following an effective hand hygiene practice has been recognized as the most formidable way in reducing transmissions. Transmissions of pathogens in the healthcare setting have been on the rise with many pundits emphasizing on the shift in the operational behavior of healthcare practitioners. The emergency department exudes low levels of adherence of hand hygiene. The unsuccessful efforts towards encouraging the healthcare practitioners to conform to hand hygiene have been as a result of the diverse challenges towards measuring and examining hand hygiene adherence. Investigations by Potdar, Shinde & Sadare, (2016) reveal that the emergency department exudes the following challenges in the analysis of adherence levels of the healthcare practitioners:
- Prevailing contact with patients takes place in numerous locations in the healthcare organization
- Opportunities for hand hygiene prevail daily and involve both the staff and non-clinical staff
- Monitoring of the activities of the healthcare practitioners is resource intensive that encompasses quality improvement, infection prevention measures, and numerous activities that demand for both time and expertise
- Observation bias is a daunting prospect to eliminate in tackling hand hygiene
Investigation/Evidence/Analysis/Areas Contributing to the Problem
Studies of the emergency department reveal that the importance of hand hygiene is not recognized sufficient. Among the emergency department workers and patients as well, there has been a reduced compliance to the hand hygiene. In the emergency department, the numbers of those adhering to hand hygiene have been as low as 76%. The reduced variations in conformity to hand hygiene have been as a result of diverse reasons. Most importantly, the higher levels of workload coupled with the opportunities for hand hygiene per hour has been in a minimal manner. Liu, et al. (2015) emphasizes that in their nature, infections emanate from numerous factors that are related to both systems and processes in the care provision process. On the other hand towards researching the aspects that influence hand hygiene there are various areas that are contributing to the non-compliance problem:
- Some of the hand washing agents cause skin irritation to the caregivers
- Inconvenient location of the sinks
- Caregivers are sometimes too busy or have insufficient time
- The needs of the patients take priority
- Some of the caregivers believe that using gloves eliminates the need for hand hygiene
- Inadequate knowledge, experience, and education
- Skeptics among the caregivers on the value of hand hygiene
- Disagreements among the caregivers on the importance of policy recommendations and implementation
- Inadequate scientific findings on the impact of the improvements in hand hygiene
Proposed solution/Justification of solution
Over the last decade, there have been numerous findings on the interventions to improve hand hygiene. Although the available measurements have been varied in the definition of the available assessment solution, it has become important to first encompass direct observation in the solution process. The majority of the studies encompass multimodal strategies that are inclusive of education, auditing of hand hygiene practices, ensuring that alcohol and hand sanitizer is available and setting up automatic sinks (Potdar, Shinde&Sadare, 2016). Instituting the different approaches encompass a more communication centric initiatives towards emphasizing the importance of hand hygiene. The failure in the promotion process of hand hygiene is an extensive cause to the spread of the multi-resistant organisms. Further, the increasing prospect of outbreaks of illnesses requires the implementation of more emphatic initiatives. There is convincing evidence on the notion that the multimodal strategies can increase hand hygiene among the individuals. In addition Chassin, et al., (2015) emphasizes that sustained decrease in the incidence of the multi-drug resistant bacteria has been through the implementation of the multimodal strategies that encompass both training and resource allocation. Further, emphasis on hand hygiene enhancement actions assists in monitoring of ailments in the emergency department. Recent research has shown that understaffing and overcrowding are consistently being linked to the poor conformity to hand hygiene. The beneficial outcomes of hand hygiene promotion are significant towards promoting health and improving the welfare of the patients (Kirk, et al. 2016). Therefore, the implementation of the multimodal strategies in health promotion is justifiable due to the following reasons:
Focus on system change: ensuring that there prevails the necessary infrastructure is a justifiable way towards improving hand hygiene. The practice of hand hygiene in the emergency department requires system change. The system change should be the emphasis on empowerment on the use of mostly alcohol based hand sanitizers to emphasize on hand hygiene.
Implementation of training and education: the multimodal strategy relies on the provision of education and training. Through training and education, the approach will correct the procedures of hand washing and hand rubbing. Provision of adequate information on the need for hand hygiene is sustainable towards instigating change among the care providers.
Emphasis on reminders at the workplace: prompting or reminding the emergency caregivers on the need for hand hygiene is fundamental in highlighting the appropriate conditions and procedures for the activity. Reminders perform a necessary role considering the busy schedule of the emergency care providers. Chassin, et al. (2015) emphasizes that caregivers forgetting on the need for hand hygiene are a common aspect.
Instituting safety climate for the patients: it is critical to creating an environment in which awareness is central to ensuring hand hygiene. The facilitation of an environment that is safe with enough resources towards enhancing hand hygiene is the basis of the multimodal strategy.
The emergency department needs to implement stricter approaches towards hand hygiene. In a facility in which handling of patients is in a constant manner, it is important to initiate a short-term implementation plan. Therefore, the implementation plan is inclusive of the following five steps:
Step 1: preparing the facility and the stakeholders for the meeting
Step 2: Establishing the foundation or the comprehension of the present position in the health facility
Step 3: Introduction and setting up of the hand hygiene enhancement process
Step 4: Follow-up evaluation denotes an analysis of the outcomes of the changes in hand hygiene
Step 5: action scheduling and analysis of the implementation steps that entails development of a plan for the next fiscal year
The multimodal strategy for improving hand hygiene in the emergency department has a timeline for a year. In the fiscal year, the multi-step approach will denote resource allocation and communication with the stakeholders (Kirk, et al. 2016). The involvement of the stakeholders should be in a regular manner to ensure that continuous assessment of the progress prevails.
Implementation of Resources/Cost Benefit Analysis
There are several resources that will be critical to catapulting hand hygiene in the emergency department. It is fundamental to ensure that resources such as alcohol, gloves, and hand wash detergents are available. Sinks should be located at all points of care with pundits such as Chassin, et al. (2015) emphasizing that the sink to patient ratio should be at least 1:9. On the other hand, the soap dispensing systems are advised to be in every sink at both the patient and emergency rooms. Differentiating the types of soap dispensers should be through constant evaluation due to the prospect of malfunction that can impede on the hand hygiene emphasis process. The use of alcohol based hand sanitizer should be mandatory to ensure (HAI) do not prevail. Most importantly, the staff should comprehend that the use of the sanitizers should protect against (C-Diff).
Hence, from the analysis of the implementation process of the resources, it is imperative to examine the costs and benefits of the approach. A cost-benefit analysis will present valuable information on the potential net benefits or loss of improving hand hygiene. Hence, a cost-benefit analysis is as follows:
|Soap dispenser 3* $270 = $810||Serves the emergency department staff for a minimum of a month|
|Shampoo and liquid dispenser 3 * $300 = $900||Serve for two months|
|Premium gloves $18000||Ensure ready access to gloves for all the medical practitioners|
Identification of Key Stakeholders/Importance of KSH’s/Engagement with KSH’s
Success/Evaluation for Success
Understanding the importance of the stakeholders necessitates effective process in policy implementation. From the evaluation of the emergency department, the stakeholders include health workers, surgeons, patients and the management. As a doctor operating in the emergency department, it is through the examination of the relationship among the stakeholders that effective decision making is bound to prevail (Staats, et al. 2016). As the stakeholders, their importance is towards:
Providing input into the analysis, strategic planning and the institutional assessment of on-ground issues about hand hygiene. Stakeholders provide a wealth of information that will necessitate successful decision-making process. The diversity in professionalism will enable access to information on the hand hygiene and the key trends available on the issue. Without the stakeholders, ineffective or biased decision making may prevail that will impede the progress of hand hygiene enhancement process in the healthcare facility.
Development of action plans towards increasing support for reform policy. The reform policy in hand hygiene is reliant on stakeholders meeting and developing policies for reforms. Therefore, the stakeholders will enable the development of action plans that will necessitate an effective reform policy.
Stakeholders are important to guiding participatory consensus building process through sharing information and encouraging discussions. Through the stakeholders, information sharing is bound to prevail (Liu, et al. 2015). Sustenance of information relay is effective to enable discussions and investment of both financial and technical resources.
Through the analysis of the importance of the key stakeholders, it is evident that evaluation of the success of the stakeholder process will generate information on the shift of the operational dynamics. Accordingly, the success of the evaluation process of the stakeholders will denote:
- Encompassing an open communication environment
- Maintaining a feedback center on the progress of improving hand hygiene
- Setting up routine meetings to address any pertinent issues
Roles of Scientist, Detective, and Manager of the Healing Environment
Role as a Scientist
Undertaking research on the available options for hand hygiene requires a scientific overview. Accordingly, in the analysis of research, in undertook an extensive scientific investigation of the pertinent issues impacting the use of hand detergents. Scientists such as Staats, et al. (2016) exude findings that some of the hand detergents may impact on the health of the users. The prospect of scientific perspective on hand hygiene is important to generate factual information on the reasons why adoption of effective hand hygiene measures has been lagging behind. Additionally, from the analysis of Chassin, et al. (2015) the emergence of multi-resistance bacteria has been as a result of ineffective hand hygiene policies. Hence, the direct relationship between the emergence of multi-resistant bacteria and hand hygiene is a causative factor towards the need for effective changes.
Role as a Detective
As a detective, it is fundamental to investigate on hand hygiene from a firsthand perspective. Therefore, investigating on hand hygiene in the workplace, information on the hand hygiene was through direct observation. Through clandestine operations, I managed to obtain information on the trends of the healthcare practitioners in their adherence to hand hygiene. Further, direct interviews provided information on adherence to hand hygiene among the healthcare practitioners.
Manager of the Healing Environment
Undertaking research on hand hygiene required management of both information and resources available. Therefore, in the health environment, my role as a manager entailed taking part in various meetings among the departmental heads and presenting ideas on changes that should be made. Through the participation in the discussions with the management, acquisition of information and relay of the changes that require implementation were some of my inputs. Further, in the management position, reminding of the healthcare providers on the need for hand hygiene was an individualistic role. Through reminding of the healthcare providers and providing information on the importance of hand hygiene, effective outcomes were evident in reducing the low rates of adherence to hand hygiene.
Hand hygiene is important in a
healthcare setting. From the above analysis, it is fundamental that the
healthcare providers implement the various changes through the multimodal
strategy. The multimodal strategy denotes the use of systematic change and
investment into new resources to enable acceptance of the need for hand
hygiene. Hence, through the focus on steadfast approaches that are reliant on
the key stakeholder involvement, improving the low rates of hand hygiene is
bound to prevail in the emergency department.
Chassin, M. R., Mayer, C., & Nether, K. (2015). Improving hand hygiene at eight hospitals in the United States by targeting specific causes of noncompliance.The Joint Commission Journal on Quality and Patient Safety, 41(1), 4-12.
Kirk, J., Kendall, A., Marx, J. F., Pincock, T., Young, E., Hughes, J. M., & Landers, T. (2016). The point of care hand hygiene—where’s the rub? A survey of US and Canadian health care workers’ knowledge, attitudes, and practices.American journal of infection control.
Liu, M. A., van de Bruinhorst, K., Olson, D., &Aiyagari, V. (2015). 904: Improving hand hygiene compliance in hospital care. Critical care medicine, 43(12), 227-228.
Potdar, N., Shinde, M., &Sadare, S. (2016). The effectiveness of Structured Teaching Programme on Prevention of Nosocomial Infection among Nurses Working At Tertiary Hospital. International Journal of Health Sciences and Research (IJHSR), 6(5), 194-200.
Staats, B. R., Dai, H., Hofmann, D., & Milkman, K. L. (2016).Motivating process compliance through individual electronic monitoring: An empirical examination of hand hygiene in healthcare.Management Science.