Benchmark – Capstone Project Change Proposal
Assessment Description
In this assignment, students will pull together the capstone project change proposal components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. For this project, the student will apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.
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Benchmark – Capstone Project Change Proposal
Background
COVID-19 has had severe impacts on different sectors, such as the healthcare system and the economy. The loss of lives and poor quality of life of affected individuals is the primary concern. As more studies were being done, it was determined that high-risk individuals are likely to have poor outcomes following infection by the coronavirus.
The high-risk individuals include those who are immunocompromised, possibly due to preexisting disease conditions such as diabetes and other medical issues. When infected with the virus, such individuals require more advanced care to help prevent complications and enable them to achieve better health outcomes. The majority of such patients also require admission to intensive care units since the infection quickly progresses to cause complications that impair normal physiological functions, including breathing hence the need for ventilator support in the ICUs (Abate et al., 2020).
Such admissions in intensive care units are associated with other challenges, one of which is bloodstream infections, which have shown to be more prevalent among COVID patients than non-COVID patients. This forms the focus of the capstone project, which aims to address the reasons for higher rates of infections among COVID-19 patients compared to non-COVID patients.
Clinical Problem Statement
The high incidences of bloodstream infections among COVID-19 patients significantly affect their health outcomes. The rate of these infections is higher among COVID-19 patients than non-COVID patients since COVID infections are associated with changes in management strategies of patients, given that the safety of healthcare workers must also be prioritized (Shukla et al., 2021).
This raises concern about the various measures which can be put in place to help in reducing the risk of such infections among COVID patients hospitalized in the ICUs. Due to the high transmission of the virus, COVID-19 patients in many facilities fail to receive optimum care since various healthcare providers cannot collaborate effectively to plan care for the patient, and the reduced need for constant and prolonged contact with the patients to protect the caregivers from getting infected.
There is, therefore lack of proper infection control measures compared to non-COVID patients who are also admitted to the ICU since the caregivers in such settings can sustain constant contact with the patients and incorporate the various infection prevention measures, thus helping in reducing incidences of infections among these patients (Giacobbe et al., 2020). Therefore, the infection control measures will help reduce the incidences of these infections, thereby helping to improve the health outcomes of COVID-19 patients in the ICU setting.
The ICU setting and the procedures, including mechanical ventilation, predispose such patients to a higher risk of developing hospital-acquired infections, such as bloodstream infections (Buetti et al., 2021). The measures help the patients achieve better health outcomes and in averting other complications such as prolonged hospital stay and increased healthcare costs, which may further distress the patients and their families.
Purpose of Change Proposal
The increasing need for ICU admissions following COVID-19 infection results in the need for interventions in the critical care setting, which may predispose the patients to a high risk of infections. Interventions such as the insertion of central lines are associated with increased chances of developing central-line-associated bloodstream infections (CLABSI), which further complicates the health status and outcomes of COVID-19 patients (Frank, 2021).
Benchmark – Capstone Project Change Proposal
This can result in prolonged duration of hospital stay and increased mortality rates among these patients. Therefore, the change proposal emphasizes the need for the reimplementation of the infection control measures within the ICU setting as a primary means to prevent spreading the infections to the patients.
Therefore, the primary purpose of the change proposal is to reduce the incidences of bloodstream infections within the ICU settings and other hospital-acquired infections within the setting through the various measures set in place. Effective prevention of such infections will enhance patient recovery and shorten the duration of hospital stay due to increased recovery rates (Pasquini et al., 2021). It will help ensure that COVID-19 patients admitted to ICU receive optimum care, which is critical in achieving better health outcomes.
PICOT Question
Concerning the healthcare problem, the PICOT question being analyzed is; Are patients admitted to the hospital Intensive Care Unit (ICU) with COVID-19 and bloodstream infections (BSIs) receive equal care for these infections compared to non-COVID patients who have a BSI during their inpatient hospitalization? In the PICOT question, the population of this project is patients who are admitted with COVID-19 and BSI.
The intervention is the nurse’s role in providing proper treatment for infections and COVID-19. The comparisons are the number of positive COVID-19 patients with BSIs compared to non-COVID-19 patients with BSIs. The outcomes are with the proper treatments and medication therapy, the COVID positive patient recovers, and lastly, the time frame, which is from admission after a positive test through the duration of inpatient admission.
Literature Search Strategy
Given the vast impacts of COVID-19, many articles have been published to present ideas and information related to this global pandemic. Therefore, there is a need to ensure that the literature sources meet the various credibility criteria to enhance the accuracy and reliability of the information obtained. The literature sources were obtained from recognized health websites and belonged to nursing and healthcare journals.
The authors of the publications were professionals, which was crucial in ensuring the accuracy of the published information. The timeliness factor was also essential to ensure that the information was updated and aligned with the most current research conducted. Search words such as infection control in COVID-19 patients were used; to help in ensuring the information obtained from them was relevant in addressing the topic.
Evaluation of the Literature
Various sources of literature describe the impacts which COVID-19 has had, especially regarding patient care. The nature of care that patients receive has changed, given the need to protect the healthcare providers as they provide care to the patients. One of the major concerns is the increased incidences of bloodstream infections, which have been identified to occur 48 hours post-admission in the ICU for patients in critical conditions following COVID-19 infection (Palanisamy et al., 2021).
Both COVID and non-COVID patients admitted to the ICU are at high risk of developing bloodstream infections, taking the form of catheter-associated urinary tract infection (CAUTI) or central-line-associated bloodstream infection (CLABSI). At the peak of COVID-19 infections, there was an influx in need for ICU admissions (Frank, 2021).
There was increased demand for ICU services and pressure on the available healthcare workforce to cater to the patients. Therefore, healthcare providers had to develop means of ensuring proper delivery of care to these patients to enable them to achieve better health outcomes. Mechanical ventilation and catheter insertion, which are characteristic of the ICU setting, can facilitate the transmission of hospital-acquired infections, especially when the infection prevention guidelines are not adhered to (Frank, 2021).
The infection prevention measures which are fundamental in the prevention of hospital-acquired infections, such as the bloodstream infections identified among COVID-19 patients, include adequate staffing, effective use of personal protective equipment, and proper medication regimens are all strategies that are effective in preventing the transmission of hospital-acquired infections among COVID and non-COVID-19 patients admitted in the ICU (Kokkoris et al., 2021). Through such prevention, patients can achieve better health outcomes since there is a marked reduction in the risk of developing complications.
Applicable Change or Nursing Theory Utilized
Jean Watson’s theory of caring human advocates for a healing environment that can help the patient achieve better health outcomes. This theory is the most applicable while caring for COVID-19 patients in the ICU. The theory emphasizes the need for healthcare providers to create a favorable environment that includes a safe environment that hastens the patient’s healing process (Hermann, 2021). By adhering to the various safety measures, healthcare providers create a safe environment that facilitates the patient’s healing.
Proposed Implementation Plan with Outcome Measures
The introduction of safety measures within the ICU setting has proved to be effective in reducing bloodstream infections among COVID-19 patients. Therefore, this intervention should be effectively implemented to help achieve the set outcomes, including lowering incidences of bloodstream infections, preventing the development of more complications among these patients, reducing the duration of hospital stay, and improving the health outcomes of the COVID-19 patients admitted in the ICU.
Therefore, an effective implementation should involve all the stakeholders to ensure that their needs are effectively addressed and their support of the initiative obtained since it is critical in the successful implementation process (Batras et al., 2016). Such support can only be obtained by informing the various stakeholders of the healthcare issue, why the intervention is the most appropriate in addressing the issue, why their support is essential in successfully implementing the intervention and the consequences of failing to implement it.
Use of Evidence-Based Practice in Intervention Plan
Evidence-based strategies are the most effective way to address various healthcare problems. The intervention plan developed, which entails incorporating safety measures while providing care to COVID-19 patients admitted to the ICU, was evidence-based. The information from credible and reliable literature sources showed its effectiveness in addressing the issue and improving patient health outcomes.
Plan for Evaluating the Proposed Nursing Intervention
Proper evaluation of the intervention developed is critical following its implementation to determine if it successfully addresses the healthcare problem. Such assessment also helps determine the barriers to successful implementation, from which strategies can be developed to address them and facilitate the intervention’s success (Batras et al., 2016).
The appropriate evaluation plan includes assessing the outcome measures, including the new incidences of bloodstream infections, duration of hospital stay, and patient health outcomes after implementing the intervention plan and comparing it with the findings before implementing the intervention.
Potential Barriers to Plan Implementation, And How to Overcome Them
Implementation of the plan can face significant obstacles, including inadequate support from key stakeholders, resistance from some stakeholders, and inadequate resources to drive the plan (Batras et al., 2016). Barriers such as insufficient support and opposition from stakeholders can be addressed by incorporating all the stakeholders in the whole process and addressing their needs and concerns (Batras et al., 2016).
Inadequate resources can be managed through collaboration with key stakeholders and funding agencies to help lobby resources to drive the plan.
Conclusion
Bloodstream infections and other hospital-acquired infections can significantly affect health outcomes, especially among COVID-19 patients admitted to the ICU. Proper implementation and evaluation of interventions such as safety measures within the ICU settings can help in reducing the incidences of such infections, thus helping in ensuring better patient health outcomes.
References
Abate, S.M., Ahmed Ali S, Mantfardo B., Basu, B., (2020). Rate of Intensive Care Unit admission and outcomes among patients with coronavirus: A systematic review and Meta-analysis. PloS ONE. 15(7). E0235653. https://doi.org/10.1371/journal.pone.0235653
Batras, D., Duff, C., & Smith, B. J. (2016). Organizational change theory: implications for health promotion practice. Health promotion international, 31(1), 231-241. https://academic.oup.com/heapro/article-abstract/31/1/231/2355918
Buetti, N., Ruckly, S., de Montmollin, E., Reignier, J., Terzi, N., Cohen, Y., Siami, S., Dupuis, C., & Timsit, J. F. (2021). COVID-19 increased the risk of ICU-acquired bloodstream infections: a case-cohort study from the multicentric OUTCOMEREA network. Intensive care medicine, 47(2), 180–187. https://doi.org/10.1007/s00134-021-06346-w Benchmark – Capstone Project Change Proposal
Frank Diamond. October 21, 2020. Study: CLABSI, CAUTI Rates Higher for COVID Patients. Infection Control Today. ttps://www.infectioncontroltoday.com/view/weekly-rounds-highlights-april-issue-covid-19-boosters
Giacobbe, D. R., Battaglini, D., Ball, L., Brunetti, I., Bruzzone, B., Codda, G., Crea, F., De Maria, A., Dentone, C., Di Biagio, A., Icardi, G., Magnasco, L., Marchese, A., Mikulska, M., Orsi, A., Patroniti, N., Robba, C., Signori, A., Taramasso, L., … Bassetti, M. (2020). Bloodstream infections in critically ill patients with COVID-19. European Journal of Clinical Investigation, 50(10). https://doi-org.lopes.idm.oclc.org/10.1111/eci.13319
Hermann, M. (2021). The COVID-19 Caring Project. Nursing made Incredibly Easy, 19(4), 4. https://journals.lww.com/nursingmadeincrediblyeasy/Fulltext/2021/07000/The_COVID_19_Caring_Project.1.aspx
Kokkoris, S., Papachatzakis, I., Gavrielatou, E., Ntaidou, T., Ischaki, E., Malachias, S., Vrettou, C., Nichlos, C., Kanavou, A., Zervakis, D., Perivolioti, E., Ranellou, K., Argyropoulou, A., Zakynthinos, S., Kotanidou, A., & Routsi, C. (2021). ICU-acquired bloodstream infections in critically ill patients with COVID-19. The Journal of hospital infection, 107, 95–97. https://doi.org/10.1016/j.jhin.2020.11.009
Palanisamy, N., Vihari, N., Meena, D. S., Kumar, D., Midha, N., Tak, V., Sharma, A., Bohra, G. K., Kothari, N., Dutt, N., Bhatia, P. K., Garg, M. K., & Misra, S. (2021). Clinical profile of bloodstream infections in COVID-19 patients: a retrospective cohort study. BMC infectious diseases, 21(1), 933. https://doi.org/10.1186/s12879-021-06647-x
Pasquini, Z., Barocci, I., Brescini, L., Candelaresi, B., Castelletti, S., Iencinella, V., Mazzanti, S., Procaccini, G., Orsetti, E., Pallotta, F., Amadio, G., Giacometti, A., Tavio, M., & Barchiesi, F. (2021). Bloodstream infections in the COVID-19 era: results from an Italian multi-centre study. International Benchmark – Capstone Project Change Proposal
Shukla, B. S., Warde, P. R., Knott, E., Arenas, S., Pronty, D., Ramirez, R…Gershengorn, H. B. (2021). Bloodstream Infection Risk, Incidence, and Deaths for Hospitalized Patients during Coronavirus Disease Pandemic. Emerging Infectious Diseases, 27(10), 2588-2594. https://doi.org/10.3201/eid2710.210538.
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