identify how effective the limitation of CVC blood draws in reducing CLABSI rates

This week you demonstrate your in-depth knowledge of your project subject, the goals of the project and how you will determine the level of success related to providing a positive change. Once you have completed the readings, reviewed the proposal and the proposal template carefully read through the two examples of the expectation for these proposal sections. Example: Related to a DNP project on reduction of CLABSI Evaluation Plan ex. 1 Evaluation Plan The selection of the participants is to be done using inclusion and exclusion criteria. Patients admitted to the adult ICU that have a CVC qualifies as a participant. Patients with central line access are considered a participant regardless of the insertion site. The project will be explained to the patients and their responsible parties as part of the recruitment process. Various data will be collected to identify how effective the limitation of CVC blood draws in reducing CLABSI rates. The number of central venous catheter days and episodes of CLABSI will be tabulated each month to get the CLABSI rates. The data will be collected through the review of the patient’s medical chart using the organization’s EMR. The organization’s infection preventionist collects and stores the data within the organization’s information cloud. This way the data is securely stored. The project manager will be given on-site access to data during the whole duration of the project. The patient hospital identification number is used instead of the patient’s name to address HIPAA concerns. The CLABSI rate will be computed and analyzed together by the infection preventionist and project manager. The CLABSI rate will be computed monthly and after three months of post-project implementation. The NHSN created a standardized formula to compute the CLABSI rate and will validate the integrity of the data analysis in this project. CLABSI rate is calculated per 1,000 central-line days by dividing the number of CLABSI episodes by the number of actual central-line days and multiplying the result by 1,000 (see Appendix J). The project will be deemed effective if the post-project implementation CLABSI rate is lower than three month’s pre-implementation CLABSI rate. An unpaired t-test will be used as the statistical procedure to identify the significant change comparing three months of pre-project. Conclusion The goal of the project is to implement a practice in the ICU that is already established and found to be effective in reducing CLABSI rates. The regulation of the access and manipulation of CVC reduces the risk for contamination of central lines. The limiting of CVC blood draw will reduce the CLABSI rate in Fountain Valley Regional Hospital’s ICU. Interprofessional collaboration is essential in attaining success in the project implementation. The team must work together to improve the screening process in reviewing CVC blood draw orders to identify if it is necessary or can be limited. The reduction of automatic CVC blood draw order and instead the promotion of bundled peripheral blood draws will encourage better compliance of the project. A better understanding of the project process and implication will provide better adherence to the project implementation. Example: Related to a DNP project on Pediatric Sepsis Evaluation Plan ex. 2 Evaluation Plan The process of evaluation includes determining the safety and effectiveness of a system, providing guidance to the implementation process, and mitigating any unplanned negative outcomes (Sligo et al., 2017). The plan will evaluate whether the implementation and adherence to a pediatric sepsis protocol in the pediatric ED will decrease hospital LOS, decrease ICU admissions, and decrease mortality for septic patients presenting to the ED for treatment. Participants will include those patients from birth to 18 years of age that present to the pediatric ED with symptoms of sepsis. Exclusion criteria include patients over the age of 18 years old, ICU patients, and patients who are on antibiotics or received antibiotics before presenting to the ED for treatment. A comparison of baseline data to postimplementation data will be evaluated to determine the effectiveness of the sepsis pathway. Data will be collected before implementation of the change project and weekly or bi-weekly after the implementation of the project. Data collected will include demographic information of the patient, medical history, medications, vital signs, physical exam findings, diagnosis, time of the administration of the fluid bolus, and time of administration of antibiotics. The project manager, the DNP student, for this change project is responsible for collecting, analyzing, and storing the data. The proposal will be submitted to the University’s IRB for approval and afterwards submitted to the organization’s IRB for approval. The project should qualify for expedited approval, as the implementation of the project poses minimal risk as the project is known evidence-based practice. Any paper data will be stored in a filing cabinet in a locked room with keypad access to the project manager and her assistant. Electronic data will be stored in the organization’s secured and HIPAA compliant database that is secured with encryption software. Access to the project’s data will be limited to the project manager, the assistant to the project manager, the pediatric ED manager, and the medical director of the Pediatric ED, to ensure that the participants sensitive information is protected. Utilizing a second person (nurse, nurse practitioner, or physician) to review the data collected will help to ensure accuracy and address any missing data concerns. Process measures include the timeliness of the initial assessment of the patient and recognition of sepsis symptoms; compliance with the use of the clinical pathway; the timeliness of administration of a fluid bolus; and timeliness of antibiotic administration. Outcome measures include a decrease in ICU admissions, a decrease in hospital LOS, and a decrease in patient mortality. Balancing measures include a false positive rate and patients being sent home without antibiotics. There is sustainability for the change project as the clinical pathway can be implemented in the pediatric ED after the project is completed. The pathway can then be implemented in the organization’s remaining pediatric EDs that currently do not have a pediatric sepsis pathway in use. The baseline and post-implementation data will be entered into the IBM SPSS program and checked for accuracy. Results will be calculated using a standard 0.5 p-value. A paired t test will be used to determine the difference between those septic patients that were treated without the utilization of a sepsis clinical pathway and those patients that were treated with the utilization of a clinical pathway. Conclusion Although sepsis results in the death of approximately 7.5 million pediatric patients annually, most of the current treatment for pediatric sepsis is extrapolated from adult studies (Mathias et al., 2016). Using a protocol that is specific to the pediatric population can increase the recognition of sepsis symptoms and decrease the treatment time for these patients. Literature supports that implementing timely care for pediatric sepsis patients decreases hospital length of stay and mortality rates. The pediatric sepsis protocol can be implemented in the organization within 12 weeks and with staff compliance, the protocol can be maintained in the organization long-term. Evaluation Plan and ConclusionDescription Evaluation Plan [Completed in DNP Scholarly Project Seminar III] The method(s) that will be used to evaluate the success of the project must be detailed and flow clearly. Refer back to your PICOT – the outcome that you identified in the PICOT is what you are evaluating to determine success. Here you will discuss where you will get your participants (outpatient clinic, using the electronic medical record, randomly present to the ED over the time of the project, etc.). If there is inclusion or exclusion criteria that needs to be stated, such as adults between the ages of 45 and 60. Explain how you will collect the information/data – time, place, and how this will be done (staff nurses, project manager, etc.). Indicate who is collecting the data, who will complete the analysis and where the data will be secured during the analysis process (integrity of the project). Also, provide information about the integrity of the data and if you are using a tool, is it validated and if you created your own tool who did you ask to ensure it was valid. If there are potential HIPAA risks, state how you will address these. Additionally, what will you do if you have incomplete or missing data, say only part of a survey is completed (will you take the answers given or discard the survey?). The evaluation design can be benchmarked using a logic model (See NSG6220) or a table. Identify the type of data that you are collecting such as ordinal, nominal, continuous or interval (See NSG6130). Identify the statistical test(s) that you will apply to the data. These statistical tests are only to determine if the intervention solution that has been determined to be effective by research was effective in your environment with your population. Define the level of statistical significance that will be used to determine if there was a positive change indicating that this was clinically significant. [1/2 – 1 page]. Conclusion [Completed in DNP Scholarly Project Seminar III related to the Project Proposal] [1/2-1 page] [Completed in DNP Scholarly Project Seminar V related to the Project completion] [1-3 pages] The conclusion provided for DNP Scholarly Project Seminar III will summarize the project proposal with key elements from each section and reiterate the importance of the solution to nursing practice. Once this is completed, your project proposal is finished and ready for IRB approval AFTER faculty and preceptor approvals. [2-3 paragraphs]. The DNP Scholarly Project Seminar III conclusion is removed. The conclusion provided for DNP Scholarly Seminar V begins with the statement of intention/purpose and the achievement of the intention/purpose. A brief summary of the project with major points made throughout the paper are provided. This is a high-level summary of the entire project. [2-3 paragraphs].
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