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Presentation/PPT
27/08/2022
NSG 3150 – Healthcare Informatics
Week 6 – Peer Response Instructions
For the discussion response, please provide a substantive review of the presentations provided by two of your fellow students (
SEE THE TWO STUDENTS POWERPOINT ATTACHED). In your review, highlight the positive aspects as well as providing constructive criticism. Comments such as “Looks good!” or “I really liked your presentation” are unacceptable for a discussion peer review. Your classmates will appreciate any additional facts you can provide that are relevant and that will help to enrich their knowledge of the topic.
· Substantially respond to at least
two other student posts in a way that prompts further input or provides another viewpoint. Describe a situation from your nursing professional experience that backs up your viewpoint and discuss the social, moral, political, and economic factors impacting your position.
· Please respond to peers thoughtfully, add value to the discussion, and apply ideas, insights, or concepts from scholarly sources, such as: journal articles, assigned readings, textbook material, lectures, course materials, or authoritative websites.
· Provide a rationale for your response with at least one scholarly source using an APA in-text citation and full reference.
CLABIs
Introduction
We need to review our CLABSI protocol
Is it effective?
How can we improve it?
Do we need to make changes?
Are we in alignment with EBP
A central line-associated bloodstream infection (CLABSI) is a laboratory-confirmed bloodstream infection not related to an infection at another site that develops within 48 hours of central line placement (Haddadin & Regunath, 2019)
One of the obstacles to overcome to achieve timely removal of unnecessary central lines is that some providers are unaware that their patient has a central line in place (Beville & Vanhoozer, 2021)
Technologies in our Protocol
Charting template to reduce CLABSIs
Communication between multiple Hospitals in our region and Organization
Results are sent to Unit, Auditors, and Organization Daily
Daily task reminders of CHG
The use of chlorhexidine gluconate (CHG), which has a broad-spectrum antimicrobial property, has proven to be effective in decreasing and eradicating pathogens often seen in oncology units, such as MRSA and VRE (Chen, 2013 as cited in Jusino-Leon, 2019)
Purpose
Quick access to Information
Hospital to Hospital access
Track High Risk Patients
Timely Removal of CVC
As healthcare systems implement insertion bundles and checklists, limiting the number of times the central line is accessed and ensuring sterilization of the caps of the lumens, attention turns to the necessity of the central line (Beville & Vanhoozer, 2021)
Lower CLABSI rates
Communication
Charting System Flags and Reminds staff of Protocol
Auditors are Informed of at-risk patients Daily
Nursing Access
Charting Template Informs Nurses of Current Status
Hourly Care Task List for Nurses
Mandatory Charting for Criteria for Central Line
Reference Text Available
Are there gaps in our protocol
Hospital to Hospital Communication can only be Accessed by Diverting to another Patient Profile
Charting System does not allow for Crucial Information to be entered
Summary
We provide excellent resources to staff to deliver quality patient care
Recommendations
Allow Easier Patient Access from Hospital to Hospital within our Organization
Modify Charting System to allow Additional Data Entry based on Current Structure
Feedback
NIC
Our Informatics Committee meets monthly to continuously improve areas of deficit and new opportunities for improvement
All departments in our Organization are allowed to Participate
References
Beville, A. S. M., Heipel, D., Vanhoozer, G., & Bailey, P. (2021). Reducing Central Line Associated Bloodstream Infections (CLABSIs) by Reducing Central Line Days. Current Infectious Disease Reports, 23(12).
https://doi.org/10.1007/s11908-021-00767-w
Chen, W., Li, S., Li, L., Wu, X., & Zhang, W. (2013). Effects of daily bathing with chlorhexidine and acquired infection of methicillin-resistant Staphylococcus aureus and vancomycinresistant Enterococcus: A meta-analysis. Journal of Thoracic Disease, 5, 518–524. https:// doi.org/10.3978/j.issn.2072-1439.2013.08.30
Haddadin, Y., & Regunath, H. (2019). Central line associated blood stream infections (CLABSI). Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430891
Jusino-Leon, G., Matheson, L., & Forsythe, L. (2019). Chlorhexidine Gluconate Baths: Supporting Daily Use to Reduce Central Line–Associated Bloodstream Infections Affecting Immunocompromised Patients. Clinical Journal of Oncology Nursing, 23(2). https://doi.org/10.1188/19.cjon.e32-e38
Technologies for Implementing Sepsis Protocol
Sepsis
Sepsis is an emergency medical condition in which a person is exposed to an overwhelming infection. This is a life-threatening condition and requires immediate recognition and intervention to improve the patient’s odds for survival.
As many as 80 percent of sepsis deaths could be prevented with rapid diagnostics and appropriate treatment (Berdugo, 2020).
Recognizing and diagnosing sepsis may be overlooked by clinicians because signs and symptoms may either be dramatic or subtle such as fever, lethargy and shortness of breath. To be able to recognize and intervene timely, hospitals developed protocols to prevent mortality rates caused by sepsis. This presentation will discuss sepsis protocols and the technologies used to achieve the desired goal of recognizing sepsis and saving a patient’s life.
Sepsis Protocol
The Sepsis Bundle
The sepsis bundle provides providers and nurses the pathway from Time Zero until the goal is achieved.
Time Zero
=
Triage time
Blood cultures collected prior to antibiotics
Lactic acid collected and timed
Antibiotics administered within 1 hour of time zero
IV Fluids (NS/LR) bolus 30ml/kg within 3 hours. Stop time must be documented
Persistent hypotension must be evaluated with 2 BP within 1 hour of IV fluid completion
Repeat lactic acid collected within 2 hrs of initial lactic acid. Repeat in 2 hrs if >2
Vasopressor within 6 hrs of septic shock presentation
Reperfusion assessment documentation within 6 hrs of septic shock
Bundle ends
Significance and Purpose
Sepsis affects 26 million people worldwide and 270,000 Americans die from infection each year, making it more deadly than breast cancer, prostate cancer and AIDS combined (Perlin, 2018).
Time is the most crucial factor in determining survival and each hour of delayed intervention, mortality increases to 4 to 7%.
The significance of sepsis protocol is to establish an effective evidenced-based intervention to quickly recognize and prevent progression of sepsis to septic shock.
5,500 lives have been saved over the last three years as a result of following sepsis protocol and HCA Healthcare’s new technology called SPOT.
Rate of mortality in the country due to sepsis:
Sepsis is the 11th leading cause of death in the U.S.;
ninth leading cause of death in all hospitals;
third leading cause of death in all intensive care units (ICU), and
leading cause of death in non-cardiac ICUs.
Technologies Used for Implementation
qSOFA (quick sepsis-related organ failure assessment)
– helps identify high-risk patients for sepsis. It uses three criteria: SBP of <100, respiratory rate of >22 and Glasgow Coma Scale of <15.
2. SPOT (Sepsis Prediction and Optimization of Therapy)
– is a new technology developed and used by HCA Healthcare. It is an artificial intelligence and algorithm based on patient’s vital signs, lab values, and nursing reports to identify sepsis approximately 18 hours earlier than clinicians (Perlin, 2018).
– It is almost impossible for a provider or nurses to stay in front of the computer to wait and receive vital signs and lab results real-time. With SPOT, computers follow information such as vital signs and lab values and alerts the clinician right away for abnormal results.
3. Digital Vital Sign machines and telemetry monitors
– This machine is present in all ICU beds and monitors patient’s vital signs real-time. A nurse can customize the time intervals to check the blood pressure, for example every 5 minutes if the patient has vasopressor.
4. Diagnostic Tests
– blood work is one of the most important tools to diagnose and identify a patient in sepsis. Blood cultures identify which specific pathogen is targeted and the antibiotics that will be prescribed is based on that findings. Without blood cultures, the provider will not be able to fix the cause of the infection. Other necessary lab values include lactic acid, CBC, BMP, and renal function.
– the laboratory uses technology to process blood samples. They also use barcode to ensure that the specimen came from the right patient.
– Nurses use a device called MobiLab to identify laboratory orders to specific patients. It also requires barcode to verify that the specimen is placed in the right tube and that it belongs to the right patient.
5. Meditech
– is HCA Healthcare’s charting system. All documentations, laboratory results, vital signs and medications can be found in this software. This helps all healthcare team such as doctors, nurses, NP, and pharmacist assess and evaluate goals of each patients.
Do these technologies communicate?
All technologies used to implement the protocols communicate with each other. It begins with obtaining the vital signs which is automatically relayed to Meditech. Laboratory values also populate in the Meditech as soon as results are obtained. This is made possible by using barcode scanning of the specimen. Nurses document the time of IV fluid infusion completion through the Meditech as well and all team members involved in that patient care including nurses and providers have to access the data and documentation entered in Meditech.
This makes communication and relaying of information quicker and more efficient, resulting in immediate planning and taking action to improve patient’s condition and prevent progression of sepsis to septic shock.
Noted Gaps
Even though technology is evolving and modernizing continuously, there are still some flaws and gaps that needed to be overcome. Some are the following:
Temperatures must be documented in Meditech manually. Monitoring temperature is crucial if sepsis is suspected. A patient in early stage of sepsis may have elevated temperature and drops in late stage.
Nurses must know the protocol and must be familiar with important laboratory values and parameters suggestive of sepsis.
Alarm and notification fatigue.
Summary:
Sepsis is life-threatening and requires aggressive fluid resuscitation and antibiotic treatment. Every hour of delayed treatment increases mortality up to 4-7%.
As medical technology continues to advance, it is vital to continuously modernize sepsis protocols. To do so, look at the technology utilized in your institution and compare it to what is newly available, such as diagnostic tests that quicken the determination of sepsis and the underlying infection or data analytics tools that empower physicians with real-time information for more targeted treatment decisions (Berdugo, 2020 ).
Organizations should provide continuing education to new or seasoned nurses about sepsis as new technologies and protocols arise. Quick assessment, recognition and initiation of treatment is key to improve patient outcome and survival.
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