Door-to-Balloon Time Reduction: Negotiations Free Sample

The paper indicates reasons for each stakeholder in supporting the proposed plan for improving the door-to-balloon time in the STEMI patients at Kendall Regional Medical Center.

STEMI patients and families

Reasons for Supporting

  • Promise for improved care outcomes
  • Promise for timely interventions

Reasons for Not Supporting

  • Failure to understand the issues involved in providing consent
  • Failure to involve them in designing and implementing the change effort
  • Inability to understand the symptoms of STEMI, leading to delay in seeking treatment

Negotiation Strategies

Engaging in honest communication with patients and family members to explain the importance of consenting and to request for their involvement (Aarons et al., 2014)

Emergency department physician

Reasons for Supporting

  • Ability to apply evidence
  • Having a positive attitude toward the EBP intervention
  • Adequate training in the STEMI area
  • Management support

Reasons for Not Supporting

  • Noninvolvement in designing and implementing the change effort (Majid et al., 2011)
  • Desire to maintain the status quo

Negotiation Strategies

Collaboration and sharing important information with the physician so that he or she may see the benefits of the change effort (Irwin, Bergman, & Richards, 2013)

Paramedics/Emergency response team

Reasons for Supporting

  • Ability to apply evidence
  • Adequate training in the STEMI area
  • Management support

Reasons for Not Supporting

  • Inability to prioritize due to the heavy workload
  • Lack of time
  • Attitudinal problems
  • Lack of institutional support
  • Noninvolvement in the change effort

Negotiation Strategies

  • The rank-ordering strategy can be used to ensure the paramedics understand what is needed and can use the limited time to support the practice change.
  • Collaboration and sharing of information can be used to address attitudinal and noninvolvement issues (Duiveman, 2012)

STEMI team

Reasons for Supporting

  • Ability to apply evidence
  • Adequate training in the STEMI area
  • “Availability of protected time to learn and implement EBP” (Majid et al., 2011, p. 234)
  • Management support

Reasons for Not Supporting

  • Difficulties in understanding the statistical analyses for various STEMI tests (Pan et al., 2014)
  • Role ambiguity
  • Lack of resources
  • Lack of knowledge about EBP (Majid et al., 2011)

Negotiation Strategies

The strategy is to gain access to the team leader to convince him or her to mentor members of the STEMI team using the EBP advocate framework (Irwin et al.,)

PBX operator

Reasons for Supporting

  • Support by other players
  • Adequate training on what needs to be done to contact and prepare stakeholders so that ball to balloon (D2B) time is significantly reduced

Reasons for Not Supporting

  • Lack of skills and knowledge on the change effort
  • Noninvolvement in the change effort

Negotiation Strategies

Honest communication can be used to address the issues

Invasive cardiologist

Reasons for Supporting

  • Ability to apply evidence
  • Adequate training and time to learn and implement the change effort
  • Management support

Reasons for Not Supporting

  • Insufficient evidence that the practice change will improve patient outcomes
  • Desire to maintain the status quo
  • Insufficient time
  • Noninvolvement of the change effort
  • Lack of institutional support

Negotiation Strategies

  • Collaboration and compromise strategies can be used to bring the invasive cardiologist to the negotiating table and ensure that an agreement or settlement is reached on issues that may be influencing their decision not to support the change project (Irwin et al., 2013).
  • The accommodation strategy can be used to yield into some of the demands of the cardiologist so that the project can be implemented successfully (Melnyk & Fine-Overholt, 2015)

References

Aarons, G.A., Fettes, D., Hurlburt, M., Palinkas, L., Genderson, L., Willging, C., & Chaffin, M. (2014). Collaboration, negotiation, and coalescence for interagency-collaborative teams to scale-up evidence-based practice. Journal of Clinical Child & Adolescent Psychology, 43, 915-928. DOI: 10.1080/15374416.2013.876642

Duiveman, T. (2012). Negotiating: Experiences of community nurses when contracting with clients. Contemporary Nurse: A Journal of the Australian Nursing Profession, 41(1), 120-125.

Irwin, M.M., Bergman, R.M., & Richards, R. (2013). The experience of implementing evidence-based practice change: A qualitative analysis. Clinical Journal of Oncology Nursing, 17, 544-549. DOI: 10.1188/13.CJON.544-549

Majid, S., Foo, S., Luyt, B., Zhang, X., Theng, Y.L., Chang, Y.K., & Mokhtar, I.A. (2011). Adopting evidence-based practice in clinical decision making: Nurses’ perceptions, knowledge, and barriers. Journal of the Medical Association, 99, 229-236. DOI: 10.3163/1536-5050.99.3.010

Melnyk, B.M., & Fine-Overholt, E. (2015). Evidence-based practice in nursing & healthcare: A guide to best practice (3rd ed.). Baltimore, MD: Lippincott Williams & Wilkins.

Pan, M.W., Chen, S.Y., Chen, C.C., Chen, W.J., Chang, C.J., Lin, C.P.,…Chen, Y.C. (2014). Implementation of multiple strategies for improved door-to-ballon time in patients with ST-segment elevation myocardial infarction. Heart Vessels, 29, 142-148. DOI: 10.1007/500380-013-0336-2.

Ventilator-Associated Pneumonia And Nursing Awareness

Introduction

Ventilator-associated pneumonia (VAP) is one of the most widespread hospital-acquired infections among American patients. VAP can cause increased mortality rates, length of stay, and health care costs both for the facility and the patient. However, there is no accurate reference definition of VAP, as it is usually suspected if the patient was intubated and ventilated within 48 hours before the onset of ventilation (Andrews & Steen, 2013).

Other radiological, clinical, and laboratory characteristics are used for the diagnosis of VAP. In the following literature review, seven articles from the nursing journals (including Nursing in Critical Care, Critical Care Nurse, and Intensive and Critical Care Nursing) will be reviewed. All of the articles are no older than five years and were published in peer-reviewed journals.

The focus of the Review

The focus of the review is the prevention of VAP by various methods, including high-quality oral care, nursing knowledge and awareness, and a training program. The review aims to examine the findings of the researches and indicate what strategies are effective and how they can be implemented in clinical care. Additional attention will be paid to VAP in children and strategies for its prevention, as Cooper and Haut (2013) provide an evidence-based protocol for the prevention of VAP in the pediatric population.

Student’s Interest

Student’s interest in VAP can be explained by the high prevalence of the infection in hospital patients and its severe and adverse influence on the health care costs for patients and hospital facilities. Furthermore, VAP can also lead to fatal outcomes in 46% of patients (Sedwick, Lance-Smith, Reeder, & Nardi, 2012). It is possible that the reimbursement for VAP in hospitals will be discontinued; in this case, hospitals will face severe financial losses (Sedwick et al., 2012). Therefore, future and current nursing professionals need to pay particular attention to VAP and strategies of its prevention; if these strategies are followed, it is possible to significantly reduce the number of fatal outcomes in patients with VAP and hospital expenditures of those who acquire VAP during their stay.

Major Findings

Sedwick et al. (2012) provided a specific “VAP bundle” to hospital staff where the research was conducted and measured the effectiveness of these interventions. Compliance of 100% was reached for PUD prophylaxis, DVT prophylaxis, HOB elevation, daily interruption of sedation, and assessment of readiness for extubation (Sedwick et al., 2012). The protocols for oral care were followed less precisely and never reached 100%. Nevertheless, the use of the VAP bundle (strategies described above) resulted in increased hospital savings and better patient outcomes.

Other data is provided by Andrews and Steen (2013), who argue that mechanical hygiene and oral decontamination are effective, whereas electronic tooth brushing is more effective than a manual one. Furthermore, the use of chlorhexidine is also associated with the reduced incidence of VAP; its effect is the strongest in cardiovascular patients. Andrews and Steen (2013) notice that a 2% concentration of it is more effective than lesser ones.

Due to the lack of official guidelines in the prevention of VAP in children and infants, Cooper and Haut (2013) provide their VAP bundle. They argue that after the implementation of the bundle, “VAP rates decreased from 5.6 to 0.3 infections per 1000 ventilator days” (Cooper & Haut, 2013, p. 26). The bundle includes oral hygiene, endotracheal suctioning, and circuit changes; overall, it provides more than fifteen interventions that can be implemented in a nursing unit.

Some of the suggested interventions are to perform hand hygiene before and after contact with the patient or the ventilator, brush teeth every 12 hours (for children <6 years old and with teeth), coat lips with petroleum jelly, rinse the mouth with 1% chlorhexidine (Cooper & Haut, 2013). Particular attention is paid to oral hygiene in adults by Cutler and Sluman (2014), who argue that the use of oral care bundles for VAP prevention can significantly lower VAP-incidents (47 of 528 patients developed VAP before the intervention, 24 of 559 patients developed VAP after it).

A high level of compliance (91%) and high-standard oral care caused a reduction in the incidents of VAP. Gatell et al. (2012) argue that to prevent ventilator-associated pneumonia in adults, nurses need to be attentive to the intervention routines and show compliance with suggested procedures. Nurses who underwent additional training demonstrated improved knowledge about VAP-prevention techniques; they also used various strategies (use of chlorhexidine, hand washing, specific headboard positioning) more often after the training program. The authors confirm that not all nurses demonstrated compliance with guidelines, possibly due to high workload and time pressure (Gatell et al., 2012).

To increase adherence to guidelines, training activities and evidence-based protocols are suggested as suitable tools. Valuable information about the relation between guidelines adherence and VAP is reported by Jansson, Ala-Kokko, Ylipalosaari, Syrjälä, and Kyngäs (2013). Nurses with more ICU experience (>5 years) tend to adhere to guidelines more often than their less experienced colleagues. Additional barriers include a high workload, as well as a lack of knowledge and resources. Some of the nurses adhered to preventive strategies only if they found them necessary (e.g., washed hands, use of protective gowns, etc.).

Akın Korhan, Hakverdioğlu Yönt, Parlar Kılıç, and Uzelli (2014) provide findings that support the arguments of Jansson et al. (2013) and Gatell et al. (2012). Lack of knowledge, lack of training programs, and lack of sufficient information on VAP prevention led to poor adherence to evidence-based guidelines among ICU nurses. Multifaceted educational programs are suggested as tools for the improvement of clinical care.

References

Akın Korhan, E., Hakverdioğlu Yönt, G., Parlar Kılıç, S., & Uzelli, D. (2014). Knowledge levels of intensive care nurses on prevention of ventilator‐associated pneumonia. Nursing in Critical Care, 19(1), 26-33.

Andrews, T., & Steen, C. (2013). A review of oral preventative strategies to reduce ventilator‐associated pneumonia. Nursing in Critical Care, 18(3), 116-122.

Cooper, V. B., & Haut, C. (2013). Preventing ventilator-associated pneumonia in children: An evidence-based protocol. Critical Care Nurse, 33(3), 21-29.

Cutler, L. R., & Sluman, P. (2014). Reducing ventilator associated pneumonia in adult patients through high standards of oral care: A historical control study. Intensive and Critical Care Nursing, 30(2), 61-68.

Gatell, J., Rosa, M., Santé Roig, M., Hernández Vian, Ó., Carrillo Santín, E., Turégano Duaso, C., & Vallés Daunis, J. (2012). Assessment of a training programme for the prevention of ventilator‐associated pneumonia. Nursing in Critical Care, 17(6), 285-292.

Jansson, M., Ala-Kokko, T., Ylipalosaari, P., Syrjälä, H., & Kyngäs, H. (2013). Critical care nurses’ knowledge of, adherence to and barriers towards evidence-based guidelines for the prevention of ventilator-associated pneumonia – A survey study. Intensive and Critical Care Nursing, 29(4), 216-227.

Sedwick, M. B., Lance-Smith, M., Reeder, S. J., & Nardi, J. (2012). Using evidence-based practice to prevent ventilator-associated pneumonia. Critical Care Nurse, 32(4), 41-51.

7M Tools For Purchasing Process Optimization

The idea of reducing costs for a particular product by improving its quality and, therefore, spending more on the raw materials so that the production process outcomes could be deemed as improved compared to the previous record is not new. However, in her article regarding the opportunity of saving an impressive amount of money by reducing the amount of waste retrieved in the production process, Jacobsen (2009) goes even further, stating that the reconsideration of the purchasing process is required to attain the ultimate success in the course of the saving process. As a manager, one will have to adopt the 7M tools such as prioritization matrices, interrelationship diagrams, and Process Decision Program Charts (PDPC).

The redesign of the purchasing process, which, as Jacobsen (2009) has proven to have a tremendous effect on the number of expenses taken in the production process, needs to be reorganized so that a more sustainable approach could be introduced into the firm’s framework. For these purposes, one will have to consider the tools that will display the link between different processes in the organization. Interrelationship diagrams, which are designed to demonstrate the connection between the above processes, will help extensively as they will purportedly serve as the means of identifying the links between the production process, the logistics-related activities, and the customer relations issues. Showing how a drop in costs for completing one of the stages will result in the increase of funds for the other ones, the matrices can and should be used by the manager so that the possible avenues for saving more resources could be identified (Pyzdek, 2014).

More importantly, the tools that will help prioritize the goals of the entrepreneurship and the further course of actions to be taken need to be viewed as an essential element of creating a more sustainable purchasing policy. The connection between the two concepts might not be obvious at first. However, a closer look at the subject matter will show that the reduction in the amount of raw material should be preceded by a careful analysis of the company’s objectives, the target number of customers, whose needs it is going to cater to, and the quality of the equipment that the organization has in its possession at present. For instance, saving on the number of items bought for the production process is rather pointless if the faults in the equipment lead to losing a certain percentage of raw materials.

The process of saving an extensive amount of money during the purchasing process and, therefore, reducing waste significantly, can be carried out by implementing the 7M tools such as prioritization matrices, interrelationship diagrams, and Process Decision Program Charts (PDPC). By deploying the above techniques in the context of entrepreneurship, one is likely to create a lean strategy that will help rearrange the current concept of resource usage. For instance, the diagrams and charts will help prioritize the essential corporate processes, shedding light on the number of resources that each will require. The interrelationship diagrams, in their turn, will show the correlation between the processes and the possible expenditures that may occur. As a result, the company will require a significantly smaller amount of resources for purchasing the raw materials, and a more sensible approach to managing resources will be introduced into the firm’s framework. Consequently, the company’s revenues can be increased greatly.

Reference List

Jacobsen, J. (2009). Optimizing purchasing processes saves $1 million. Web.

Pyzdek, T. (2014). The define phase. In The Six Sigma handbook (6th ed.) (pp. 245-270). New York, NY: McGraw-Hill Education.

error: Content is protected !!