Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)

You will identify an issue or opportunity for change within your healthcare organization and propose an idea for a change in practice supported by an EBP approach.

To Prepare:

Reflect on the four peer-reviewed articles you critically appraised see below

Reflect on your current healthcare organization and think about potential opportunities for evidence-based change

Create an 8- to 9-slide PowerPoint presentation in which you do the following:

• Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)
• Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.
• Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.
• Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.
• Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.
• Be sure to provide APA citations of the supporting evidence-based peer-reviewed articles you selected to support your thinking.
• Add a lessons learned section that includes the following:
  • A summary of the critical appraisal of the peer-reviewed articles you previously submitted
  • An explanation about what you learned from completing the evaluation table (1 slide)
  • An explanation about what you learned from completing the levels of evidence table (1 slide)
  • An explanation about what you learned from completing the outcomes synthesis table (1 slide)

Expert Answer and Explanation

• I am currently working in a nursing and rehabilitation center, which mainly deals with patients with diverse needs. Our main task is to ensure that patients receive safe and quality care that will assist them regain independence and functionality like they were before their illness.
• The current organizational culture is unsupportive of the change with poor leadership, lack of accountability, and laxity by staff being some of the factors contributing to this culture.

• Currently the organization is having high number of cases of falls and other safety issues, which has drastically affected the facility’s rating, patient outcomes and to some extent even work satisfaction of the employees working within the facility. This problem can be attributed to lack of urgency shown by the staff when answering call-lights and alarms
• Scope: The issue mainly affects patients under admission, where at times they require help from the nurses but laxity of the nurses to respond to call lights and alarms, delay the help they require, which in most instances lead to adverse outcomes, like patient falls. The issue also mainly revolves around nursing unit, who are supposed to be at the forefront in responding to alarms and call lights.
• The change needed should therefore target at improving the response of nurses in tending to the sensory alarms and call lights to improve patient outcomes.

The stakeholders involved in the change include the following;

• The organization leadership – The organization leadership should show interest in the change given the impact of the issue on the performance of the organization. In support of the change, they should allocate the necessary resources needed to implement the change, and also be at the forefront in leading the change.
• Another stakeholder are the nurses, nurse practitioners and physicians who are in charge of delivering care to patients. They are supposed to actively participate in resolving the issue with the aim of improving patient outcomes.
• Technicians will also be among the stakeholders involved. Their role will be to ensure that the monitoring systems are properly functional to avoid false positives and false negatives which end up causing alarm fatigue and laxity by nurses to respond (Baker & Rodger, 2020).
• Quality assurance team should also be part of the initiative, with their role being to provide oversight on whether the change is meeting the intended quality- related outcomes
• The patients are also key stakeholders involved given that impact of the change in their outcomes.
• Some of the risks attached to implementing the proposed change include change resistance from nurses which will affect the success of the project. The other risk is increased nurse workload from what is currently is due to the requirement to increase their level of responses to sensory alarms and call lights. As it currently is, the nurses and other care providers have a lax attitude to respond to call lights and sensory alarms.

One of the main causes of laxity to respond to sensory alarms and call lights by nurses can be attributed to alarm fatigue (Baker & Rodger, 2020). Studies have indicated that sensory alarms fatigue is caused by faulty monitoring systems, inadequate training on how to respond to the sensory alarms and organizational factors including poor culture and leadership (Bach et al., 2018).

Therefore the evidence based change that is suggested is to train nurses and introduce an online monitoring system that will reduce the number of false alarms, in turn improving response times and reducing alarm fatigue. The suggested intervention is linked with various studies as being effective including studies by Bach et al. (2018) and Ruskin and Hueske-Kraus (2015).

To facilitate knowledge transfer for the change the following plan will be used. The first step is knowledge creation which will entail collection of evidence on good practices which can assist to improve nurse response times to sensory alarms. Knowledge will be created by collecting evidence on the current practice and its impact on patient outcomes and comparing it with best practices, through which the change initiative will be created.

The second step is to disseminate the knowledge to various stakeholders using various platforms including through meetings, print media and group discussion. The third stage is organizational adoption which will involve training on the best practices, that is the importance of prompt response to call lights and how to react on the new monitoring system that aims to eliminate alarm fatigue whose efficacy has been indicated by Bach et al. (2018), before they are implemented.

The last stage is implementation, which will involve collective effort by the stakeholders led by the leadership, within the leadership to ensure successful implementation of a more responsive system to call lights and sensory alarms. Implementation will last for 3 months.

Some of the measurable outcomes that the evidence based change will aim to achieve include better response times by the nurses, reduction of fall incidents within the facility, improved rating of the facility and improved patient experience.

The peer-reviewed articles were used in the clinical inquiry provided a descriptive information on the application of sensory alarms. The first study by Chopra and McMahon (2014) indicated that sensory alarms were a major medical hazard that could jeopardize patient safety. The authors noted that they need to be redesigned to improve patient safety.

In another study by Baker and Rodger (2020) it was also reiterated that false alarms were part of the problem that posed safety risks to patients. The research indicated that care providers got alarm fatigue by trying to determine which alarms were legit and which ones were not. As such, they were slow to react when legit signals were sent, leading to adverse patient outcomes.

Ruskin and Hueske-Kraus (2015) indicated that better patient outcomes could be realized by reducing the number of monitoring alarms. The study by Bach et al. (2018), revealed various factors identified as being a major impediment to the application of sensory alarms. These factors were categorized into three major themes, human, technical, and organizational factors

Some of the lessons learned after completing the evaluation table include evaluation of evidence  of in form best practices. Using the evaluation table, I was able to assess various forms of evidence and their relevance in informing a practice change.

Completion of the evaluation table also helped tome to learn different search strategies which improved my efficiency in collecting relevant evidence.  The third lesson I learned was assessing articles based on their level of evidence.

References

• Bach, T. A., Berglund, L. M., & Turk, E. (2018). Managing alarm systems for quality and safety in the hospital setting. BMJ open quality, 7(3), e000202. https://doi.org/10.1136/bmjoq-2017-000202
• Baker, K., & Rodger, J. (2020). Assessing causes of alarm fatigue in long-term acute care and its impact on identifying clinical changes in patient conditions. Informatics in Medicine Unlocked, 18, 100300. https://doi.org/10.1016/j.imu.2020.100300
• Chopra, V., & McMahon, L. F. (2014). Redesigning hospital alarms for patient safety: alarmed and potentially dangerous. Jama, 311(12), 1199-1200. DOI: 10.1001/jama.2014.710
• Ruskin, K. J., & Hueske-Kraus, D. (2015). Alarm fatigue: impacts on patient safety. Current opinion in anaesthesiology, 28(6), 685–690. https://doi.org/10.1097/ACO.0000000000000260