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NURS FPX 6021 Assessment 2 Change Strategy and Implementation

Student Name

Capella University

NURS-FPX 6021 Biopsychosocial Concepts for Advanced Nursing Practice 1

Prof. Name

Date

Change Strategy and Implementation

Kidney failure is a chronic condition that is manifested by inadequate functioning of the kidneys or complete shutdown, whereby external support is needed to maintain the homeostasis and filtration of waste products. This external support is hemodialysis treatment. Long-term hemodialysis may impose various complications for the patients, which include severe morbidities and increased risk of mortality. The most common complications associated with hemodialysis are bloodstream infections. 

Hemodialysis treatment increases the risk of serious infections because of the frequent penetration of needles and catheters inside patients’ bodies. These infectious agents may lead to severe infections, which if spreads throughout the body, can cause sepsis. Sepsis is one of the life-threatening conditions whereby, reduced immune system response can even result in death. According to a report, in 2020, approximately 14,000 and higher patients had bloodstream infections due to dialysis in the U.S. (Office of the Associate Director for Communication – CDC, 2023). Thus, essential strategies are needed for healthcare providers to bring change within the system for reducing the risk of infections in dialysis-dependent patients. 

Data Table of Current and Desired Outcomes

To evaluate the presence of infections in dialysis patients, a data table is formulated using the information from Vila Health Facility. This data table presents the current situation as well as the desired outcomes of the actual and potential systemic infections. The data is HIPAA compatible because it doesn’t reveal patients’ identities and maintains privacy and confidentiality. This data is ambiguous as it doesn’t present the role of healthcare professionals behind these infections. It is unclear if these infections are caused by hospital practices or due to patient factors. However, it is imperative to consider bringing changes in healthcare practices to minimize the risk of systemic infections. 


Current Results

Desired Results 

Patients who undergo dialysis have an increased risk of developing Hepatitis C infections. In Vila Health, 40% of dialysis-dependent patients had developed viral Hep C infection which led to increased length of hospital stay. 

Using change strategies, the rate of Hep C infection in Vila Health will decrease and patients will have minimal chances to acquire infections due to their hemodialysis treatment. 

Vila Health shows poor healthcare practices especially related to infection control which becomes one of the reasons hemodialysis patients acquire hospital-led infections 

By the utilization of change strategies, healthcare providers will ensure to improve their infection control practices to eradicate the risks of nosocomial infections. 

Patients who are undergoing hemodialysis face various problems like increased hospital stay, financial burden, and morbidities, and some also face deaths due to dialysis-associated bloodstream infections. 

Patients undergoing hemodialysis will receive quality care in terms of infection control which will reduce the chances of morbidities, ultimately decreasing hospital stay and financial burden. Moreover, reduces death rates will be observed in such patients. 

Long-term Hemodialysis Treatment and Bloodstream Infections 

Patients who are on long-term hemodialysis treatment are significantly impacted due the treatment they receive. One of the most common health issues in such patients is bloodstream infections (BSI). According to a study, the United States Renal Data System registry declared that infections are the second most important cause of increased mortality in end-stage renal disease patients. Furthermore, the data provided by North America reveals the rate of infections in hemodialysis patients as 0.5- 27.1 out of 100 patient months. Central Venous Catheter increases the risk of infection by ten folds as compared to other dialysis accesses (Alhazmi et al., 2019). 

Since patients with end-stage renal disease receiving hemodialysis treatment are immunosuppressed,  they are more likely to interact with infections eventually developing septic states within the body. Although the exact reason is unclear in the given data, nurses and other healthcare professionals must strive together to bring changes within the healthcare systems. These changes will ensure that patients remain free of such infections due to poor healthcare practices. For this purpose, some change strategies are important to improve health outcomes and enhance quality of life. 

Change Strategies to Prevent Infections in Dialysis Patients 

The focus of this assessment is to improve the lives of long-term hemodialysis-dependent patients by minimizing the risks of infections and improving existing infection states among the selected population. The evidence-based strategies which are important to bring change within the healthcare system are applying standards CDC for preventing bloodstream infections, increasing the use of catheters that have a low risk of infections, patients’ self-care education, and adequate care of dialysis catheters/access. 

Following the Standard Guidelines of the CDC 

According to the CDC guidelines, it is essential to initially encourage the practices which will help in the prevention of the progression of the disease. Moreover, it is advised to use the types of vascular accesses which claim to have reduced risks of infections like fistulas and grafts. Lastly, it is recommended to apply proven healthcare practices to prevent infections in hemodialysis units (Office of the Associate Director for Communication – CDC, 2023). 

Using Catheters with Low Risk of Infections 

Catheters with a low risk of infections should be utilized for hemodialysis patients. However, certain interventions have proven to decrease the risk of catheter-associated infections in dialysis patients. The strategy of early referral to nephrologists, vascular access coordinators, and healthcare teams is significantly important. These stakeholders will provide adequate education to the patients regarding the implantation of permanent access to decrease the use of catheters ultimately, reducing the risks of infections (Fisher et al., 2019). 

Patients’ Self-care Education 

Patient education is important in the prevention of catheter-associated infections by self-care. This enables patients to play an active role in their self-management of the disease process. Patients must be educated about the care of catheters while they are at their homes. Moreover, instructions must be provided about the management of catheters during showers, which improves the quality of life. According to the recommendations provided by CDC, showers are permitted however, patients must be careful about the ports and hubs of the access site. These ports and hubs should be covered with an impermeable sheet to control the introduction of microorganisms on the access site (Fisher et al., 2019). 

Providing Care of Dialysis Access 

Many of the infections observed in dialysis patients are related to poor practices of healthcare professionals especially in terms of managing catheters. Some of the preventive measures advised are the use of antimicrobial ointments during the insertion of the catheter and after every dialysis session. Moreover, it is essential to use antimicrobial dressings to cover the catheter site. Along with the use of antimicrobial products, it is also essential that healthcare professionals improve their practices of hand hygiene and aseptic techniques to ensure patients remain free of infectious agents interacting with their bodies (Fisher et al., 2019). 

Various challenges might take place while these strategies are implemented. These challenges include socio-economic factors, whereby various social and cultural differences would arise in choosing the types of therapies and treatments. Economic factors would be essential in defining the insurance status while patients are referred to developing invasive vascular access. Other challenges can be limited resources (human and financial) and a need for standardized guidelines within the organization. To combat these challenges, a multidisciplinary team should be established to identify the barriers to standard practices and change strategies and analyze the solutions for these challenges. Moreover, it is essential to collaborate with governmental organizations which provide financial aid in terms of healthcare, for example, the Center for Medicaid and Medicare Services. 

Justification of the Proposed Change Strategies

All of the change strategies presented above are important for improving quality of life by reducing the risks of infections in hemodialysis patients. A study showed that nurses’ knowledge of CDC guidelines to prevent central line infections in dialysis patients is crucial to reduce the risk of infections (Saggu et al., 2018). Thus, adequate training of nurses and other healthcare professionals is recommended. Another study that justifies the early referral to nephrologists concludes that it reduces the complications of kidney disease and can lead to the early formation of AV fistula for hemodialysis.

This will eventually improve patients’ health outcomes, reduce the risk of getting secondary infections, and improves the quality of life in terms of managing the disease effectively (Khatri et al., 2021). Moreover, patient education in this regard as well as for the management of catheters is considered important as well for involving patients in their care process, and ensuring effective management is done outside the hospital as well. Lastly, healthcare practices – hand hygiene and aseptic techniques are considered essential preventive measures against all kinds of healthcare-acquired infections (Rowley & Clare, 2019; Toney-Butler et al., 2022). Thus, these strategies are justified to be applied in hemodialysis patients to reduce the risks of infections and improve health outcomes as desired. 

Change Strategies and Quality Improvement

These change strategies are helpful in quality improvement in terms of patient safety and equitable care. Following CDC guidelines, using less infectious vascular access, patient education, and catheter care will help in improving healthcare practices related to infection prevention as well as enhancing self-care management within the patients. These results will help in achieving the desired outcomes presented in the data table to reduce the chances of infections, decrease hospital stays, lowers financial burden, and eventually maintains patients’ safety (Moretti, 2018).

On the other hand, healthcare organizations must provide equitable care which is defined as care whereby socio-economic, geographical, and cultural factors are disregarded and patients are provided with unbiased care (Dzau et al., 2022). All the change strategies presented above are applied to the general population covered by the healthcare organization. Thus, the described factors are overlooked, and safe, secure, and impartial care is provided to all patients with long-term hemodialysis care. This explanation is based on the assumption of ethical principles whereby it is the responsibility of healthcare organizations to provide autonomous (informed), beneficial, and justified care to all consumers. 

Interprofessional Perspectives of Change Strategies

Interprofessional collaboration is imperative in bringing change reforms within a healthcare organization. They must work together to successfully implement the change strategies (McLaney et al., 2022). Implementation of CDC guidelines, and patient education requires the training and development of nurses, doctors, and other healthcare professionals who are primarily involved in the role. Moreover, a curriculum must be designed for this purpose where health educators will play an important role.

Besides this, early referral for vascular access and improving healthcare practices also require efforts from physicians, nurses, and other professionals who are part of the care team. To make resources available for the formation of permanent dialysis access and for appropriate hand hygiene and aseptic techniques, financial planning is essential with the involvement of governmental bodies for the provision of insurance. Hence, hospital administration and the budget department should plan to achieve this collaboration. This explanation is based on the assumption that healthcare professionals and other stakeholders within the hospital work for the same goal and mission to provide safe and patient-centered care, which is why building a collaborative environment is necessary to fulfill organizational goals and achieve desired outcomes.  

References

Alhazmi, S. M., Noor, S. O., Alshamrani, M. M., & Farahat, F. M. (2019). Bloodstream infection at hemodialysis facilities in Jeddah: A medical record review. Annals of Saudi Medicine39(4), 258–264. https://doi.org/10.5144/0256-4947.2019.258 

Centers for Disease Control and Prevention. (2023). Preventing bloodstream infections in people on dialysis. Centers for Disease Control and Prevention. https://www.cdc.gov/vitalsigns/dialysis-infections/index.html 

Dzau, V. J., Mate, K., & O’Kane, M. (2022). Equity and quality—improving health care delivery requires both. JAMA327(6), 519. https://doi.org/10.1001/jama.2022.0283  

Fisher, M., Golestaneh, L., Allon, M., Abreo, K., & Mokrzycki, M. H. (2019). Prevention of bloodstream infections in patients undergoing hemodialysis. Clinical Journal of the American Society of Nephrology15(1), 132–151. https://doi.org/10.2215/cjn.06820619 

Khatri, N., Nasir, K., Dhrolia, M., Qureshi, R., & Ahmad, A. (2021). Delay in permanent vascular access formation and referral to a nephrologist in incident hemodialysis patients: A single center experience. Cureushttps://doi.org/10.7759/cureus.20728 

McLaney, E., Morassaei, S., Hughes, L., Davies, R., Campbell, M., & Di Prospero, L. (2022). A framework for interprofessional team collaboration in a hospital setting: Advancing team competencies and behaviors. Healthcare Management Forum35(2), 112–117. https://doi.org/10.1177/08404704211063584 

Moretti, S. (2018). Reducing dialysis related infections and hospitalizations. Health Services Advisory Group. http://health.wyo.gov/wp-content/uploads/2018/09/Moretti-ReduceDialysisRelatedInfHos508.pdf 

NURS FPX 6021 Assessment 2 Change Strategy and Implementation

Rowley, S., & Clare, S. (2019). Standardizing the critical clinical competency of aseptic, sterile, and clean techniques with a single international standard: Aseptic Non-Touch Technique (ANTT®). Journal of the Association for Vascular Access24(4), 12–17. https://doi.org/10.2309/j.java.2019.004.003 

Saggu, Y., Asmat, K., Margrate, M., & Ahmad, N. (2018). Preventing central line infections among hemodialysis patients: Nurses’ knowledge and practices in accordance with Center for Disease Control and Prevention (CDC) guidelines. Israel Medical Journal10(2), 102-108. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwiE5b3I7o7_AhWZR_EDHXdVDo4QFnoECBkQAQ&url=http%3A%2F%2Fwww.imj.com.pk%2Fwp-content%2Fuploads%2F2018%2F06%2FPreventing-Central-Line-Infections-among-Hemodialysis-Patients-Nurses%25E2%2580%2599-Knowledge-and.pdf&usg=AOvVaw0dTJ3i16qDXqM2pw4THGOy 

Toney-Butler, T. J., Gasner, A., & Carver, N. (2022). Hand hygiene. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK470254/