PICOT Question Paper

Reducing Infections in the Dialysis Department

The PICOT Question

For patients undergoing dialysis at the dialysis department (P), can optimization of nursing infection preventive measures through direct supervision and step wise check-list use during and after dialysis (I) compared to the practices (absence of step-wise checklist use) (C) reduce the number of infections to the lowest cases possible and by at least 50% (O) over a period of nine weeks (T)?.

Dialysis Related BSIs and Evidence Based Solutions

Center for Disease control (CDC), through research and evaluation has come up with interventions, auditing tools and checklists for use in BSI infection prevention (CDC, 2020). Strict implementation and adherence of such interventions and protocols have been shown to be a solution to BSIs. These interventions reduce infection rates by 20-50% (Fisher, 2020). Lee et al (2018) discovered that the main causative problem of BSIs was inconsistent hemodialysis tunneled catheter care (HTC) protocol in the dialysis units, lack of standardized audits for the protocols and lack of patient education. Through proper implementation of infection control protocols such as ‘scrub the hub’ protocols, standardized audits, nurse and patient education, infections were reduced by up to 50% (Lee K. G., 2018). Another investigation applied strict implementations of the aseptic techniques and sterile dressing coupled with nurses training and patient education towards infection control. This resulted to more than 50% infection reduction in a 24-chair dialysis unit within a month (Hoffman, 2018).

Dialysis Related BSIs and Nursing Interventions

The CDC in conjunction with the American Society of Nephrology’s Nephrologists Transforming Dialysis Safety Initiative came up with interventions which are considered the gold standard preventive measures for BSIs. When implemented strictly, nurses can optimally prevent BSIs. This study aims at carrying out full implementation of these interventions. These interventions include; hand hygiene, catheter exit-connection and disconnection using aseptic technique and antiseptic use, catheter lumen and hub care and the assessment of these techniques every three months with nursing staff training and audits. Other nursing interventions include early patient referral to nephrologists, more specialized teams, and vascular access coordinators, implantation of early-stick grafts and early peritoneal dialysis (Fisher, 2020).

Dialysis Related BSIs and Patient Care

Patient care before, during and post-dialysis is key in infection prevention. Prior to vascular access, it is important to remove any restrictive jewelry and clothes from the patient’s arm. Other clinicians should be informed so as to avoid procedures such as blood pressure measurements and venipunctures on the same arm. When examining the patient, nurses should always disinfect their hands and put on gloves as an infection preventive measure. The vascular access should be checked for patency and smooth blood flow at least three times daily (Rushing, 2019).

Post dialysis, the patient should be moved in a manner that will avoid any trauma or pressure on the arm. The vascular access should be checked on a daily basis for signs of infection such as swelling, tenderness, open sores and purulent discharge. Patent education on self-care and infection prevention is paramount and this is the responsibility of his/her nurse. Patient self-care is key in preventing infections associated with dialysis and proper practice effectively reduces infections (Rushing, 2019)

Health Care Agency Involved in BSI Prevention

CDC in collaboration with the National Safety Healthcare Network (NHSN) developed a surveillance and feedback platform for data sharing and comparisons from different facilities in the US. This plays a role in informing policy making towards mitigation methods (CDC, 2020). Agency for Healthcare Research and Quality also provides support to researches and facilities aiming at reducing BSIs (AHRQ, 2020).

BSIs and Nursing Practice

Dialysis associated BSIs is a significant issue in nursing practice. In the US, BSIs arise mainly due to the failure to strictly implement and stick to the nursing protocols put in place for dialysis infection control. This largely depends on nurses and can be solved through strict nursing practice, regulations and standardized audits in dialysis units. This will lead to reduced infections, reduced hospitalizations, better clinical outcomes and reduced hospital bill burdens to patients (Fisher, 2020).

References

AHRQ. (2020, June 08). Retrieved from https://www.ahrq.gov/patient-safety/settings/esrd/resource/clinicalcare.html

CDC. (2020, June 07). Retrieved from https://www.cdc.gov/dialysis/prevention-tools/audit-tools.html

Fisher, M. G. (2020). Prevention of Bloodstream Infections in Patients Undergoing Hemodialysis. . Clinical Journal of the American Society of Nephrology, 132-151.

Hoffman, S. (2018). Reducing Blood Stream Infections from Tunneled Dialysis Catheters. . . Nephrology Nursing Journal.

Lee, K. G. (2018). Reducing tunneled catheter-related infection in hemodialysis patients with nationwide standardization of catheter care protocol. The journal of vascular access, 110-111.

Lee, K. G. (2018). Reducing tunneled catheter-related infection in hemodialysis patients with nationwide standardization of catheter care protocol. . The journal of vascular access, 110-111.

Rushing, J. (2019). Caring for a patient’s vascular access for hemodialysis, . Nursing Management, 47.

Review your problem or issue and the study materials to formulate a PICOT question for your capstone project change proposal. A PICOT question starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention used to address the problem must be a nursing practice intervention. Include a comparison of the nursing intervention to a patient population not currently receiving the nursing intervention, and specify the timeframe needed to implement the change process. Formulate a PICOT question using the PICOT format (provided in the assigned readings) that addresses the clinical nursing problem.

The PICOT question will provide a framework for your capstone project change proposal.

In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome.

Describe the problem in the PICOT question as it relates to the following:

Evidence-based solution
Nursing intervention
Patient care
Health care agency
Nursing practice

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

No of Criteria: 9 Achievement Levels: 5

Criteria

Achievement Levels

Description

Percentage

Unsatisfactory

0.00 %

Less Than Satisfactory

75.00 %

Satisfactory

79.00 %

Good

89.00 %

Excellent

100.00 %

Content

80.0

PICOT Question

20.0

A PICOT question is not presented.

An incomplete PICOT question is presented. The PICOT does not follow the correct format.

A PICOT question is presented. The PICOT generally follows the correct format.

A PICOT question is presented. Some detail is needed for clarity.

A PICOT question is presented and provides a clear framework for the capstone project change proposal.

Nursing Intervention

20.0

The intervention and comparison are omitted

The intervention used to address the problem is not based on a nursing practice intervention. A comparison of the nursing intervention to a patient population not currently receiving the nursing intervention, and timeframe needed to implement the change process, are omitted.

A nursing intervention used to address the problem is presented. A comparison of the nursing intervention to a patient population not currently receiving the nursing intervention, and timeframe needed to implement the change process, are summarized. Some information is needed. There are minor inaccuracies.

A nursing intervention used to address the problem is clearly presented. A comparison of the nursing intervention to a patient population not currently receiving the nursing intervention, and timeframe needed to implement the change process, are thoroughly discussed.

Clinical Problem and Patient Outcome

20.0

The clinical problem and how it can result in a positive patient outcome are omitted.

The clinical problem and how it can result in a positive patient outcome are incomplete.

The clinical problem and how it can result in a positive patient outcome are summarized. More information and rationale are needed.

The clinical problem and how it can result in a positive patient outcome are presented. Some minor detail is needed for clarity.

The clinical problem and how it can result in a positive patient outcome are thoroughly discussed. Strong rationale is offered for support.

PICOT Problem

20.0

The PICOT problem as it relates to evidence-based solution, nursing intervention, patent care, health care agency, and nursing practice is omitted.

The PICOT problem as it relates to evidence-based solution, nursing intervention, patent care, health care agency, and nursing practice is incomplete.

The PICOT problem as it relates to evidence-based solution, nursing intervention, patent care, health care agency, and nursing practice is summarized. More information and rationale are needed.

The PICOT problem as it relates to evidence-based solution, nursing intervention, patent care, health care agency, and nursing practice is described. Some minor detail is needed for clarity.

Organization, Effectiveness, and Format

20.0

Thesis Development and Purpose

5.0

Paper lacks any discernible overall purpose or organizing claim.

Thesis is insufficiently developed or vague. Purpose is not clear.

Thesis is apparent and appropriate to purpose.

Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

Argument Logic and Construction

5.0

Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.

Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.

Argument is orderly but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.

Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.

Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

Mechanics of Writing (includes spelling, punctuation, grammar, language use)

5.0

Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present.

Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.

Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.

Writer is clearly in command of standard, written, academic English.

Paper Format (use of appropriate style for the major and assignment)

2.0

Template is not used appropriately, or documentation format is rarely followed correctly.

Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.

Template is used, and formatting is correct, although some minor errors may be present.

Template is fully used; There are virtually no errors in formatting style.

All format elements are correct.

Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)

3.0

Sources are not documented.

Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.

Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.

Sources are documented, as appropriate to assignment and style, and format is mostly correct.

Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

Total Percentage 100

PICOT question

Any patient that answers yes to current smoker during a physical with their primary care physician will receive educational information from nursing staff on ways to quit smoking and resources to help them quit smoking to see if they are able to become and stay a non-smoker for 6 months versus how many patients become non-smokers with no interventions from nursing staff.

Evidence-based Solution

There is not enough easily accessible education for patients in regards to smoking cessation. Currently there is no information provided to patients when they answer yes to being a current smoker. Not only would there be tips available to help quit smoking but also additional resources. “Many people find support groups and hotlines helpful when quitting tobacco” (American Heart Association, 2020). There will also be information available on the dangers of smoking. This is important to share with patients as per The World Health Organization it is the cause for 7 million deaths annually (McWilliams, et al., 2019, p.1059).

Nursing Intervention

The nursing intervention will be completed by nursing staff within the clinical environment. When a patient answers yes to being a current smoker, the nursing staff will then provide the patient with education and resources to help them quit smoking. This should only take 3-5 minutes and the patient can take the pamphlet home with them. The pamphlet will include how to contact nursing staff with additional questions or support for the patient to use as needed.

Patient Care

This pamphlet will provide information on ways to quit smoking without the use of medication for patients. It will also provide resources for additional information available online. It will also allow patients to have access to nursing staff to ask questions and provide additional support.

Health Care Agency

The health care agency this program will assist is ProHealth Care Medical Group. There are generally classes offered from ProHealth Care but unfortunately due to COVID all classes are cancelled and there is no information online about what classes were previously offered to determine if smoking cessation classes were previously offered. This organization has 12 locations that offer family practice and/or primary care services. Once this project is complete this pamphlet for smoking cessation education can be used at all of the 12 locations.

Nursing Practice

Providing education to patients is a nurse’s duty. Having information available to assist the education can be beneficial to the nurse and the patient. The patient may have additional questions outside of the patient information pamphlet, if the nurse is unable to provide the patient an answer at that point, they can inform the patient they will find the answer, and call them at a later time. Providing the pamphlet ensures that all patients are getting the same information, as well as resources to use to help them with their smoking cessation.

References

American Heart Association. (2020). Help! I want to quit smoking. Retrieved from https://www.heart.org/en/healthy-living/healthy-lifestyle/quit-smoking-tobacco/help-i-want-to-quit-smoking

McWilliams, L., Bellhouse, S., Yorke, J., Lloyd, K., & Armitage, C. J. (2019). Beyond “planning”: A meta-analysis of implementation intentions to support smoking cessation. Health Psychology, 38(12), 1059–1068. https://doi-org.lopes.idm.oclc.org/10.1037/hea0000768.supp

ProHealth Care. (2020). Medical services. Retrieved from www.prohealthcare.com