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Leadership Strategy AnalysisKelly GeraghtyFerris State UniversityAbstractThis paper contains information on the need for a bathing protocol in the Neonatal Intensive Care Unit. The interdisciplinary team that is involved in making these changes will be described. It also will contain the goals for this protocol followed by implementation of this policy. The education methods will be discussed. Finally, the outcomes will be evaluated and described. Quality Improvement ProcessQuality and safety is important in the care of infants in the Neonatal Intensive Care Unit (NICU). There are policies and procedure in place to insure that care that is given is the best possible. An important factor in ensuring quality and safety is making sure that infants remain infection free. A bathing protocol is an important tool that needs to be developed for the NICU to help decrease the risk for infection. The NICU currently does not have a bathing protocol in place.According to Hughes (2008) quality health care means that heath services increase the likelihood of desired outcomes and use current professional knowledge. Most medical errors happen because of a faulty system, not from human errors. Because of these errors it is important to create and follow process improvement techniques to help prevent errors and provide effective care.Background and Clinical NeedA quality improvement that is important in the NICU is the development of a bathing protocol. According to Allwood (2011) infants that are born between 23 and 30 weeks gestation have a different skin structures that a full term infant. Skin provides many vital functions including thermoregulation, barrier against toxins and infections, tactile sensation, insulation and storage of fat, and water and electrolyte excretion. When an infant is born premature they are at risk for sepsis, dehydration, temperature instability, and skin breakdown.The skin of a premature infant is undeveloped. The outer most layer of the skin is the epidermis and it contains the stratum corneum (SC). Allwood (2011) states that this SC and epidermis is severely compromised in premature babies and can lead to a greater water loss. The SC matures rapidly in the first two weeks of the neonate’s life. The neonate is also born with vernex which is a fatty film that begins to develop after 20 weeks gestation. According to Allwood this is shown to contain anti-infective agents. It is recommended that this is not removed from the preterm infants for the first several weeks of life.According to Allwood (2011) the purpose of bathing is not only to remove waste but to potentially reduce microbial colonization. This can be harmful to the premature infant. It can cause hypothermia, unstable vital signs, and absorption of harmful chemicals. The skin of a premature infant can be easily injured. We need to be sure that we are using proper types of soaps and bathing procedures at the right gestational ages. Interdisplinary TeamAccording to Yoder-Wise (2011) a team is a group of people that are associated by the work that they do. When putting together a team to work on the bathing protocol for the NICU I would need to involve many disciplines. I would first need to consult with the Certified Nurse Specialist (CNS) for the NICU. I would also need to involve the Quality and Safety Nurse, several staff nurses, the Infection Control Nurse, and finally one of the units Neonatologists. The process would start with an article search for current literature of why this policy change would need to take place. This would be done by the CNS. She would find the latest literature in journals as well as inquiring what other units use as their protocol. She would take this information and present this to a committee that meets in the NICU. This committee is called the Fighting Bacterial Infection Committee (FBI). This committee takes the latest research and makes policy recommendations. Involved in this process would also be the Infection Control Nurse for the children’s hospital. This person would oversee that the policy that is created follows the guidelines that the Center for Disease Control (CDC) recommends. This person would make sure that any changes that were going to be made are approved by the CDC. She would provide the research needed from the policies from the CDC. Several staff members would be needed to insure that the policy that is being written will be able to be accomplished by the staff. They would be involved in reviewing the final drafts. These staff member might even try out the bathing techniques to ensure that these will be possible to use effectively. Finally a Neonatologist would be involved to ensure that the protocol that is being submitted is what is in the best interest of the patients.Data Collection MethodThe data collection method that could be used to monitor the progress of the bathing protocol is collecting information about the protocol from QI’s and using this information in a dashboard. Along with these the infection rate would also be followed. The QI would list things that would be evaluated such as type of bath, proper procedure followed, gestational age, and type on intravenous catheter if any. This information would then be added to the dashboard that is used for data collection in the NICU.A dashboard is a type of graph that alerts where each unit in the hospital stands against each other in certain categories such as infection rates. The data collected from the QI’s would be transferred to this graph. A dashboard of this type allows people to be in red, yellow, or green zones. If you are in a red or yellow zone, you have improvements to be made in this area. If you are in green this would mean the policy is functioning and you should keep up the good work. The interdisciplinary team that was created to work on this bathing protocol would be also used to work on the problem areas that are shown on the dashboard. OutcomesThe goal for improvement is to develop a bathing protocol for the NICU that will help decrease infection risks and allow for a standard of care that is equal across the board. Currently there is no policy regarding bathing in the NICU. The outcome will be the successful implementation of the bathing protocol with a decrease in infection rates. Also the hope would be to have everyone educated and using the protocol with a short education period. Consistency in bathing can help keep parents feeling less confused and can also increase the patient satisfaction scores. Using the dashboard will allow the team to track if the goal needs to be reevaluated or change at any point.Implementing StrategiesAccording to Hughes (2008) it is important for successful implementation of change for leadership and staff to work together. This can be done once the bathing protocol has been compiled, by having the management work with the staff in the education of the new policy. A good way to begin to introduce this policy would be to send out a unit wide email introducing this new policy. This would give staff member’s information on what changes could be expected with the new bathing protocol. According to Yoder-Wise (2011) change is constant and inevitable and a natural social process. How these changes affect an organization depends on the way an organization responds to change. It will be important to implement this bathing protocol in a way that staff members will be able to easily use and understand why the changes are needed.Once this email is sent the staff members will be sent an online learning module. This will be through a program called Spectrum Health Learning Institution On-line (SHLIO). This is used by Spectrum Health to help with the in-services and introduction of new policy and procedures. This will contain information about all of the changes that will occur with the bathing policy. It will list the procedures involved with these changes. It will then include a quiz at the end to test the employees understanding of the module. Each employee will also receive a pocket sized card to serve as a reminder of the policy rules.Super users will be recruited which is basically staff members that are given extra training on the protocol and procedures. These super users will staff the unit for the first week of the roll out of the new bathing protocol. On the day of the roll out of the new protocol the employees involved in the development of the protocol along with the super users will be on hand to assist in the change. The supplies needed will have been stocked and ready for use.EvaluationYoder-Wise (2011) states that when a plan is implemented the members involved continue to gather data and evaluate this data to see if revisions need to be made or if the outcomes are being met. Staff members may find as they begin using this protocol that there are changes that can be done to make this policy work more effectively. It is the goal to provide the safest care possible in the NICU. Evaluating the success of the bathing protocol will take many months. It will require that the tools that were described above be used. The QI and dashboards need to be collected and the staff members will need to evaluate the process. Along with this the infection rates will need to be looked at to see if this has had a positive impact on the number of infections. This could be a good indicator if this protocol is making an impact or not. This dashboard will be updated and followed for several months after this protocol is introduced.ConclusionEnsuring that every patient in the NICU has a safe and infection free stay is a very important goal. Policies and procedures need to be developed to ensure this. A bathing protocol is an important step in the prevention of infection in the NICU. Implementation and evaluation would need to be done. A group will be formed and will collaborate to ensure this protocol is developed from researched material and is evidence based. The staff will be educated and the protocol will be evaluated and improved according to the QI and dashboard results. The end hope is to have a safe and effective method for bathing infants in the NICU and decreasing the infection rate.ReferencesAllwood, M. (2011). Skin care guidelines for infants aged 23 – 30 weeks gestation: a review of the literature. Neonatal, Pediatric, and Child Health Nursing, 14(1), 20-27.Hughes, R. C. (2008). Tools and strategies for quality improvement and patient safety. Retrieved from http/ncbi.nlm.books/NBK26821Yoder-Wise, P. S. (2011). Leading and management in nursing (5th ed.). St. Louis, MO:Elsevier Mosby. ................
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