Research Paper on Problem or Issue Explored in The DNP Project

Introduction

Ambulatory care and urgent care networks have increased the number of emergency cases handled by the hospital on a daily basis. The increase in such cases has increased the pressure on resources and response time has declined. Medical errors have also increased due to poor coordination among nurses and improper medication reconciliation in the emergency department. These problems call for culture change and adoption of technology for managing all these problems. Even though the hospital has adopted the electronic health records systems, coordination among the nurses is still poor.

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The Practice-Focused Question (PICOT)

In an emergency care setting (P), will the adoption of technology for emergency response (I) compare to non-technology driven emergency response (C) help in improving coordination (O) within two months?

How the Problem Affected Nursing Practice and the Overall Health Care System

Rational coordination among the provider functions is necessary because it underlies the value of the high-quality relationship. In an emergency care department, shared goal, shared knowledge as well as respects can only be successful if high-quality communication is guaranteed. Nurses need to communicate in a timely, manner, frequently and made use of accurate information for decision-making and problem solving (Buckwalter et al., 2017). Lack of coordination and medication reconciliation in the emergency care department lead to high mortality rates. Other problems include an increase in the case of medication errors and s increase length of stay.

How the DNP Project Explored Possible Strategies for Addressing the Problem or Issue.

The DNP problem was spearheaded by the registered nurse and supported by the multidisciplinary teams that evaluated the problem and experimented several strategies for solving the problems. The multidisciplinary teams were asked to propose solutions with evidence and the proposed solutions were tried in the hospital over two months and evaluated to determine the effectiveness of the solutions (Magers, 2014).

Evidence

The Practice Setting and Context in Which You Conducted Your Project

The project was conducted at the districts referral hospital. The hospital is an eighty five-bed capacity, with over 120 nurses and 20 physicians. The hospitals have all the departments found in typical hospitals such as the emergency department, neonatal departments, intensive care unit, burn center, pediatric, and psychiatric department.

Summary of the Evidence Supporting the Project

Medication errors: Previously there were many cases of medication errors. Patient information reconciliation was poorly done and coordination among the nurse was poor, the emergency department was plagued with perennial cases of delays in delivering care to the hospitals

Capacity: Capacity was also another major problem in the emergency department. The hospital's capacity to handle emergency cases was affected as each patient cases required a lot of time allotted to each case. The ambulatory and urgent care networks were to blame of the increasing number of ED referrers. Most of the emergency department physicians did not have all the information they need to deliver care to the parties such as patient background, medication history as well as the social factors

The length of stay in the horsiest was another problem: Most patients stayed in the emergency department because the traditional triage never allowed early assessment of patients at the initial point of care. The hospital adopted the split flow model to reduce the length of stay

Declining reimbursements: Declining reimbursements was also another problem, as the hospital had to work with thin margins. Improving cost-cutting and koshering helped in improving patient care.

Staffing: Staffing in the emergency department was a problem because the hospital did not have the budget for recruitment. The hospital had to select qualified physicals, physician assistants, nurse practitioners, and another multidisciplinary team to manage the emergency department.

The hospital adopted technology in the emergency department to help to manage emergency medical records that also helped in improving efficiency. The newly introduced computer-aided dispatch system was useful in integrating the nurse call and wireless phone solution into the care plan.

The Process for Implementation and Evaluation

The hospital adopted the Promoting Action on Research Implementation in Health Services (PARIHS) Framework to implement the EBP project. The framework views evidence-based change as practice innovation (Magers, 2014). The main tenets of the PARIHS framework include the type of evidence that the hospital could attain, the context of the healthcare setting where the evidence is implemented as well as the process of facilitating the EBP (Magers, 2014). The main requirement for the EBP is taking into consideration the contribution and perspectives of all the people that would be affected by the change.

Step 1: Gathering Evidence

The first step is to assess the strength of evidence and the evidence's potential for implementation in the hospital. The evidence is assessed based on research (research evidence), the research evidence should be rigorous and peer-reviewed. The second basis of the evidence is the practitioner expertise and experiences (Magers, 2014). The tacit knowledge of practitioners is taken into consideration as part of the evidence. Finally, the local context and environmental information are taken into consideration as part of the evidence.

Step 2: Context

The second step is to examine the healthcare organization setting where the proposed change will be implemented. The organization culture is primed for the changes, the leadership and the resources available for the change implementation. It is important to note that this model requires a multidisciplinary approach (Magers, 2014).

Step 3: Facilitation

The third step is the facilitation step where support is organized to help the staff change their attitudes. Dimension such as personal characteristics, role characteristics, and leadership style will be the basic requirements for a successful EBP facilitation (Buckwalter et al., 2017)

Step4: Evaluation

The EBP was evaluated in terms of the patient outcomes. The change was appropriate, comprehensive and accurate in solving the clinical problems defined by the PICOT question

Presentation of Results

The Results of Your DNP Project

The adoption of technology in emergency response has been effective in improving patient outcomes. The hospital's main goals are to provide compassionate, accessible, high quality and cost-effective care to the patient and promote health. Therefore, technology helped in achieving the goals (Kowalski, 2017).

Improved nurse coordination which helped in reducing medication errors.

Culture change was done. New positions were created and the team was selected to oversee change in the hospitals.

Improve response time. Nurse's response to emergencies improved by 50% as the nurses got alerts in their pagers immediately the critical cases reached the hospital switchboard.

Patient health information was secured and patient privacy improved. Patient data collection, retrieval, and storage also improved. Cases of data breach and death were reduced as medication reconciliation also improved significantly (Havens, Vasey, Gittell & Lin, 2010).

Recommendations for Change that was Made to the Organization

Multidisciplinary teams should be formed in each department to help in sustaining the change.

Clinical research should be encouraged and investment to made to support clinical research.

Evidence-based practiced should be driven by three pillars of EBP including Patient Values, Clinical Expertise, and Relevant Research.

References

Buckwalter, K., Cullen, L., Hanrahan, K., Kleiber, C., McCarthy, A., & Rakel, B. et al. (2017). Iowa Model of Evidence-Based Practice: Revisions and Validation. Worldviews On Evidence-Based Nursing, 14(3), 175-182. Doi: 10.1111/wvn.12223

Havens, D., Vasey, J., Gittell, J., & Lin, W. (2010). Relational coordination among nurses andother providers: impact on the quality of patient care. Journal Of Nursing Management, 18(8), 926-937. Doi: 10.1111/j.1365-2834.2010.01138.x

Kowalski, M. (2017). Strategies to heighten EBP engagement. Nursing Management (Springhouse), 48(2), 13-15. doi: 10.1097/01.numa.0000511928.43882.55

Magers, T. (2014). An EBP Mentor and Unit-Based EBP Team: A Strategy for Successful Implementation of a Practice Change to Reduce Catheter-Associated Urinary Tract Infections. Worldviews On Evidence-Based Nursing, 11(5), 341-343. Doi: 10.1111/wvn.12056