Standardization of Nursing Protocol for Cardiac Arterial Bypass Patients
Evidence-Based Practice (EBP) is an important factor in determining medical courses of action. Nurses have long used tradition rather than evidence in making decisions about beside care; to convince them to switch practice, it is useful to draw a comparison between the efficacy of these disparate routes. Our study designed a research question based on the PICOT model for the cardiac floors and designed procedures using the Kotter and Cohen’s Model of Change. In order to study the effect discussed in our PICOT question, a web search was conducted and the quality of each pertinent study reviewed.
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Standardization is rooted in an effort to improve efficiency and the quality of care. Given the very significant levels of health care expenditures throughout the Western world, the reasons for concern over efficiency are immediately obvious. The United States spends 14% of gross domestic product on healthcare (G.Ellingsen, et al., 2007). Despite efforts to contain it, expenditures keep increasing. Volume for admissions across the country is down, so it is even more important for the improvement in the standardization of care among the nursing staff because each institution is competing for these same dollars. This could mean millions of dollars lost over time. As with any healthcare field, nursing practice often varies considerably with the development of institutional policies and procedures not consistently based on best-practice evidence, but rather upon personal experience or non-peer review literature accounts (C., Pierce, 2011).
Thirty-eight percent of all hospital-acquired infections are surgical site infections (SSIs), with 4% to 16% being among hospitalized patients, according to the Institute for Healthcare Improvement (Institute of Health Improvement). In 2002, the Centers for Medicare and Medicaid Services (CMS) and the CDC united to allocate evidence on antibiotic use to prevent SSIs. Then known as the Surgical Infection Prevention (SIP) project, the first manual had three infection prevention topics focusing on antibiotic administration: SIP-1, prophylactic antibiotic received within 1 hour of surgery; SIP-2, prophylactic antibiotic selection for surgical patients; and SIP-3, prophylactic antibiotics discontinued within 24 hours after surgery end time . By August 2005, the SIP project grew to become a national quality partnership of organizations called the Surgical Care Improvement Project, or SCIP, with the goal of decreasing surgical complication by 25% by 2013 (SCIP, 2011).
The current SCIP measures now include not just antibiotic administration but also nonpharmacologic interventions. The three current issues that are being concentrated on for the SCIP protocol are: infection prevention (administration of antibiotics, monitoring blood glucose levels, appropriate hair removal, removal of urinary catheters, and perioperative temperature management), cardiac care, and venous thromboembolism (VTE) prevention (SCIP, 2011).
The Joint Commission along with several other organizations has established procedures regarding patient outcomes and care in order to meet standards for Medicare qualification. These standards, known in cardiac care as the SCIP, help to guarantee that cardiac patients receive the best standard of care because it is based on evidence-based practice. Evidence-based practice (EBP) is “the practice of nursing in which interventions are based on information from credible research efforts that describe and illustrate successful treatments, decisions, and patient care outcomes," (Adamson,...