Phase 2 Reflection

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School

Western Governors University *

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Course

D156

Subject

Health Science

Date

Oct 30, 2023

Type

docx

Pages

Uploaded by lric200

Written Reflection Summary-Phase 2 I work in an ambulatory clinic with Orthopedics, our site is a critical access hospital that is part of a much larger healthcare system. I am the only RN that works within the department with 1 surgeon and 1 PA and have a floating medical assistant. With our immediate department being very small I am always looking for ways to improve processes, workflows, and procedures. Although we are a small facility, our orthopedic department stays very busy. We perform total hip and total knee arthroplasty surgeries, which make up a significant number of our orthopedic surgeries performed within the facility. I wanted to focus on the orthopedic department for a healthcare improvement project. After working with my preceptor and establishing an option for the healthcare improvement project, I developed my stakeholders. The stakeholders and I met and had a round table discussion. This is where I proposed my plan to develop a risk assessment tool to assess patients for their risk of developing contact dermatitis with the use of skin adhesives post operatively. We performed an affinity analysis and determined that there was a need to for this healthcare improvement project. Based off of research, skin adhesives used for surgical site skin closures has an average of 2-3% of developing contact dermatitis. Our facility’s incidence of post operative contact dermatitis associated with skin adhesives in the last year was 15%. This data was very evident to the stakeholders that we needed to improve this. Our justification for this healthcare improvement project is that cases of post operative contact dermatitis has led to unscheduled clinic visits, prolonged recovery times for the patients, dissatisfied patients, and extra resources utilized to manage the contact dermatitis. Post operative contact dermatitis has an increased potential to lead to a surgical site infection with further complications. This healthcare improvement project will allow us to assess patients for their risk of developing post operative contact dermatitis pre-operatively and determine the appropriate surgical incision closure and/or dressing. We will focus on this to help reduce the cases of post operative contact dermatitis, improve negative patient outcomes, and improve patient satisfaction. Our focus for this project will be our total hip and total knee arthroplasty patients. We then moved on to complete an impact analysis. The two categories that we chose to include were organizational and consumer. Benefits for the organization included improved patient outcomes and minimize the risks of surgical site complications or infections. Benefits for

the consumer were improved patient satisfaction and decrease in costs of additional visits related to a surgical site complication or infections. Risks for the organization included increase stress on staff to complete additional investigation and documentation and variable surgical closure method and/or dressings used. Risks for the consumer included inadequate pre-operative education for incisional care if unknown what surgical closure and/or dressing may be used and possibility of additional testing to be performed prior to surgery to confirm allergy. The stakeholders were asked to rate each benefit and risk on the 1 to 3 scale and then these ratings were tallied and that is how we come up with our impact ratio of 1.4 which reflects that the benefits outweigh the risks. Lastly, we performed a SWOT analysis. Internal criteria included leadership and commitment. These were chosen as the organization’s leadership is committed to ensuring patient safety and providing the highest standard of care to our patients. Factors that we considered weaknesses for our internal criteria included dedicated time of our leadership stakeholders to provide to the project implementation as they are already very busy in their day to day required tasks. Another weakness included the increased stress on staff to completed the additional step of investigating and documenting to complete a risk assessment. It is an additional component to be added to the already stressful work environment. External criteria chosen were stakeholder involvement and development of knowledge. Opportunities for stakeholder involvement included having a variety of areas represented can aid in the successful implementation of this project. Threats of stakeholder involvement included have too many stakeholders may cause decision making to become more difficult as there would be lots of opinions and ideas brought forward. Development of knowledge has many opportunities as healthcare is an ever-evolving field. One threat to the development of knowledge is the possibility of evidence-based research may not be abundant on proposed topic. Overall, performing these analyses with the involved stakeholders has been met with great opportunities and each stakeholder felt that this was an area that would ultimately be beneficial to our organization and they are committed to the successful implementation of this healthcare improvement project.

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