Phase 1 Relfection

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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 1 I was very excited to get this course going. 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. I met with my preceptor, who is also my immediate supervisor. We discussed various ideas that could help improve the orthopedic department, but most importantly to improve patient outcomes. One idea that resonated with both of us the use of skin adhesives for surgical site skin closures after total hip and total knee arthroplasty surgeries. We specifically use Dermabond Prineo as our surgical skin closure system. My preceptor and I discussed various outcomes we have had with this. In the last year we have had an increased incidence of patients who had developed contact dermatitis around their surgical incisions within the first two weeks post operatively. This has led to increased care for management of the contact dermatitis and the increased risk of developing a surgical site infection that will ultimately lead to further treatment and poor outcomes for the patient. My preceptor and I had brought in the orthopedic surgeon and discussed ways in which we could use this information to develop a healthcare improvement project. Ideas that were discussed were changing to a different type of surgical dressing or using staples with a different surgical site dressing and eliminating the skin adhesives. Which are good ideas but looking at budgets and timeframes, we didn’t see this as a feasible option to start with. At this time, we decided to table the ideas until I had completed some research on the use of skin adhesives and contact dermatitis. I was able to find research related to this and then I brought this information back to my preceptor and surgeon. Within the research, it was not clearly evident that switching to a different type of surgical dressing or surgical skin closure method was the answer. After more discussion, it was evident that we need to develop a risk assessment tool to assess patients for their risk of developing contact dermatitis with the use of skin adhesives post operatively. This was agreed upon by the three of us. Next step was to involve key stakeholders. My preceptor and I had discussed different people that I thought would be good candidates for this project. Then I set out to contact the stakeholders for their input and willingness to participate in this healthcare improvement project. Stakeholders that I have included within my healthcare improvement project included leadership (from both clinical and surgical service lines), infection prevention, quality director, dermatologist, wound care nurse,

and orthopedic nurse (me). I felt that each of these stakeholders held value with their input and expertise to help this project be successful. Clinic and surgery supervisors will have the role of leadership. They will be responsible for support and facilitation within leadership. They will provide input and direction with process workflows and procedures. Assist with implementation and morale of staff. They will play a role in policy development during the implementation process. The infection prevention specialist will have the role of being subject matter expert, education, and training. She will be responsible for bringing old and current practices to the table and provide input. Ensure we are following best-practice in relation to infection prevention. Facilitate up-to-date guidelines throughout the implementation. The quality director will have the role of quality metrics and data. She will have the responsibility of providing data in relation to our metrics. She will have the role of providing input throughout the implementation process as to what is working and what is not working. She will be responsible for collecting our metric data. The dermatologist has the role of subject matter expert. Their responsibilities are critical to the successful implementation of this project. They will provide education and training to the dermatologic aspects of this project. Help guide in the appropriate direction and ensure that we are following best-practice. The wound care nurse has the role of subject matter expert in caring for wounds. She will have the responsibility of providing input regarding wound care and management for post operative contact dermatitis. She will provide feedback throughout the implementation process. The orthopedic nurse (me) will have the role of team leader, education, training, input. I will have the responsibility of leading this team to the successful implementation of this healthcare improvement project. But also provide input and knowledge to current practices and policies related to total hip and total knee arthroplasty surgeries. I will be responsible for pre- and post operative screening and education for orthopedic staff and patients. With this healthcare improvement project, I am confident that we can be successful with implementing and have improved patient outcomes. I know that there will be lots of initiating, planning, implementing, and evaluating to be successful but ultimately, we are working towards improved patient outcomes and the patients are why we do what we do!

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