discussion question 2 response


1 (fb), My change practice proposal chosen as a topic for my evidence-based practice project focuses on switching meperidine epidural, that was kept in the patient spine for forty- eight hours, with morphine epidural which will be removed in two-three hours after surgery, prior on transferring the patient in the post-partum unit.

To address the symptoms, the induced adverse side effects on the patients (dizziness, drowsiness, nightmares when the medication is building in after twenty- four hours, inability to void, constipation) the clinical guidelines recommend changing the epidural medication with a medication with fewer side effects and using it for less time, considering it is an opioid (Sultan, Halpern, Pushpanathan, Patel& Carvalho, 2016).

Initially, the proposed solution to prevent the adverse events associated with meperidine after surgery was to improve the inability to void once the indwelling catheter was discontinued. As the project progressed and we gather more data, the proposed intervention changed on switching the epidural medication from meperidine with morphine, combining the removal of the epidural three hours after surgery and decreasing the time of temporary indwelling catheter to eight-twelve hours, to improve the patient’s outcomes and decrease the hospital stay, with improved recovery time and patient satisfaction.

The idea of this proposal started after management rounding on our patients found out that not only the medication is coming with lots of side effects, but patient satisfaction was decreasing due to a longer stay in the hospital and slower recovery compared with other health systems. However, the proposed solution takes into consideration a health assessment for every individual patient and will set up an appropriate plan of care.

2.(ds) Many patients living in lower socioeconomic areas have poor control over their diabetes, and they utilize the emergency department frequently to deal with the ailments of uncontrolled diabetes (Jackson et al., 2017). My proposed solution to this issue, since this population does not always follow up appropriately with their primary care provider, is to implement text messaging and health coaching outpatient to provide education, resources, and simply to communicate with the needs of this vulnerable population. From the beginning, I wanted to write about diabetes as an uncontrolled disease for many people and the issues that uncontrolled diabetes brings along with it. Upon further research, I then realized that a majority of those living with uncontrolled diabetes are those with a lower educational level living in medically underserved areas (Jackson et al., 2017). This is what changed my perspective from just writing about those with uncontrolled diabetes to the identification of a population in need living with uncontrolled diabetes. This population is in need of a change proposal; they make up a large majority of those living with uncontrolled diabetes and they have a lot less resources available to them than their higher wealth counterparts. This change project would not only help this population but overall help with the burden of cost uncontrolled diabetes presents to our nation.

3. (aa) While incidences of catheter-associated urinary tract infections continue to increase within the healthcare system, Mitchell et al. (2017) indicate that most of the healthcare-associated issues are preventable by adopting and implementing current evidence-based practices. Incidences of catheter-associated urinary tract infections development are influenced by the intensity and level of expertise on healthcare professionals inserting the catheter and due to failure of embracing other effective cleaning and monitoring of the catheter. Most importantly, inadequate compliance by nurses on adhering to proper catheter insertion guidelines and protocols also results in a high number of infections. Catheter-associated urinary tract infections could be prevented by a multidisciplinary team by increasing education to patients and nurses on the benefits of maintaining hand hygiene, ensure proper catheter insertion technique, use of antiseptics and proper monitoring of the catheter (Mitchell et al., 2017).

Moreover, the formulation and enactment of appropriate hospital policies on maintaining clinical guidelines on proper catheter insertion techniques and appropriate use of equipment could also be a step towards the prevention of catheter-associated urinary tract infections. The proposed solution of the change project, in this case, will be providing education on the importance of using catheter insertion techniques, active catheter monitoring, proper handwashing effective staff management for inpatients in the patient wards, intensive care units, and the PACU. The researcher will also encourage the involved parties to always ensure routine catheter monitoring and following catheter insertion protocols by nurses and other nursing staff. Since the beginning of the proposed change, a lot of ideas have been developed and adopted for use in the change project. Review of literature from scholarly articles and medical journals have been ensured a build-up of knowledge and skills in catheter-associated urinary tract infections. The author is now able to see the prevention )intervention on catheter-related urinary tract infections from a broader perspective. Having worked in the long term care facilities and other hospitals, I have encountered a high number of hospital-acquired infections, especially due to low compliance on handwashing and lack of necessary skills to insert or remove the catheter. This among the factor that led to my perspective of selecting the proposed change project on catheter-associated urinary tract infections. The low handwashing among current nurses and patients at my workplace has also led to the current perspective of focusing on the topic. Intensified mentorship by the selected mentor, coupled with an in-depth review of recommended clinical guidelines and protocols on the reduction and prevention of catheter-related urinary tract infection has led to a wide perspective on the matter.

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BMJ Best Practice

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Bellman, S. (2022). Experiences of living with juvenile idiopathic arthritis [Best practice information sheet]. JBI EBP Database, 24(1), 1-4.

Cochrane Database of Systematic Reviews

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Perth Children’s Hospital. (2022, April). Appendicitis [Emergency Department Guidelines]. Child and Adolescent Health Service. https://www.pch.health.wa.gov.au/For-health-professionals/Emergency-Department-Guidelines/Appendicitis

Department of Health. (n.d.). Who is being active in Western Australia? https://ww2.health.wa.gov.au/Articles/U_Z/Who-is-being-active-in-Western-Australia

Donaldson, L. (Ed.). (2017, May 1). Healthier, fairer, safer: The global health journey 2007-2017. World Health Organisation. https://www.who.int/publications/i/item/9789241512367

NCBI Bookshelf

Rodriguez Ziccardi, M., Goyal, G., & Maani, C. V. (2020, August 10). Atrial flutter. In Statpearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK540985/

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