n/a, Nursing

Discussion #1
My Clinical question is the use of capnography over pulse oximetry in PACU and reducing hypoxia and apnea events. The resources involved include the actual capnography monitor and the end tidal 02 device . The capnography monitor is in place in PACU presently. It is compatible with the device in the OR. The end tidal CO2 is monitored in the OR and that same tubing can be attached in PACU. There is no added cost to the patient or department. The issue is more of an education and communication problem. Education to staff of what patient needs the additional monitoring and communication to the OR to bring the device with them upon transport. I would accomplish the education by a collaboration inservice with respiratory therapy to discuss how exhaled C02 is a much more sensitive and accurate was to assess ventilation.
The OSA patient when not monitored is at a higher risk for hypoventilation. This device and nurse vigilance provides an earlier indication of impending respiratory failure. The improved outcome will be fewer emergency interventions (reintubations) and reduced unplanned ICU stays.
My plan for communicating is to show this technology has been in consistent use since 2011. The monitors have already been purchased and the mechanism is already in use in the OR. Showing that a decrease in anesthesia intervention in PACU and decreased PACU stays proves that monitoring and nurse intervention improves patients safety and satisfaction. Presenting data pulled from EHRs to show last year when capnography was not in consistent use compared with this year when it has been applied more frequently. It will show reduction of length of stay in PACU, decreased in unplanned ICU admissions from PACU, and reduction of anesthesia calls to PACU for intervention.
The support I am seeking is more capnography monitors in PACU , as well as funds for education for clinical support.

Discussion #2
Creating an action plan is one of the most important processes that must be done while taking on any type of project. For a project as long as this one, a good action plan can help turn the visions that we create into a type of reality. Normally, the action plan must be something that we consider the moment that we finish making up the PICO question. The action plan also must be separated into multiple parts. Each action plan that we create should include all of the following parts:

– What actions of changes will occur
– Who will carry out these changes
– By when will they take place and for how long
– What resources(money, staff, etc) are needed for this to take place
– communication(who needs to know)

In addition, a good action plan must incorporate all the moving parts that we believe will be in the project till the very end and also leave room for changing the plan as it comes together in case it becomes necessary. An action plan is like a \”lesson plan\” where we write everything out in detail of how we \”expect\” it to take place, but, we also know that our visions very rarely fully come true. There are always unforeseen obstacles that will happen during the course of the project that none of us can control.

My project involves lowering the amount of HAI\’s in patients by not having them have a soap/water/basin bath and instead changing it to a chlorhexidine bath to lower the amount of flora that is on the skin of the patients, and thus, lower the chances of a HAI. For me, my action plan will consist of the following:

– What(lower the amount of flora on the skin of the patients by utilizing a chlorhexidine bath as opposed to a water/basin/water bath)
– Who(nurses, aides, patients, higher-up staff who will oversee education of practice)
– By when(plan is for within next six months to begin)
– What resources(money, staff, education)
– Communication(staff, patients, higher-ups at hospital)

I will include in my references a few good websites that I found that discusses how to create a good action plan so that other students who need the assistance can look it over and hopefully it can help them out.

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