What is the main issue for your organization in addressing a solution to evidence-based nursing practice? Discuss what might be the first step in addressing and resolving this issue.

What are your thoughts? Reply to this discussion question.

Per our infection control nurse, one area in which my hospital lacks is with patients diagnosed with sepsis. I have yet to get ahold of the numbers which I will have later this week, but per Melissa, these numbers are not great and could be improved. She believes and even from working as a bedside nurse in the Intensive Care Unit (ICU), I agree with her that we are lacking in the department of handoff communication between nurses. Report from the emergency room to the floors, or from the floors to a higher level of care (I.e. ICU’s, Cardiac ICU’s, ICU step downs or telemetry), there is a lack of effective communication between nurses. 

We all are aware of a sepsis bundle as it was drilled into our minds during our nursing programs and very well followed us into our careers. Whether you work medical-surgical, telemetry, critical care, mother/baby, labor and deivery, pediatrics, etc., we will always have patients of all ages who can have sepsis. Although the sepsis bundle is quite straightforward, communicating that is not always easy. Many times, nurses are not thorough in their reports of interventions and cares already provided, fail to notify the receiving nurse of sepsis protocol interventions that were canceled by physicians although this is not allowed in my facility or miss handing off important parts of report. By discontinuing interventions I am talking about a physician saying it is not necessary to achieve repeat lactates, administer fluid boluses, more than one sets of blood cultures, etc. Main things you would do during a sepsis bundle. It is now the nurses responsibility, per protocol, to reorder any interventions that a physician has canceled despite the discontinuation.  

Our hospital is beginning to implement a paper form, strictly for nursing to complete and then hand into our quality department for review. We are calling this the “Sepsis Handoff Tool”. It is a form that has the nurse fill out the time and date of when severe sepsis was recognized and what systemic inflammatory response syndromes (SIRS) were identified. It also requires the hospitalist notified three sets of vital signs to be noted. The form also has two boxes, one with a three hour sepsis bundle power plan and the other with a six hour sepsis bundle power plan; all which much be checked off with no exceptions. Then registered nurse and physician both must sign the paper and send to the quality department. With this new implemenation, infection control will then perform a study on whether this new tool increased patient outcomes or not. 

As nurses, there are many implications to our job. WIth sepsis and nursing in general, we are expected to be on top of our patients, their cares and interventions. We are responsible for making sure our patients are receiving all of the treatments they have ordered and that they are appropriate. WIth sepsis, a patients condition can rapidly deteriorate. We are a part of the team that attempts to prevent this from occuring, which means implementing our protocols and policies to the fullest extent. This handoff tool has the potential for nurse to nurse and nurse to phyisicians to both be on the same page and aware of patient care. The second implication for nurses would be that we are here to help our patients. As nurses, we do what we do to help those who are sick. Accurately implementing interventions that have been proven to decrease morbidity related to sepsis when performed together are interventions that we should be doing. Having a form that helps nurses reduce time wasted in determining what has and has not been done is very beneficial as we can go right ahead to implement appropriate interventions that are left. 

Mr. E is a pleasant, 70-year-old, black, male

Source: Self, reliable source

Subjective:

Chief complaint: “I urinate frequently.”  

HPI:  Patient states that he has had an increase in urination for the past several years, which seems to be worsening over the past year. He estimates that he urinates clear/light yellow urine approximately every 1.5-2 hours while awake and is up 2-4 times at night to urinate. He states some urgency and hesitancy with urination and feeling of incomplete voiding. He denies any pain or blood. Denies any head trauma. Denies any increase in thirst or hunger. He denies any unintentional weight loss.

Allergies: NKA

Current Mediations:

Multivitamin, daily

Aspirin, 81 mg, daily

Olmesartan, 20 mg daily

Atorvastatin, 10 mg daily

Diphenhydramine, 50 mg, at night                                                                                                                   

Pertinent History: Hypertension, hyperlipidemia, insomnia

Health Maintenance. Immunizations: Immunizations up to date

Family History: No cancer, cardiac, pulmonary or autoimmune disease in immediate family members

Social History: Patient lives alone. He drinks one cup of caffeinated coffee each morning at the local diner. He denies any nicotine, alcohol or drug use. 

ROS: Incorporated into HPI

Objective:

VS – BP: 118/68, HR: 86, RR: 16, Temp 97.6, oxygenation 100%, weight: 195 lbs, height: 70 inches.

Mr. E is alert, awake, oriented x 3.  Patient is clean and dressed appropriate for age.

Cardiac: No cardiomegaly or thrills; regular rate and rhythm, no murmur or gallop

Respiratory: Clear to auscultation 

Abdomen: Bowel sounds positive. Soft, nontender, nondistended, no hepatomegaly           

Neuro: CN 2-12 intact                                                                                                                        

Renal/prostate: Prostate enlarged, non-tender. No asymmetry or nodules palpated

Labs:

Test Name

Result

Units

Reference Range

Color

Yellow

Yellow

Clarity

Clear

Clear

Bilirubin

Negative

Negative

Specific Gravity

1.011

1.003-1.030

Blood

Negative

Negative

pH

7.5

4.5-8.0

Nitrite

Negative

Negative

Leukocyte esterase

Negative

Negative

Glucose

Negative

mg/dL

Negative

Ketones

Negative

mg/dL

Negative

Protein

Negative

mg/dL

Negative

WBC

Negative

/hpf

Negative

RBC

Negative

/hpf

Negative

Lab

Pt’s Result

Range

Units

Sodium

137

136-145

mmol/L

Potassium

4.7

3.5-5.1

mmol/L

Chloride

102

98-107

mmol/L

CO2

30

21-32

mmol/L

Glucose

92

70-99

mg/dL

BUN

7

6-25

mg/dL

Creat

1.6

.8-1.3

mg/dL

GFR

50

>60

Calcium

9.6

8.2-10.2

mg/dL

Total Protein

8.0

6.4-8.2

g/dL

Albumin

4.5

3.2-4.7

g/dL

Bilirubin

1.1

<1.1

mg/dL

Alkaline Phosphatase

94

26-137

U/L

AST

25

0-37

U/L

ALT

55

15-65

U/L

Pt’s results

Normal Range

Units

WBC

9.9

3.4 – 10.8

x10E3/uL

RBC

4.0

3.77 – 5.28

x10E6/uL

Hemoglobin

11.5

11.1 – 15.9

g/dL

Hematocrit

35.0

34.0 – 46.6

%

MCV

85

79 – 97

FL

MCH

28

26.6 – 33.0

Pg

MCHC

34

31.5 – 35.7

g/dL

RDW

14

12.3 – 15.4

%

Platelets

220

150 – 379

X10E3/uL

PSA

5.4

0-4.0

ng/mL

Assessment:

Diagnosis: Benign prostatic hyperplasia, ICD-10: N40.1

Please answer the following:

For the sake of this case study, the patient has confirmed BPH and prostate cancer has already been ruled out. Hence, please document your prescribed treatment plan for this patient (i.e. don’t state “refer to urology”).

1. What is your treatment plan (include specific dosage and frequency)? Why did you choose this treatment plan? Do you change any of his current medications?  In your answer, please describe, briefly, the pharmacodynamics (1 point) and pharmacokinetics (1 point) of your treatment choice and how they influenced your decision. Does the patient have any comorbidities that influenced your choice as well (1 point)? 

       Three months later, the patient notes improvement, but no resolution of symptoms. What would be your next prescribed treatment option (1 point)?

1. Document the education you would provide for this patient, specific to the prescribed medication. Please include information pertinent to the patient (2 points) and common potential adverse effects (2 points).

Assignment: Evidence-Based Practice and the Quadruple Aim

Healthcare organizations continually seek to optimize healthcare performance. For years, this approach was a three-pronged one known as the Triple Aim, with efforts focused on improved population health, enhanced patient experience, and lower healthcare costs.

More recently, this approach has evolved to a Quadruple Aim by including a focus on improving the work life of healthcare providers. Each of these measures are impacted by decisions made at the organizational level, and organizations have increasingly turned to EBP to inform and justify these decisions.

To Prepare:

• Read the articles by Sikka, Morath, & Leape (2015); Crabtree, Brennan, Davis, & Coyle (2016); and Kim et al. (2016) provided in the Resources.
• Reflect on how EBP might impact (or not impact) the Quadruple Aim in healthcare.
• Consider the impact that EBP may have on factors impacting these quadruple aim elements, such as preventable medical errors or healthcare delivery.

To Complete:

Write a brief analysis (no longer than 2 pages) of the connection between EBP and the Quadruple Aim.

Your analysis should address how EBP might (or might not) help reach the Quadruple Aim, including each of the four measures of:

• Patient experience
• Population health
• Costs
• Work life of healthcare providers

 Follow instructions carefully: I live in Homestead, Florida. county Miami Dade. Sample letter is being attached. grading eval is being attached. Thank you. 

Identify which two senators represent your state(FLORIDA) and who the congressional representative is for the district you live in. Of these three, who do you feel would be most sympathetic to your health policy issue?

Health Policy issue: Prescription drug Abuse

Write a 570-word petition letter to your senator or congressional representative regarding a health policy bill you would like to propose to address your selected health policy issue.

Include the following in your letter:

Identify who you are and who you represent.

Clearly define the issue that needs to be addressed, providing evidence that establishes the sense of urgency to take action.

Layout your proposal for legislation that will address the issue.

Provide at least two strong arguments that could persuade your senator or representative to support and hopefully introduce your proposal as a bill into the legislative process.

Utilize the articles you selected in prior weeks to support your proposal. 

Research at least one opposing argument by locating academic articles using the University Library and provide a detailed response to your opposition’s argument.

If there is currently any active legislation that would negatively affect your selected issue, identify the legislation and explain why your senator or representative should vote against its passage. 

Close out your letter by addressing how your proposed legislation may influence outcomes.

Utilize Box 44-2: Sample Letter/E-Mail to a Policymaker located on p. 396 in Ch. 44 of Policy & Politics as a guide.

Cite and reference using APA guidelines.