Healthcare-associated infection is a major public health concern with a significant impact on healthcare costs, quality of life, morbidity, and mortality. Most healthcare-associated infections are preventable through effective infection and control measures (Storr et al., 2017). Infections are symptoms caused by the invasion and multiplication of microscopic organisms such as bacteria, viruses, fungi, or parasites (Ahmad et al., 2022). Cancer patients are at a higher risk of hospital-acquired infection as they are often immunosuppressed due to the underlying disease and treatment. The proposed change project will focus on infection prevention measures in an oncology unit. Evidence-based research will identify studies and guidelines supporting unique aspects of hand hygiene, catheter placement, and disinfection for infection prevention. This project will also involve educating and training patients and medical personnel on infection risk and appropriate prevention measures. There will be a routine audit to ensure compliance and use of a reporting system to monitor the incidence of infections. This paper is a plan for the planned change containing a change theory, ethical and legal considerations, cultural competency, change agent, organizational leadership, and stakeholders.
The proposed topic for a hypothetical quality improvement and safety EBP change project aims to prevent and reduce the risk of infection in cancer patients by enhancing safety protocols and infection control measures. According to an article published by the American Cancer Society (2020), cancer patients have an increased risk of infection due to changes in the immune system that control their body’s defense systems. Cancer treatment such as targeted therapy, chemotherapy, or radiation therapy weakens the body’s defense, making it more susceptible to infection. Thus, healthcare professionals and patients must take precautions to prevent these infections. Essential components of infection prevention that will be researched and implemented include hand hygiene, catheter placement, and disinfection. In most clinical situations, alcohol-based hand rub is the preferred method over water and soap, except in the case of exposure to C. difficile or norovirus or when hands are visibly soiled (CDC, 2017; Cure & Van, 2015). Evidence recommends avoidance of catheter use, especially when the patient is functionally or quantitatively neutropenic (Malek & Raad, 2020). In unavoidable circumstances, full barrier precautions and aseptic practices should be followed during placement. For further infection prevention, there should be thorough cleaning and disinfection of devices and environmental surfaces using a combination of traditional and modern technologies, such as no-touch room decontamination methods and self-disinfecting surfaces (Boyce, 2016). The planned change will research and implement infection prevention measures, including alcohol-based hand rubs, aseptic practices for catheter placement, and traditional and modern technologies for disinfection, such as no-touch room decontamination and self-disinfecting surfaces.
Kotter’s Theory of Change
Change is inevitable in the constantly evolving healthcare industry. Various theories have been developed to provide a framework for understanding how change occurs and how it can be effectively managed in a diverse organizational setting. One well-known and widely used model is Kotter’s theory of change, which outlines eight steps for successfully implementing change in an organization (Rajan & Ganesan, 2017). These steps include creating a sense of urgency, forming a powerful coalition of leaders, developing a vision and strategy, communicating the vision, removing obstacles, empowering, creating short-term wins, consolidating gains, and anchoring change in the organization’s culture (Lv & Zhang, 2017). In this quality improvement project aimed at preventing infection in cancer patients, Kotter’s change theory can be applied as illustrated:
|1. Creating a sense of urgency||– A sense of urgency can be created by highlighting the increased rate of infection in cancer patients as well as the risk factors.
-Emphasize the need for improved infection prevention measures in oncology/hematology unit for quality patient outcomes.
|2. Forming a powerful coalition of leaders||-key stakeholders include hospital leadership, chief nursing officer, ward head nurse, nurses, physicians, finance officer, and patients.
– This diverse and powerful coalition will help support and lead the proposed change.
|3. Developing a vision and a strategy||-Having identified the risk factors and high incidence of infection among cancer patients, it is important to develop vision.
-Reduce the incidence of infection by 30%.
-Ensure 100% compliance with infection prevention protocols.
· implementing alcohol-based hand rub
· use and aseptic practices for catheter
· traditional/modern disinfection technologies.
|4. communicating the vision||-Effectively communicate the vision and benefits of the change project to all stakeholders:
-improved patient outcomes, reduced healthcare costs, and increased patient satisfaction.
|5. Removing obstacles||-Ensure the vision is aligned with the overall organizational vision.
-Check people or barriers who are resisting change and create buy-ins.
-Provide necessary resources and support to implement change.
|6. Creating short-term wins||-celebrate the success of removing risk factors for infection in oncology unit.
-Celebrate a decrease in the incidence of infection.
|7. Consolidating gains||-analyze success in reducing the incidence of infection and improve from experience.|
|8. Anchoring change in the Organization’s culture||-make infection prevention an integral part of the organization’s culture.
-Regular training and educational programs to ensure proper implementation.
Ethics are a fundamental and integral aspect of clinical medicine, as healthcare professionals have a moral duty to prioritize the well-being of their patients, minimize harm, and respect the values and preferences of the individual (Varkey, 2020). Autonomy and beneficence are the two principles of ethics applicable in this quality improvement project aimed at preventing and reducing the risk of infection in cancer patients. Autonomy is the ethical principle that involves respecting the right of patients to make their own decisions about their healthcare. It is crucial to ensure that patients are fully informed about the risks and benefits of different infection prevention measures. In this way, patients can exercise self-determination and make decisions that align with their own values and preferences. The principle of beneficence requires healthcare professionals to act in the best interests of their patients and to take proactive steps to protect and promote their welfare (Varkey, 2020). This principle will be applied through implementing evidence-based practices and protocols to prevent infections in cancer patients as well as training and educating healthcare professionals to identify and prevent risk factors. The two principles will play a significant role in the quality improvement project, especially in guiding the efforts to act for the benefit of the patient at the same time, supporting informed consent.
Laws and regulations are important even in the process of observing ethical considerations. Healthcare professionals who fail to comply with laws and regulations risk losing their licenses or facing disciplinary action (Brenda & Mindy, 2018). There are several legal considerations to take into account when implementing this project. First, it is essential to ensure that the new protocols comply with all relevant laws and regulations, including those related to hand hygiene, catheter placement, and disinfection. Secondly, it is also important to consider the potential liability risks associated with the new protocols. This includes the risk of legal action if the protocols, such as the use of a catheter or disinfection, cause harm to patients or healthcare professionals. It is thus crucial to have appropriate policies and procedures in place to mitigate these risks and to provide training and resources to support the safe and effective implementation of the new protocols. Another important legal consideration is ensuring that the implemented protocols do not discriminate against any specific group of population to avoid problems with discrimination laws.
American Hospital Association (2013) defines cultural competency as the ability of healthcare providers to provide care to patients with diverse beliefs, values, and behaviors and customize this care to meet patients’ cultural, social, and linguistic needs. The first cultural consideration that is important to the proposed change project is cultural beliefs and practices that may affect infection control and prevention. For example, some cultures may have specific beliefs about the causes of illness or the role of the body in healing, which could influence their adherence to infection control protocols (Wilson & Seaton, 2016). It may be necessary to consider these cultural beliefs or provide additional education and resources to address any potential misunderstandings to ensure effective project implementation. The second cultural consideration is the role of the family in decision-making. In some cultures, the family plays a significant role in the healthcare of their loved ones and may be involved in making treatment decisions. It may be necessary to involve family members in decision-making and ensure they are aware of and understand the new protocols.
Leadership for Change Agent: Transformational leadership
Healthcare organizations often face changes that require flexible and adaptive leadership styles. As explained by Doody & Doody (2012), transformational leadership is characterized by the ability to adapt to changing circumstances, hence it is ideal for a rapidly changing healthcare environment. In transformational leadership, leaders inspire and motivate followers to achieve their goals and strive for personal growth. Transformational leaders focus on the needs of the individual and the team and work to create a shared vision and a sense of purpose (Doody & Doody, 2012). They also encourage open communication, innovation, and creativity and provide support and resources for their team members to develop their skills and achieve their full potential. This change project requires a transformational change agent to inspire and motivate others to adopt the new protocols. The change agent will be able to create a shared vision and a sense of purpose and communicate this to the stakeholders to inspire them to work toward the change. Using transformation leadership, the change agent will build a strong coalition, address resistance, and communicate the benefits of the change project to influence the stakeholders to work towards preventing infection in the oncology unit. It is also crucial for the change agent to have sound knowledge and skills in infection control and the best current evidence-based practices to effectively implement the project.
Organizational leadership has an important role in the successful implementation of this proposed change project. It is responsible for providing the necessary administrative support and resources for effective implementation. The key organizational leadership in this change project include the Chief Executive Officer (CEO), Chief Nursing Officer (CNO), and Chief Financial Officer (CFO) (University of Southern California, 2021). This project requires implementation of modern technologies such as no-touch room decontamination devices and self-disinfecting surfaces. Additionally, new protocols for hand hygiene and catheter use will be introduced. Since the CEO is responsible for making decisions on all aspects of operations, policy, and finances, their support is crucial for successful implementation. The CNO is responsible for overseeing the organization’s nursing practice and implementing policies and procedures to ensure that nursing care is of high quality (University of Southern California, 2021). The CNO focuses on nursing operations, protocols, quality, and delivery of patient care. CNO’s support is thus vital in ensuring the proposed protocols are implemented, and that nursing staff are trained on appropriate measures. The CFO, who heads the finance and accounting department, will also play an important role because he is responsible for providing financial leadership and support through fund allocation for resources and staff training.
There are several stakeholders who have a vested interest in the outcomes of this project proposal. These stakeholders include cancer patients and their families, physicians, nurses, and hospital leadership. Cancer patients and their families are key stakeholders, as the project’s success directly impacts them. They have a vested interest in ensuring that the change is successful because it will impact their health and well-being. Physicians and nurses working in the oncology unit have a vested interest in the project’s outcome because its success will help them deliver quality and safe patient care leading to improved care, which is a top priority for all healthcare professionals (World Health Organization, 2017). The hospital leadership, such as the CEO and management, have a vested interest in the project’s outcome because the success of the change project will positively impact the organizational reputation as quality of care. These stakeholders are vital because they directly impact the implementation and adoption of the proposed protocols and measures to prevent and control infection.
In conclusion, the proposed change project aims to reduce the risk of infection in cancer patients by implementing evidence-based infection prevention measures such as hand hygiene, catheter placement, and disinfection. Kotter’s theory of change will be used as a framework to guide the implementation of these measures. The project will apply several ethical and legal considerations, including autonomy, beneficence, legal compliance, and potential liability risks associated with the new protocols. Since the patient population is diverse, cultural considerations such as beliefs, practices, and family roles in decision-making may impact acceptance and adherence to the protocols. The change leadership style that will be used is transformational leadership, in which the change agent will inspire and motivate others to prevent and reduce the risk of infection in cancer patients. The organizational leadership, including the CEO, CNO, and CFO, will play important roles in ensuring the successful implementation and sustainability of the change project. Also, there are key stakeholders who have a vested interest in the outcomes of this change project, including the ward head nurse, nurses, physicians, and patients, and it is important to involve and consider their perspectives and needs throughout the process to avoid resistance and build a strong coalition towards making positive changes. Successful implementation of this quality improvement project will promote a culture of safety and lead to improved outcomes in the long term.
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