Question

CASE: Evidence has shown that aseptic technique practices for central venous catheter (CVC) care, such as alcohol CVC hub decontamination before every hub access, can significantly reduce CVC-related bloodstream infections among oncology patients (Horvath et al., 2009; Secola et al., 2012). The American Society of Clinical Oncology has incorporated aseptic practices in a recently developed evidence-based guideline of CVC care for patients with cancer (Schiffer et al., 2013). You are a clinical educator on a 40-bed pediatric oncology inpatient unit within a tertiary hospital and wants to implement these aseptic technique practices for CVC care within the unit. The patient census on the pediatric oncology unit is almost always full, and the patient acuity has been high. You have been noting reluctance among staff nurses and hesitancy from administration to adopt the new practices. Questions: What initial steps can be implemented to change the opinions of the administration and staff nurses on the unit regarding the need for change? Now that buy-in has occurred, and administration/staff/etc. are on board, what steps can be performed prior to the actual implementation to help assure the change’s success? The change has been implemented. Describe activities/practices to ensure that the practice change is sustained?

Answer 1

What initial steps can be implemented to change the opinions of the administration and staff nurses on the unit regarding the need for change?

Using Kotter’s model of change

Increase urgency

Demonstrate the past history of difficulties because of CVC tainting e.g. expanded contamination rate, expanded hospitalization, expanded re affirmations and so forth

Demonstrate the chances – e.g. enhanced consumer loyalty , less disease, enhanced patient recuperation rates, diminished money related expenses and so forth

• Request the contribution and support of staff
• Framing Powerful Guiding Coalitions
• Select a group of senior medical attendants and staff and in addition specialists who can affect others
• Demand for their association
• Building up a Vision and a Strategy
• Build up a dream of what we mean to accomplish – indicate what is the eventual fate of this change
• Build up a technique to execute it well ordered e.g. ensuring disinfectant is accessible day by day before each center point get to, reminding and checking each medical attendant constantly
• Impart the Vision
• Impart the vision to medical caretakers in straightforward and compelling dialect so that everybody comprehends in uniform
• Investigate the worries of individuals

Now that buy-in has occurred, and administration/staff/etc. are on board, what steps can be performed prior to the actual implementation to help assure the change’s success?

• Ensure procedures and structures help in the change and are lined up with the vision.
• Pay special mind to medical caretakers opposing change
• Make prompt move to evacuate hindrances for change-both human and others
• Build up execution criteria and connection prizes to change. E.g. decreased disease rate in unit can be granted.

The change has been implemented. Describe activities/practices to ensure that the practice change is sustained?

Make Short-Term Wins

• Set up short terms targets and short terms wins. Reward the individuals who help in accomplishing the change.

Expand on the change

• Examine the examples of overcoming adversity. Check for what went right and what turned out badly. Enhance them

Set future targets

• Request thoughts and Seek for constant enhancement.

Join change into culture

• Take the change to whole center and examine about the examples of overcoming adversity of progress regularly e.g. utilize the sterilization as gathering of other customary secures
• Roll out the improvement a piece of day by day schedule E.g. utilize the sterilization as a component of conventions, keep up inside decorations and pics. of purification
• Perceive the medical attendants and specialists associated with change