Organizational Plan Part I

Topics: Antiseptic, Intensive care medicine, Bacteremia Pages: 6 (1623 words) Published: September 3, 2013
Organizational Change Plan Part I
Creating Change Within Organizations/ HCS/587
August 26, 2013

Introduction
The proposed organizational change is designed for Cincinnati Children’s Hospital Medical Center (CCHMC) in Cincinnati, Ohio. CCHMC’s vision statement states that it “will be a leader in improving child health (Cincinnati Children’s, 2013).” Therefore, to provide and advance excellence of care, it is necessary to improve constantly. The Centers for Medicaid and Medicare Services (CMS) passed regulations commencing on October 1, 2008 that denies reimbursement for selected conditions occurring during the hospital stay and are not present on admission (Stone, Glied, McNair, Matthes, Cohen, Landers, & Larson, 2010). Catheter-associated blood stream infections are listed as one of three hospital acquired conditions covered by the new CMS policy. Health-care associated infections, which are common, expensive, and are often preventable causes of inpatient morbidity and mortality (Stone et al, 2010). After careful review of literature, Nursing Practice Council (NPC) would like to change from daily soap and water baths to 2% chlorhexidine gluconate baths in critical care areas.

Organizational Change Plan
Intravascular catheters are indispensable in critical care areas. They provide essential, stable, and large bore access to critically ill patients. Unfortunately, their use puts patients at risk for local and systemic infectious complications, including but not limited to local site infection, catheter-related bloodstream infections (CA-BSI), septic thrombophlebitis, endocarditis, and other metastatic infections (lung abscess, brain abscess, osteomyelitis, and endophthalmitis) (eResource: An Education Program Infection Control & Patient Safety, 2011). The cost of care for a patient with a CA-BSI is estimated to be between $34,508 and $56,000 (Rello & Sabanes, 2009); while annually the cost for all patients’ ranges from $296 million to $2.3 billion (Consunji, Dimick, Hendrix, & Lipsett, 2010).

After review of evidence-based research, CCHMC instituted a central line bundle three years ago. The key components of the bundle include: good hand hygiene, maximal barrier precautions upon insertion (use of sterile technique), chlorhexidine skin antisepsis, optimal catheter site selection (avoidance of femoral veins if at all possible), and daily review of the line necessity with prompt removal of unnecessary lines (Classen & Marchall, 2009). The total number of CA-BSI’s saw an initial drop by 40% with the roll out of the bundle but in the past year that number has seen a slow but steady increase.

CCHMC is now proposing a change in how critical care patients are bathed. Studies show that daily bathing with CHG decreases the incidence of CA-BSI’s among children in the ICU (Milestone et al., 2013). Through the hospital’s Nursing Professional Practice Council (NPPC), it is recommended that staff no longer use soap and water, but instead use CHG wipes. Their use could decrease CA-BSI’s by 50% (Cheng & Karki, 2012).

An individual’s awareness and knowledge of what needs to change and why, are vital steps in the change process. Evidence shows that healthcare professionals are often unaware of, and lack familiarity with, the latest evidence-based guidance (National Institute for Health and Clinical Excellence, 2007). Lack of motivation and practical barriers (lack of resources) on the individual level can be hard to overcome. Ineffective communication with employees is a barrier the organization could face (Rampur, 2010). Prior to applying the change, NPPC should state and provide in writing the specific goals this new proposed change in practice will achieve. The NPPC should also provide a succinct statement of vision and rationale for the projected change implementation, as well as a plan of action (Rampur, 2010).

No matter how well planned the change program is,...

References: Cincinnati Children’s Hospital Medical Center, (2013). Vision and Mission.
Retrieved from http://www.cincinnatichildrens.org/about/mission/
Cheng, A.C. & Karki, S. (August 2012). Impact of non-raised skin cleansing
with chlorhexidine gluconate on prevention of healthcare-associated
Classen, D. & Marschall, J. (2008). Strategies to prevent central-line
associated bloodstream infections in acute care hospitals
eResource: An Education Program on Infection Control and Patient Safety.
(2011)
Morrison, M. (2010). Kurt Lewin three step model and theory change. Retrieved
from http://repidbi.com/management/kurt-lewin-three-step-change-theory
National Institute for Health and Clinical Excellence. (2007). Retrieved from
http://www.nice.org.uk/media/af1/73/howtoguidechangepractice.pdf
Powers, J., Peed, J., Burns, L, & Ziemba-Davis, M. (2012). Chlorhexidine
bathing and microcial contamination in patients’ bath basins
catheter-related Infections in critically ill patients. American Journal
of Respiratory Critical Care, 162(3 Pt 1), 1027-1030
Spector, B. (2010). Implementing organizational change: Theory in practice
(2nd ed)
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