Will someone help me reply to this interview? The reply is just a review of thes

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Will someone help me reply to this interview? The reply is just a review of these interview questions and answers what looks good and what other things they could have talked about. thank you

What EBP changes have you been involved in implementing?

As a Patient Navigator, she noticed an increase in spine patients being readmitted for surgical site infections (SSI) (S. Johnson, personal communication, March 21, 2018). From her work in the operating room, she was familiar with the pre-operative procedures for preparing the patients skin, specifically the use of chlorhexidine gluconate (CHG). While following spine patients readmitted for SSI, results indicated they were staphylococcus type infections. Johnson wanted to see what intervention(s) could be done preoperatively to decrease the number of SSI occurrences. A surgeon mentioned a technique he learned about at a conference called Nose to ToesTM, where the nares, oral mucosa, and skin were all cleansed with antiseptic solution before surgery. Johnson conducted her own evidence-based practice research and learned that the oral prep showed an increase in aspiration occurrences, but the nasal swabs, using povidone-iodine, and CHG skin prep were both successful. Johnson purposed the following interventions to be used to reduce the number of SSI on elective spine surgery patients: nasal swabbing with povidone-iodine and full skin cleansing with CHG wipes, not just the surgical site. Additionally, Johnson learned that SNGH ortho and joint surgical patients were already receiving an at home CHG prep kit to be used the night before and morning of their procedure. Johnson created and implemented a preoperative patient education class for spine patients which reviewed general education about surgery, pre- and post-operative instructions, information about their hospital stay, and each patient received their own at home CHG prep kit with instructions.

How did you get administrative support or approval when it came to EBP changes?

Johnson created a business plan and had to prepare for a Test of Change because the Nose to ToesTM povidone-iodine nasal swab was not a product Sentara used or carried. She had to present her plan to Administration and Materials Management. Utilizing a power point presentation, she shared the research and supporting evidence justifying the need for a change, the cost information for purchasing and implementing the new product, how she would use the product in her study. Their approval allowed the product in the hospital for testing and Johnson trialed the product for one year.

A major component of her presentation was the organizations return on investment when compared with the cost of treating SSI, especially when the infection was methicillin resistant staphylococcus aureus (MRSA). Johnson’s research indicated the hospitals cost for treating MRSA related SSI exceed $80,000 per patient; and the year prior to implementation, there were 16 infections reported.

What are some barriers you've come across while trying to implement a EBP change and how did you overcome these barriers?

Johnson shared there was an initial barrier of compliance from the nurses and staff, but that it may have been unintentional. The nasal swabs were not initially packaged together with the CHG wipes so when staff went to gather supplies, the nasal swabs were missed. Johnson said they have now since changed this and the nasal swabs come prepackaged with the CHG wipes and increased compliance. Another barrier Johnson shared was that this new protocol was only being utilized on the surgical spine patients, but the preoperative nursing staff care for all surgical patients. It was difficult to remember to use this specific procedure on only a small number of patients for the day.

Did you have an EBP mentor?

               In the beginning, “yes, however my supervisor [program director of the back and spine program] left her position shortly after I initiated this” (S. Johnson, personal communication, March 21, 2018). Johnson said as the project progressed, she received guidance and support from a hospital staff member working in Infection Control, and she became more her mentor.

How many patients are usually included in a pilot test?

               Johnson shared, “There were 951 surgeries completed from March 28, 2016 to March 27, 2017, compared to 644 from [previous] year” (S. Johnson, personal communication, March 21, 2018). Only elective spine procedures were included in the pilot.

When EBP changes were made, how did you measure the outcomes?

Johnson tracked patient data using an excel spreadsheet and information recorded in the patient’s EPIC chart. She compared SSI results and tracked patients readmitted for post-operative SSI, including the exact type of bacteria causing the infection (staph or non-staph). Results showed significant decrease in infections, despite a significant increase in number of surgeries during the pilot year when compared to previous year.

How are new EBP changes communicated to the nurses?

Johnson conducted training with the nursing staff and provided verbal and written instructions. When actual implementation began, Johnson and a representative from the product manufacturer were present daily for the first few weeks to provide on site guidance and instruction. Now new staff nurses are oriented to the procedure as part of their regular orientation.

How did you ensure these changes were being followed?

              Johnson worked to have a space added to the nursing flowsheet to indicate all components, at home shower prep, nasal swabbing, and CHG wipes were provided prior to surgery. She tracks and follows up on compliance issues for all spine patients, including being alerted to any past patients entering a Sentara facility for care. Johnson noted compliance becomes an occasional problem and she will “send the nurse manager an email asking for staff to be reminded” of the procedure (S. Johnson, personal communication, March 28, 2018). The nasal swabs are now approved for use in the Sentara Health System and are utilized for all elective spine surgeries as well as general surgery patients at Norfolk General, Leigh, and Virginia Beach General. Johnson is now working to make this a standing physician order set for all patients prior to surgery.

Are patient ideas and concerns considered when it comes to EBP implementation?

Johnson did seek feedback from patients and she shared some reported minor discomfort and burning from the povidone-iodine nasal swabs. She shared that her instructional material needed to be adjusted because one patient swabbed the outside of their nose instead of in the nares. With the CHG shower at home, Johnson reported patient compliance was an issue, as they reported not wanting to wake up so early to shower on the morning of their procedure. Johnson said she included the nasal swabbing information in the preoperative class as well, and has begun stressing the importance of the CHG shower and its evidence for decreasing infections.

Do you feel Sentara encourages and fosters an EBP environment? Meaning, will nurses feel comfortable starting an EBP change that they see could benefit their unit?

Johnson said she does feel Sentara encourages evidence-based practice and promotes changes based on this information, but did stress that there will “obviously always be those resistance to change” (S. Johnson, personal communication, March 21, 2018). She said it’s important to do your homework and of course, justify any costs for the pilot or implementation.

Explanation / Answer

The interview is quite interesting. The interview is mainly related to the topic of EBP changes. When talking about the prevention of surgical site infection they do not mention about the antibiotic prophylaxis. Antibiotic prophylaxis is necessary before surgical incision. Glycemic control of patient and aseptic techniques during the procedure is also necessary for the prevention of SSI. Health education of patient about the proper use of CHG kit should be demonstrated.

The use of nasal swab should be included in the preoperative checklist of the surgical spine patients. So less chance of missing the new protocol. Instead of EBP mentor, the organization can utilize the Infection Control Nurse who looks after the infection control measures and can easily approach the staff members. Also, Infection Control Nurse can take responsibility for educating the patient about prevention of infection and follow-up of the patient after discharge through phones and e-mails.

EBP changes implement into practice by ongoing education and training program to all staff members periodically. The nurse manager can also visit all the surgical patient prior to surgery to make sure of home shower bath with CHG kit and use of povidone-iodine nasal swab. The patient should give proper instruction sheet of the importance of the nasal swab and the correct way of application through pictures.

The success of pilot study should be discussed with the nurses and make them realize their contribution to the success. Encourage them to participate in the future EBP changes of Sentara and its success. Sentara should focus on employee growth.

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