Table of ContentsDescription of the ProblemLiterature ReviewStakeholder Assessment and Communications PlanDescription of the Plan Commentary MEGAN by Meredith Ferfolia:a. Discuss the change strategies to use and the variable(s) to measure (process, outcome, balancing). Description of Evaluation Plan Conclusion References Children's National Medical Center (CNMC) is located in the northwest quadrant of Washington, DC; it was established in 1870 and remains the region's only free-standing pediatric teaching hospital serving patients primarily ages 0 to 21 ("At a Glance," 2017). Hospital admissions last an average of 6 days and total approximately 15,700 per year (“At a Glance,” 2017). CNMC is ranked fifth nationally by U.S. News & World Report on the 2018-2019 U.S. News Best Children's Hospitals Honor Roll and is ranked first in neonatology nationally. Children's National Medical Center serves elementary school children, as well as adults with congenital conditions. Much attention is paid to family- and patient-centered care, so caregivers are highly involved in all aspects of their children's care and advocacy, even in the sickest states. Children's provides acute and intensive inpatient care as well as primary, emergency and specialty outpatient care on the hospital's main campus; there are also primary and specialty care services throughout the Washington, DC area. Say no to plagiarism. Get a Custom Essay on “Why Violent Video Games Should Not Be Banned”?Get the original essayDescription of the problemSIDS is the sudden, unexpected death of a child under one year of age whose cause of death cannot be determined. be identified after investigation. (Centers for Disease Control and Prevention, 2018); According to a 2016 report from the American Academy of Pediatrics, approximately 3,500 infants die from sudden infant death syndrome each year in the United States. Of these, approximately 900 are preventable and are potentially due to preventable accidents such as strangulation or suffocation in a bed or crib (Centers for Disease Control and Prevention, 2018). Although the causes of infant deaths are unknown, many can be attributed to unsafe sleep environments. In 1994, the American Academy of Pediatrics (AAP) launched the “Back to Sleep Campaign”; after the launch of this campaign, the national SIDS rate decreased by 50 percent (American Academy of Pediatrics, 2016). The current safe sleep recommendations from the American Academy of Pediatrics are identified as the “ABCs” of safe sleep (2016). The “A” stands for “alone” – in an empty crib, and involves avoiding blankets, pillows, stuffed animals, and any crib bumpers (American Academy of Pediatrics, 2016). The “B,” “back,” instructs caregivers to place infants on their backs to sleep on a flat surface; however, if the baby is able to roll over on his own and does so after being placed on his back, it is safe and acceptable to leave him in a non-supine sleeping position (American Academy of Pediatrics, 2016). Finally, the “C,” “cradle,” encourages parents to place their child in a crib to sleep, not in the parent’s bed or other unsafe sleep environment (American Academy of Pediatrics, 2016). Other recommendations include that the infant share a room with parents for the first 6 months of life and avoid exposure of the infant to smoke and drugs (American Academy of Pediatrics, 2016). Unfortunately, 22% of parents do not placedo not place their baby on their back to sleep, 61% of parents report sharing their bed and 39% use soft bedding (Centers for Disease Control and Prevention, 2018). There is a higher incidence of sleep-related infant deaths among American Indian, Alaska Native, and African American populations (Centers for Disease Control and Prevention, 2018). Health care providers are often found to be role models for safe sleep practices. infants, and educate parents. In the hospital setting, members of the health care team have a special opportunity to promote safe habits, including safe sleep. A 2002 study by Colson and Joslin found that parents who saw health care providers put their babies on their backs to sleep were twice as likely to do the same at home; however, approximately half of healthcare providers have failed to model safe sleep practices in the hospital setting. Several barriers related to staff's lack of adherence to safe sleep guidelines can include concerns about reflux, attempts to improve the patient's respiratory status, and not having access to resources such as sleeping bags or swaddling devices available, as determined by Ohio Education and Safe Sleep Environment (EASE) Project Researchers Macklin, Gittelman, Denny, Southworth, and Arnold (2016). Despite any perceived or real barriers, care team members have a responsibility to model safe sleep practices to help caregivers promote positive outcomes for infants at home, especially as many of these hospital barriers are resolved in pediatric patients before hospital discharge. At Children's National Medical Center, a safe sleep policy was instituted in 2008 and last revised in 2017; This policy reflects AAP recommendations and highlights the need for nurses to adhere to and model caring behaviors that influence infant sleep safety in the home at all times. Following the policy change, training was provided to nurses via an emailed PowerPoint and unit audits have taken place monthly since then, without additional training, intervention or follow-up. Compliance with the policy has shown some improvement, although it is inconsistent and audit results vary widely from month to month, ranging from 46 to 81 percent compliance with an overall target of 100 percent compliance across all units ([National Children's Clinical Audits of Safe Sleep Practices], 2018). The audit forms list reasons why specific patient environments and sleep states were found to be inadequate, but do not specify how often each problem occurred or what corrective actions were taken. This proposed evidence-based practice project will be built to target not only compliance consistency, but also variance management to achieve and model best practice behaviors. The specific goal of this evidence-based practice project is to increase safe sleep compliance among hospitalized infants to 90% by June 2019, after 3 full months of project implementation at the Center national medical for children. Literature Review A safe sleep program was instituted at the Hospital of the University of Pennsylvania following the deaths of two former neonatal intensive care unit patients who had leftthe hospital; This evidence-based practice project was described in the 2016 article “An Evidence-Based Infant Safe Sleep Program to Reduction Sudden Unexplained Infant Deaths” by Zachritz, Fulmer, and Chaney and published in the American Journal of Nursing in 2016. Additionally, the authors provide significant statistics demonstrating that of all infants experiencing sudden death in Philadelphia, Pennsylvania between 2009 and 2010, 89% were in unsafe sleep environments that may have contributed to their deaths (2016). Prior to the program's implementation at the hospital, unit audit results were found to be inconsistent and did not demonstrate adherence to AAP guidelines. Additionally, parental teaching was lacking, and self-reported data revealed that parents often put their child at risk by "sleeping with their baby,...placing objects in infants' cribs, and...putting infants in the crib." bed ". sleeping on a non-flat surface” (Zachritz, Fulmer and Chaney, 2016). According to the evidence-based practice article, Fulmer and Chaney created a multidisciplinary team, including nurses, doctors, and occupational and respiratory therapists, who met over a one-year period. period of two years preceding implementation of the project. Using recommendations from the Institute for Healthcare Improvement on change projects, a safe sleep package was developed which included the purchase and use of sleeping bags for hospital sleep that parents could take home. discharge for home use, a new clinical guideline, standardized recommendations for parents and caregiver education, and prenatal community outreach (Zachritz, Fulmer, & Chaney, 2016). Infants were included in the practice change only if their medical needs did not outweigh the benefits of the guidelines in reducing the incidence of SIDS. Training was provided to all direct caregivers of patients as well as other unit support staff and assessed through audits on all infants, in addition to staff compliance with caregiver training . Implementation of the safe sleep program demonstrated a 70 percent increase in compliance with the hospital sleep environment; real-time education was provided when discrepancies were noted to improve future staff and caregiver compliance and better model appropriate behaviors (Zachritz, Fulmer, & Chaney, 2016). The overarching goal of the project was not only to comply with best practice standards, but to model healthy sleep behaviors outside of the hospital. The importance of a program that models appropriate behaviors for caregivers is truly immeasurable and standardization of best practices is important so that caregivers receive the same message from all healthcare providers. This project further embodies the fundamental bioethical principles of beneficence and non-maleficence; When these principles enable caregivers to act in the best interests of the vulnerable child, they enable the infant to develop and grow safely while minimizing the known controllable risks of SIDS. A quality improvement project to improve safe sleep practices, as described in the article "Integrating Safe Sleep Practices in a Pediatric Hospital: Results of a Quality Improvement Project" was initiated implemented in a large US children's hospital in Arkansas, where the infant mortality rate in 2010 was 133% higherto the national average (Rowe et al., 2016). This study aimed to discover if education and policy change would affect adherence to safe sleep practices (SSPs) in the 370-bed inpatient children's hospital. A group known as the Safe Sleep Task Force was created to study the current SSP in use at the hospital with the goal of increasing the percentage of infants in safe sleep environments recommended by the American Academy of Pediatric, and maintain these practices (Rowe et al., 2016).A literature review regarding PAS helped the Safe Sleep Working Group develop an education and implementation plan for the hospital. Baseline data were collected from various healthcare professionals to assess PAS-focused knowledge and beliefs and the sleep environments of all infants up to 12 months were audited weekly using an audit tool developed by the working group (Rowe, et al., 2016). ). 1,656 hospital staff completed safe sleep video modules and received information on new policy and documentation changes; Sleeping bags were also provided for use in the hospital to avoid the use of excessive blankets in the sleeping environment (Rowe, et al., 2016). The effectiveness of the interventions was measured through audits of the sleep environment and documentation, and compared to pre-intervention audits; hospital staff were also asked about their knowledge and perceptions of PAS. Evaluation of sleep environments showed a 13 percent increase in PAS adherence with an overall increase in knowledge and beliefs surrounding PAS, and a decrease in barriers (Rowe, et al., 2016). All inpatient hospital settings should make it a priority to increase interventions on safe sleep practices and adherence to American Academy of Pediatrics recommendations. Caregivers of infants younger than 1 year of age, unless medically excluded, should follow AAP guidelines to reduce the risk and incidence of sudden death related to preventable causes. Medical and hospital staff modeling safe sleep behaviors in the hospital would create a higher likelihood that parents and caregivers will maintain these behaviors at home. With infant mortality much higher in the United States than in other developed countries, it is important to identify and intervene on preventable risks, particularly in hospital settings where caregivers have the opportunity to observe behavior experienced staff who are seen as experts acting in the best interests of the infant (Rowe, et al., 2016). Stakeholder Assessment and Communications Plan Because the current policy in effect at Children's National Medical Center was designed solely by the Neonatal Intensive Care Unit, it does not currently reflect attributes of care and practices at the core of each unit, therefore, the key stakeholders in this multidisciplinary evidence-based practice change team should be representative of all hospital specialties and units. Unit nursing managers and leaders of other disciplines listed previously will be asked to identify individuals who will serve as members of this practice change team to ensure that the team is complete and representative and that the chairs of the Committees will be elected at the initial meeting. Key disciplines that play an important role in implementing safe sleepamong hospitalized infants and who are stakeholders in this change project include nurses, nursing support staff, respiratory therapists, occupational therapists and physiotherapists, advanced practice registered nurses, physicians, nursing managers and directors , suppliers. chain representatives, linen services and, last but not least, parents and caregivers. Nurses, nursing support staff, and respiratory therapists play a critical role in implementing and modeling protocol elements because they spend a significant amount of time in direct patient care. Nurses, respiratory and occupational therapists and physical therapists also share a great responsibility in educating parents and dispelling myths about safe sleep, such as baby's position during sleep and objects allowed in the sleeping area . Advanced practice nurses and physicians should reinforce safe sleep behaviors during meetings with parents and caregivers and also correct discrepancies through real-time education. Nursing managers and directors should work with the multidisciplinary team including supply chain representatives and linen services to ensure sleeping bags are available for staff to support safe sleep recommendations. a cost-conscious way. After the initial meeting, other staff members and potentially a parent or guardian representative may be recommended for inclusion in the project at the discretion of the team to promote the most comprehensive intervention possible. Bi-weekly meetings will begin in January and February 2019 until the practical change project is rolled out on March 1. Initial meetings will evaluate current policies and procedures regarding safe sleep against current best practices as published in peer-reviewed journals and by influential organizations, such as the American Academy of Pediatrics (AAP) and the Association National Pediatric Nurse Practitioner (NAPNAP). In mid-February, stakeholders will complete an initial staff knowledge baseline survey which will be reviewed after the practice change is implemented. Stakeholders will also educate staff on best practices through internal services using PowerPoint slides and simulations. Between March 1 and May 30, stakeholder meetings will be held monthly, although unit representatives will conduct weekly bedside audits and completed tools will be sent to committee chairs for analysis and intervention if necessary. Real-time training will be provided to staff when deficits are noted, and audits will be assessed to check overall compliance and areas of weakness of the hospital unit. Stakeholders will also create signs to display on the unit and at the bedside to remind staff, parents and other caregivers of safe sleep practices. Parents will also receive stakeholder-created materials at admission and discharge, in addition to individual discharge education provided by the discharge nurse. The full stakeholder group will meet again in June to determine whether the practice change should be incorporated into a nursing practice guideline and additional staff training needs will be determined using the results of the 'audit. Description of plan MEGAN Comment fromMeredith Ferfolia:a. Discuss the change strategies to use and the variable(s) to measure (process, outcome, balancing). The goal of our quality improvement project is to improve compliance with the safe sleep protocol among hospitalized infants; We will use the PDSA cycle, or Plan Do Study Act, to formulate our plan. After the creation of the Safe Sleep Team and initial planning meetings, as described previously, planning for the audit and education process will begin to complete the “Do” portion of the model. The basis of our training and audit will be centered on the American Academy of Pediatric's current recommendations for safe sleep. The Safe Sleep Environment Audit Tool will be a concise eight-question survey focused on: keeping the head of the bed flat with the baby supine, in the crib on a firm surface with only a fitted sheet , in a sleeping bag, with the hat removed. , and without excess materials or medical devices. The exact elements of the audit will be decided and approved by safe sleep stakeholders. A baseline practices audit will be conducted to assess how many infants are following safe sleep guidelines before interventions occur; Infants who will be excluded from the audit include patients who are intubated, have central lines or other equipment requiring device protection, or are unable to follow the entire protocol for non-healthcare reasons. specified elsewhere. During the planning phase, a survey will also be conducted to assess staff and parent knowledge and barriers to implementing safe sleep. The staff knowledge and beliefs survey will cover topics such as: awareness of AAP recommendations, frequency with which recommendations are actually followed, knowledge of existing policy, barriers to implementation work of practice and beliefs regarding the relationship between unsafe infant sleep and SIDS. The survey given to parents will ask them if they are aware of current recommendations, details about current infant sleep practices at home, and obstacles encountered when trying to sleep safely. Training of staff members will take place following initial environmental audits and knowledge surveys. and will include a safe sleep PowerPoint presentation with a clinical educator and a simulation session. The simulation will involve staff evaluating an infant-sized doll that has been placed in a crib with the goal of finding any objects that do not belong in the crib, resolving dressing issues and positioning, as well as other environmental issues. The hospital will post easy-to-read leaflets at the bedside that include visual and written references to safe sleep guidelines. Additionally, an educational video from the hospital television network will be automatically broadcast to all parents of children under one year of age upon admission to the hospital; Additionally, staff members will demonstrate safe sleep interventions to parents and caregivers. It is important that multidisciplinary healthcare providers consistently model and encourage PAS and that safe sleep behaviors are also reinforced by the provider during medical team visits. Finally, upon discharge, health workers should again reinforce education about safe sleep and the importance of continuingthis behavior at home. After adequate staff training, interventions will be studied to examine their effectiveness, compared to the “study” part of the PDSA cycle; this should take place three months after the project launch. Safe sleep audits will be carried out again, with a target of 20 audits per week per unit to measure whether the interventions have been effective. During these audits by the Safe Sleep Team, real-time education should take place by reviewing any discrepancies with healthcare members, parents and caregivers. This real-time education should further include investigation of the barriers that prevent safe sleep practice, as it is imperative that once education is provided to staff, audits and follow-up training not only improve practical, but also provide insight into weak points. and enable improvement of practices if necessary. Areas of weakness and continuing education needs of staff should be formulated. Clinical practice guidelines should be further developed and modified based on barriers and discrepancies noted post-intervention, thereby completing the “Act” portion of the PDSA cycle. Description of the evaluation plan The main outcome indicator for this project will be the overall compliance percentage. . Initially, 90 percent compliance will be targeted as an internal benchmark, as several months have demonstrated compliance close to this value. Although there is currently a frequent and significant deviation between the monthly average and this objective, this objective appears to be achievable, but requires consistency in its achievement. It would be best to demonstrate this evidence-based practice project on a progress chart to adequately assess adherence to practice guidelines and determine the impact of subsequent interventions on adherence. The data would be displayed on the progress chart with time plotted at monthly intervals and the measurement figure as overall compliance with all aspects of the set. Operational diagrams will be completed for each unit as well as one compiled for the hospital as a whole. A bar chart will also be used to evaluate the various other data points obtained before and after the intervention, including overall compliance, variances found, staffing. knowledge of guidelines, parent knowledge of guidelines, incidence of cited barriers to staff implementation of guidelines, incidence of cited barriers to parent implementation of guidelines, and documentation of compliance of guideline 'together. An example of this table is presented in the appendix. Keep in mind: this is just a sample. Get a personalized article from our expert writers now. Get a Custom Essay Conclusion We hope that our change project will be implemented at Children's National Medical Center in hopes of encouraging parents to continue practicing safe sleep practices in their home environment. We recognize that the hospital is a controlled environment and that, through close attention of staff and electronic monitoring, sudden events in infants are often identified and treated; we therefore hope that caregivers will use the modeled behaviors as best practices for the home where infants may be left alone for a period of time while sleeping. Furthermore, project implementation should not take place over a given period of time, but rather on a continuum and should be continually evaluated and2