EP7EO - Nurses systematically evaluate professional organizations' standards of practice, incorporating them into the organization's professional practice model and care delivery system.

Provide one example, with supporting evidence, of a change in clinical practice resulting from the application of professional organizations' standards of nursing practice. The example provided may be at the unit, division, or organizational level. Supporting evidence must be submitted in the form of a graph with a data table that clearly displays the data.

Background

Nurses at Thompson routinely scan the literature from their professional organizations and work to incorporate best practices into the workplace. This activity, supported by the Synergy Model of care, ensures that nurses are using clinical inquiry to evaluate and improve their practice.

In 2012, the infection control nurses and the nurses from perioperative services came together to review current practice surrounding surgical site infections. Using best practice guidelines for reduction of surgical site infections they reviewed and revised the skin preparation guidelines within the hospital and reinforced surgical attire best practices (see Exhibits EP7EO.1-EP7EO.3).

The Association of Perioperative Registered Nurses (AORN) best practice guidelines for reduction of surgical site infection (SSI) include: 

• Appropriate clothing (particularly hair coverage) 
• Skin preparation 
• Maintenance of the surgical sterile field 
• Reduction in interruptions in the rooms

Exhibit EP7EO.2  AORN_Evidence for Using CHG

Exhibit EP7EO.3 Preoperative Chlorhexidine Baths Showers For or Against

Goal
Reduce Surgical Site infection rates by 30% 
  
Intervention

• Reviewed current practices 
• Reviewed AORN and Association for Professionals in Infection Control and Epidemiology (APIC) guidelines 
• Re-education and monitoring of compliance with guidelines related to 
  • Attire to OR staff, Anesthesia and Surgeons. Read and Acknowledge Policy and Procedure 
  • Proper skin prep and hand hygiene for surgeons, OR and Surgical Care Center (SCC) associates. 
  • Patient education brochure developed and being distributed on or before admission. 
• Memo sent out to the Hospital Nursing in regards to CHG Baths. 
• CHG baths presented at an OR Committee Meeting. 
• Presented at a Department of Surgery meeting:       
  • “The Infection Control Committee has the Department of Medicine’s support to implement the protocol in the ICU. Although it is strongly encouraged for implementation on the floors for all surgical patients, it will be left to the discretion of the attending physician.” 
• Implementation of CHG Baths implemented on 13 May 2013 in response increases in SSI’s, Catheter Associated Urinary Tract Infections (CAUTI) on 3E, and Central Lined Associated Blood Stream infections (CLABSI) on 3W.
• Monitored results/ongoing surveillance of recommended practices

(see Exhibits EP7EO.4-EP7EO.9 for evidence of above action items).

Exhibit EP7EO.4 Memo to Anesthesia

Exhibit EP7EO.5 Memo to OR Staff 5-12

Exhibit EP7EO.6 Surgical Site Infection Brochure

Exhibit EP7EO.7 Surgery attire

Exhibit EP7EO.8 Chlorhexidine Memo

Exhibit EP7EO.9 SCIP 2014 Nursing Presentation

Participants
Gloria Karr, MS, RN-BC, CIC Director of Infection Control/Emergency Preparedness
Donna Fulmer, MS, RN, CPAN, NE-BC Director, Perioperative Services
Vickii Bement, BSN, RN, CNOR Clinical Nurse/Charge Nurse, Operating Room, Perioperative Services


Results/Data

Outcome:
The graph demonstrates that that the goal of a 30% reduction in SSI’s was exceeded shortly after implementation of the new process. The new process continues to be an integral part in improving patient safety as well as ongoing surveillance of recommended surgical aseptic practices.