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The end-tidal capnography is used to monitor the amount of carbon dioxide (CO2) (Kerslake & Kelly, 2016). No use of capnography can result in adverse situations or severe damage, even death. To ensure that patients life is not at risk, medical personnel need to use capnography more often. The equipment should always be available, the staff needs to know how to use it, and the providers need to be persuaded that capnography is crucial for the safety of patients.
Change Model Overview
The ACE Star model Evidence-Based Practice Process is a strategy that allows medical professionals transfer knowledge and evidence into nursing to improve the quality of the services (Schaffer, Sandau, & Diedrick, 2013). The model suggests discovering knowledge, summarizing the evidence, translating this evidence into practice, integrating the change, and evaluating the change after integration (Schaffer et al., 2013). The model can be used by nurses to identify relevant issues and translate the evidence into practice. The contribution of nursing strategies and interventions based on this model will potentially improve the quality of services at medical facilities.
Define the Scope of the EBP
Not every medical facility provides obligatory end-tidal capnography for patients in the ICU on supplemental oxygen via nasal cannula. The question is the following: should medical personnel check end-tidal capnography or not if a nasal cannula is used? At least ten incidents related to the lacking check of data provided by end-tidal capnography were reported at the facility. According to the study used in the previous paper, failure to use capnography contributed to more than 70% if the ICU-related airway deaths (Kerslake & Kelly, 2016, p. 1). The failure to use capnography (which leads to fatal outcomes) results in additional costs both for hospital facilities and for insurance companies. Furthermore, it also leads to ineffective care and possible lawsuits.
Stakeholders
Various professionals can influence the use of capnography in the ICU settings. Registered nurses use capnography in critical care units. EMS personnel can also be engaged to point out the life-threatening conditions that can be caused by failure to use capnography. Anesthesiologists can be asked to provide information about the relation between capnography, anesthesia mishaps, and fatal outcomes. Supervisors (such as physicians, for example, if nurses collaborate with them and do not work autonomously) should also take part in the project. Providers will be engaged to receive information about the outcomes of the study.
Determine Responsibility of Team Members
The team members chosen for the project are important because they all have experience in working with (or without) capnography when patients are on supplemental oxygen via nasal cannula. The team members can provide information about the efficiency of capnography, possible adverse effects when capnography is not used in the ICU patients, and the relation between fatal outcomes and the use of capnography. Registered nurses can be determined as project leaders because the main aim of the project is to integrate the evidence into nursing practice.
Evidence
Summarize the Evidence
Langhan, Kurtz, Schaeffer, Asnes, and Riera (2014) point out that using capnography is efficient, especially in those patients who receive sedation. Capnography can detect respiratory depression earlier than other monitoring modalities (Langhan et al., 2014, p. 1038). Only 25% of ICUs in the UK use capnography to see whether the tube was placed correctly after patients intubation (Byhahn & Cavus, 2012). Internal research showed that ICUs rarely engage capnography, either because some see it as inefficient or because physicians/supervisors of the nurses prefer not to use it. All data gathered from this research is relevant and directly linked to the main objectives. There is good evidence that capnography needs to be used to avoid fatal outcomes; the results are consistent.
Develop Recommendations for Change Based on Evidence
The evidence-based interventions discovered in Evidence Summary are the following: data provided by end-tidal capnography needs to be checked regularly; patients life depends on the use of end-tidal capnography, which implies that both nurses and physicians should not avoid using it; instructions for medical staff on how to use end-tidal capnography are required. Moreover, the presence of required equipment for capnography (e.g. patient capnography monitors) makes regular use easier (Langhan et al., 2014). Those ICUs that were better equipped reported the more regular use of capnography (Langhan et al., 2014). When no capnography is used, the risk of adverse events, injuries, brain damage, or death increases (Byhahn & Cavus, 2012). Therefore, the equipment needs to be always available. Medical staff also needs to be trained to ensure that they can use it if necessary. Some providers require additional evidence to ensure that the use of capnography is justified (Langhan et al., 2014). If providers require evidence, medical facilities need to conduct researches to evaluate how capnography influences the efficiency of interventions and reduces the risk of adverse effects or fatal outcomes. The studies reviewed show that there are no conflicting results: use of capnography is capable of preventing deaths and serious damage.
Translation
Action Plan
The proposed changes are feasible. The team members will need to gather data about the issue, evaluate it, and develop specific guidelines that can be provided to other medical personnel. Furthermore, the team members will also need to evaluate whether the equipment is available. If not, hospital administration or those responsible for capnography equipment will need to be contacted. The authors of the project can engage patients to create two groups, which will agree or disagree on using capnography during their treatment. The efficiency of the intervention can be evaluated using these two groups. To implement the action plan, the team members will need to coordinate their actions with hospital administration and patients, as well as with other medical personnel who will be willing to participate in the study.
Process, Outcomes Evaluation and Reporting
The desired outcomes are proven efficiency of capnography and reduction of adverse events and fatal outcomes. The outcomes will be measured with statistical software for clinical interventions. The results will be reported via intervention reports.
Identify Next Steps
As the results of the study apply to the ICU only, there will be no need to engage other units that do not use capnography regularly. However, to ensure that the implementation is permanent, the team will conduct additional researches to provide information about the importance of using capnography.
Disseminate Findings
The studys findings will be published on the facilitys website and provided to personnel that work in the ICU. The results of the study will be sent to other local hospital facilities with a suggestion to implement a similar intervention. The results of other studies can be summoned in a larger report that can be published in a peer-reviewed journal and sent to state Departments of Health.
Conclusion
The failure to use capnography can result in adverse events, injuries, damages, and death. The use of capnography in ICUs can enhance patients safety and improve the quality of care. The issue was discovered from clinical practice; the reviewed quality evidence supported the authors assumption about the needed intervention. The evidence was translated into action plan where two groups would be examined to see whether capnography was efficient. After the change is integrated, the team members will gather data about the efficiency of intervention and share it on the internal and external levels. To maintain the plan, the team members will conduct additional evaluations regularly.
References
Byhahn, C., & Cavus, E. (2012). Airway management disasters in the ICU-lessons learned? Critical Care, 16(5), 162-163.
Kerslake, I., & Kelly, F. (2016). Uses of capnography in the critical care unit. BJA Education, 12(1), 1-16.
Langhan, M. L., Kurtz, J. C., Schaeffer, P., Asnes, A. G., & Riera, A. (2014). Experiences with capnography in acute care settings: A mixed-methods analysis of clinical staff. Journal of Critical Care, 29(6), 1035-1040.
Schaffer, M. A., Sandau, K. E., & Diedrick, L. (2013). Evidencebased practice models for organizational change: Overview and practical applications. Journal of Advanced Nursing, 69(5), 1197-1209.
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