The paper at hand is going to dwell upon air traffic in operating rooms. Owing to the fact that the majority of OR in American hospitals have specially designed systems supporting the atmospheric pressure a little higher than outside, the air flows out of the room but does not get in, thereby preventing infections (Mears, Blanding, & Belkoff, 2015). However, the system becomes ineffective if doors open too often, which poses patients at risk. Thus, the practice problem that is to be addressed is how to reduce air exchanges in the operating room. For this purpose, different modes of door usage will be compared.
Change Model Overview
In order to address the problem, it is necessary to select a framework that would systematize theoretical data and help integrate new information into the bulk of the existing knowledge. The ACE Star Model of Evidence-Based Practice will help to achieve these goals as it allows performing successful translation of knowledge into practice emphasizing barriers that might be encountered in the process. Although methods and processes in the model may vary, five stages that it comprises always include: 1) discovery research; 2) evidence summary; 3) translation to guidelines; 4) integration into practice; 5) evaluation of the process and the outcome (Schaffer, Sandau, & Diedrick, 2013). The model is especially valuable for nursing as it not only teaches how to transform one form of theoretical knowledge into another but also gives nurses clear guidelines on how to apply theory incorporating it with patients’ preferences to achieve EBP.
Define the Scope of the EBP
The practical issue the research addresses is to reduce the foot traffic through a sterile operating room (OR) to minimize the risk of infection and shorten the time of returning positive pressure to the OR. The practice will compare the time of returning positive pressure in the OR on two modes. The first mode presupposes the doors propped open, and in the other one, the doors are used intermittently.
The problem affects not only the selected facility but also the whole health care system as patients are at risk to get surgical site infections (SSIs) that increase morbidity and mortality, prolong hospitalization (by the app. 8 days), and lead to additional $1 billion expenses per year (Esser, Shrinski, Cady, & Belew, 2016).
The stakeholders include:
- charge nurses;
- circulating nurses.
Determine Responsibility of Team Members
Each member will perform a significant role in the project. Patients will provide information on their condition when different modes are implemented; the administration will regulate the process; surgeons are going to use their authority to influence staff behavior; anesthesiologists and charge nurses are to ensure the reduction of the traffic; whereas circulating nurses will provide ideas to improve the process.
The major strength of the research is its evidence-based approach and outcome-orientation. In addition to the search of scientific works required to estimate the state of the problem, expert opinion on the application of those researches’ results will also be considered. Standards that regulate the OR positive air pressure rates are be studied to compare the practice results with the basic data.
Summarize the Evidence
The study of the evidence revealed that the level of contamination in OR is lower due to laminar airflow that provides positive air pressure and decreases contamination (Smith et al., 2013). This allows concluding that there is a direct connection between the time of air pressure return and the patient’s outcome. These findings will be implemented in the project to devise ways of shortening the time of returning positive pressure.
Develop Recommendations for Change Based on Evidence
In order to change traffic behaviors, it can be recommended to the leaders to launch educational campaigns and provide continuous monitoring of OP. Moreover, it may be useful to place warning signs on the doors and send memos to everyone who can enter OP. The traffic can also be reduced if current pick-lists are updated to free clinicians of the necessity to go in and out for supplies.
It is difficult to identify exactly how long implementation of the project will take, but the first visible results are supposed to be obtained in 3 months. The action plan will include the following steps:
- monitor OP on two modes;
- compare the results;
- devise ways to reduce traffic;
- introduce interventions;
- disseminate findings;
- launch an awareness campaign.
The results will be reported in the written form to the hospital administration.
Process, Outcomes Evaluation, and Reporting
The desired outcome is the reduction of infection occurrence through shortening the time of returning positive pressure to the OP. The outcome will be measured by comparing recovery periods and reported to the stakeholders in the written form and at an open conference.
Identify Next Steps
It is highly important to introduce the same interventions to other units that have sterile rooms. The implementation may become permanent if there appear approved regulating standards.
Findings will be disseminated at an open conference for the hospital staff. For outer dissemination, the results will be posted on the Internet medical sites.
The research discussed above deals with safety and risk management in operating rooms (OR) designed and equipped to provide maximum safety for the patient and favorable working conditions for surgeons. Comparative analysis of the two modes will help find out what changes are to be introduced to reduce infection incidence. The ACE Star change model EBP will help implement the change plan by organizing the evidence into a coherent sequence applicable to practice.
Esser, J., Shrinski, K., Cady, R., & Belew, J. (2016). Reducing OR traffic using education, policy development, and communication technology. AORN Journal, 103(1), 82-88.
Mears, S. C., Blanding, R., & Belkoff, S. M. (2015). Door opening affects operating room pressure during joint arthroplasty. Orthopedics, 38(11), e991-e994.
Schaffer, M. A., Sandau, K. E., & Diedrick, L. (2013). Evidence‐based practice models for organizational change: Overview and practical applications. Journal of Advanced Nursing, 69(5), 1197-1209.
Smith, E.B., Raphael, I.J., Maltenfort, M.J., Honsawek, S., Dolan, K., & Younkins, E.A. (2013). The effect of laminar air flow and door openings on operating room contamination. The Journal of Arthroplasty 28, 1482–1485.