I work as a Registered nurse in the department of Endocrinology. Endocrinology is a broad term for the body’s hormone regulation system and the organs that produce the hormones needed to sustain life. The majority of our patients are patients with type 1 diabetes, thyroid nodules, and hyper/hypo thyroidism. When a patient comes to our office for a thyroid nodule we perform an ultrasound on the thyroid. If a significant size nodule is found a thyroid biopsy is done.
The nurse is responsible in preparing the patient for this biopsy which includes a passage of four needles into the thyroid using ultrasound guidance. Thyroid aspiration biopsies are performed on a daily basis. The guidelines for the perioperative procedure are as follows: THYROID ASPIRATION BIOPSY 1. Prepare patient with gown open to back 2. Remove all jewelry around neck 3. Place pillow on table for procedure mid back so neck is hyper-extended 4. Apply non-sterile gloves 5. Cleanse neck with Betadine (providone-iodine).
6. Rinse each syringe in cytolyte container 3 times.
Apply sample to slide per MD instructions. 7. Place slides in cardboard holders and specimen bag 8. Make sure lab slip accompanies slides, cytolyte container 9. Take sample to 2nd floor pathology department at the end of the day. 10. After patient’s neck is cleansed with alcohol, apply Band-Aid. Current evidence-based practice uses chlorhexidine in place of Betadine for antiseptic skin preparation when an invasive procedure is to be performed. I will show through evidence-based practices that this is a valid change to this procedure. A2a. BASIS FOR PRACTICE
The Term Paper on Thyroid Disorders Graves Disease
Summery According to the American Thyroid Association, millions of Americans (especially women) suffer from a thyroid disorder, and many of them dont even know it. In fact, thyroid disorders occur much more often than even many doctors realize. The butterfly-shaped thyroid is in the neck, its two wings wrapped around the windpipe just below the Adams apple. This vitally important gland normally ...
At Kaiser Permanente, procedures, protocols, and guidelines are researched, overseen, and implemented by the Nursing Education Department, the Risk Management Department, and the Patient Safety Department. Evidence-based practice was once in favor of cleansing the skin with Betadine as a skin antiseptic prior to an invasive procedure. According to the Center for Disease Control (2013),” Surgical site infections “(SSIs) remain a substantial cause of morbidity and has an associated mortality rate of 3% and 75% of the mortality rate has been directly related to a SSI.
Surgical site infections (SSI) costs are in the millions and reducing these risks are imperative. A2b. RATIONALE Betadine is a microbicidal and kills existing bacteria at the site. The use of Betadine to cleanse the neck area is practiced as a skin antiseptic for the destruction of microbes prior to an invasive procedure to reduce the incidence of post procedural infection. A2c. EXPLANATION Evidence based practice has proven that cleansing the area before an invasive procedure reduces the risk of infection.
Evidence-based practices have influenced and driven the practices of medical personnel and the corporations they work for. The Nursing Education Department at Kaiser Permanente appoints nursing staff to research the newest evidence based practices to develop new protocols and guidelines within the company. The nursing staffs in all departments are encouraged to bring current research and findings to the forefront to enhance their practices. Many agencies (state and federal) oversee and regulates policies set in place to ensure patient safety and quality of care.
The use of Betadine versus chlorhexidine with alcohol as a skin antiseptic preparation has been a popular subject of research in the medical field for over a century. A skin antiseptic is used to cleanse and prepare a specific area prior to an invasive procedure to decrease the risks of post procedural infections. Numerous research studies have shown that chlorhexidine with alcohol can decrease the risk of infection far more superior than with Betadine. “Some 16% of patients in the iodine group had SSIs, compared with 9. % of patients in the chlorhexidine group” (Darouiche, et al. , 2010).
The Review on Betadine And Alcohol Intravenous Preparations
Background It stands to reason that some type of preparation needs to occur before an IV needle is inserted into a vein. For one thing, even as sterile as the needle might be, this is still a foreign object being introduced into the body -- and as such, the body will likely bring its defenses to do everything it can to reject the foreign object. For another thing, the skin itself is a breeding ...
Evidence based practice shows that using chlorhexidine with alcohol opposed to Betadine is a more conducive way of preventing infection and decreasing a patient’s exposure to iodine. Several studies comparing chlorhexidine and Betadine concluded chlorhexidine with alcohol is superior in reducing the risks of infection. It is being proposed to change the use of Betadine as an antiseptic cleansing agent with chlorhexidine with alcohol.
According to Tanner (2009), the specifics of Chlorhexidine, alcohol, and providone iodine are as follows; “Chlorhexidine kills a range of Gram positive and Gram negative bacteria, viruses and fungi, and binds to the top layer of the skin, which results in persistent activity. Providone iodine also kills a range of Gram positive and Gram negative bacteria, viruses and fungi. The providone carrier releases its iodine slowly; the iodine kills bacteria quickly but does not have a residual effect. Iodine is inactivated by organic material so should be applied only to clean skin.
Alcohol kills a range of Gram positive and Gram negative bacteria and many viruses and fungi. It kills more quickly than chlorhexidine or Betadine, but has little residual effect. I propose 2% chlorhexidine and 70% isopropyl alcohol to be used”. There are several disadvantages in the use of Betadine: Betadine must be allowed to dry (up to 5 minutes) before introducing the needle for biopsy, Betadine must be removed following the procedure with alcohol or soap and water to reduce the risk of skin irritation or allergic reaction, and Betadine can be absorbed and expose the patient to unnecessary iodine.
According to the Toxicological Profile for Iodine (2004), “dermal exposure to providone-iodine has induced acute toxicity in humans”. The report goes on to say that it is possible that providone-iodine exposure can aggravate a pre-existing autoimmune disorder which would not be good for a thyroid nodule patient. The expected improved outcomes for using 2% chlorhexidine and 70% isopropyl alcohol versus Betadine are as follows: 1. Chlorhexidine does not require drying time, dries within seconds of application. 2. Chlorhexidine does not obscure the site; Betadine stains the skin a dark brown color. 3.
Dug and alcohol research paper
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Chlorhexidine is more effective in reducing post-operative infections per evidenced – based practices. 4. Chlorhexidine does not contain iodine which has the potential to cause skin irritation and exposure relating to adverse events (iodine is classified as a cytotoxic agent).
In one research study, meta-analysis report revealed that chlorhexidine antiseptic was associated with significantly fewer SSIs than was iodine antisepsis (Noorani, Rabey, Walsh, & Davies, 2010).
A6. STAKEHOLDERS ? -1 page There are an estimated 290,000 SSIs each year and approximately 8,000 result in death (Chauous, 2010).
Skin antisepsis for preoperative preparation has been an indispensable part of medical practice and patient safety. The interest in SSI and the role of skin antisepsis as a simple and effective way for preventing healthcare-acquired infections has been researched and published as evidenced based practice. We can further reduce the risk of infection in SSI by the use 2% chlorhexidine and 70% isopropyl alcohol of instead of Betadine. By reducing the risk of infection we will improve patient outcomes and lower medical costs.
The costs of SSIs are estimated at $2,734 – $26,019a year, that is an estimated National cost of $130 million to $845 million a year in the United States to treat SSIs, (Chauous, 2010).
Infection of a surgical wound can prolong hospitalization, increase the rate admissions, and significantly increase the cost of treatment (Swenson, et al. , 2009).
Trials have shown that 2% chlorhexidine and 70% isopropyl alcohol demonstrated better immediate and long-term residual antimicrobial activity than providone-iodine (Betadine) alone (Swenson, et al. , 2009).
Maki et. al. (1991), observed that cutaneous disinfection with chlorhexidine before insertion of an intravascular device and for post insertion site care can substantially reduce the incidence of device-related infection, compared with cutaneous disinfection with providone-iodine. In one study, a cost-benefit model baseline scenario was reported “that switching from iodine to chlorhexidine resulted in a net cost savings of $16-$26 per surgical case and $349,904-$568,594 per year for the Hospital of the University of Pennsylvania”, (Noorani, Rabey, Walsh, & Davies, 2010).
The Research paper on Fundamentals of Nursing Research: evaluation of the evidence for nursing practice
1.How do nurses and doctors interact in acute settings? In this study, I would like to use ethnography. When compared to other qualitative methods like ;phenomenology or grounded theory,ethnography is a systematic approach,which includes observing,detailing,describing,and analyzing the patterns of culture(Leininger,1985).The key feature of ethnography as a qualitative research methodology is that, ...
This change would involve the Nursing Education Department, the Risk Management Department, and the Patient Safety Department to back the change. To implement, the Nursing manager for the Endocrinology Department will have to provide teaching to the nursing staff to replace the old guidelines and protocols and giving the nursing staff time to adjust to the change and answer any questions that they may have prior to the change. The facility buyer would need to replace all Betadine applicators with 2% chlorhexidine and 70% isopropyl alcohol applicators.
The costs would need to be tallied into the cost savings along with the reports of SSI events. B1. TRANSLATION OF RESEARCH 1-2 pages The research included searches in the PubMed Agency, CINAHL, the Cochrane Library, and Medline, for eligible studies. Included in these studies were systematic reviews, meta-analyses, or randomized controlled trials (RCTs) comparing preoperative skin antisepsis with chlorhexidine with alcohol versus Betadine and assessing for the outcomes of surgical site infections (SSI).
To understand these research studies one would need to compare qualitative and quantitative studies and know the difference between the two and which one would stand as evidenced-based material. Critical appraisals of the resources and articles would need to be done to validate its material. The question of which type of resources may be used in the research; filtered, unfiltered, or just general information? Is the research primary, evidence summary, or evidence-based guideline?
Deciphering all the different types of resources and research data can be confusing especially to new nursing professionals but taking a course in evidence-based practices can give the nursing professional the knowledge to go forward. The question of where to find creditable resources is overwhelming and may require the assistance from a librarian to find reliable websites and resources. Are the research, the guidelines, and resources up-to-date? To research evidence-based practices one must look or the most current (within last five years) as the medical field is ever-changing. I found the hardest part in finding research in the area I was questioning. I found going to scholarly sources most helpful and talking with my Nursing Education Department. B2. BARRIERS Barriers to implementing the use of chlorhexidine opposed to Betadine will include asking nurses to accept the change in preparation, preparing the patient for the biopsy, and changing protocols through nursing education and risk management.
The Term Paper on The resource based view of the firm (RBV)
The resource based view of the firm (RBV) deals with the concept that by understanding the internal resource base and core competences, the management of a business will be able to employ this specific knowledge to create and sustain a competitive advantage. The RBV promotes the idea of firm heterogeneity and the notion that the conscious and tacit development of idiosyncratic bundles of resources ...
Patient safety and reduced risks for infection within this institution will be ongoing and will be proven over time. B3. STRATEGIES An in-service for all medical personnel that will be affected by the change will take place prior to implementation. To overcome the barriers we will replace Betadine with chlorhexidine with alcohol swabs in the procedure room and rewrite the procedure guidelines and place in the Departmental Master Protocol binder. Supplies of chlorhexidine will be maintained by the facility buyer and stocked accordingly. B4. APPLICATION OF FINDINGS
By removing Betadine from the procedure room and replacing it with chlorhexidine will improve a patient’s outcome by reducing the chance for infection and decreasing the patient’s exposure to iodine. Educating the nursing staff of the newest or most current evidence-based practice will validate the reason for the change. Documentation will need to be implemented to track the events of SSIs to help validate the evidence-based practice guidelines
