NURS 6052 Module 6 Week 10 Assignment, Evidence-Based Project, Part 4, Recommending an Evidence-Based Practice Change

Evidence Based Practice Change Evidence Based Practice Change Walden University NURS 6052: Essentials of Evidence-Based Practice Student Name Submission Date Health Care Organization Patient-centered culture Committed to safe and effective patient care based on the newest evidence based best practice Ready and Willing to implement change Welcome to employee suggestions through unit based councils Level 1 Trauma Center Spinal Immobilization Problem Spinal Immobilization has remained an integral part of most emergency medical services protocols despite the lack of evidence of efficacy and concern for associated complications (Velopulos et al., 2018). Circumstances numerous studies showing that secondary neurological damage resulted from edema and hypoxia exacerbated by the delays to care caused by the spinal immobilization (Velopulos et al., 2018). Stakeholders Patients, hospital, EMS, Firefighters, quality improvement specialist, emergency department staff Risks Associated with Change Adverse Reactions Litigation due to lack of understanding of the need for the change Selective Spinal Immobilization Protocol There is a need to end the use of spinal immobilization in penetrating trauma patients as there is studies that have shown that the use of spinal immobilization in penetrating trauma patients risks of local pressure injury, increased intracranial pressure, covering of penetrating wounds therefore missed injuries, delaying lifesaving procedures including endotracheal intubation. The use of the C-Spine rule was used and evaluated in Ontario, Canada had exceptional results with decrease in morbidity & mortality in penetrating trauma patients(Vaillancourt et al., 2011). Organizational Implementation Knowledge Transfer Paramedics & other emergency medical services team participate in a two hour web-based training sessions followed by practical demonstration of the selective spinal immobilization protocol with check off and yearly follow-up educations sessions with check offs Include risks vs benefits along with evidence based results from other hospital systems to explain the why in the change Organizational Adoption & implementation Include all groups of the interdisciplinary healthcare teams Chief nursing officer, informatics nurse specialist, quality improvement specialist, emergency department team, and emergency medical services team Implementation of selective spinal immobilization protocol including the benefits of the protocol Measurable Outcomes Decrease in pressure injuries to the neck Decreased incidences of increased intracranial pressure due to unnecessary spinal immobilization Decrease in missed injuries Decrease in delay of lifesaving procedures included but not limited to endotracheal intubation Improved efficiency for EMS systems Decrease in time spent in the field Critical Appraisal Summary Spinal precautions are a key component of most emergency medical services protocols despite the lack of evidence supporting spinal immobilization to improve patient outcomes (Long, Koyfman, & Gottlieb, 2019). There is a study that assesses patterns of error leading to trauma mortality citing 16% failure to secure an airway due to spinal immobilization (Velopulos, et al, 2018). With the use of selective spinal immobilization protocol, we can expect improved efficiency for EMS systems, the hospital’s emergency department, and the healthcare system. An estimated 40% of all very low-risk trauma patients and penetrating trauma patients can be transported safely without c-spine immobilization devices decreasing time spent in the field immobilizing and can quickly transfer the