Change Paper

smk1, LPN · Mar 7, 2008

Hello everyone!
I am a senior in my last semester of nursing school. I am currently taking a leadership class which requires a "change" paper that is due at the end of this month. For those who never heard of a change paper it is based on observation of issues or problems you see on any of the units you may have worked on that need change. An example is observing nurses who administer chemo or obtaining blood samples without wearing the proper gloves. Unfortunately, this topic is already being used by a classmate of mine. Can anyone offer any other suggestions? Any input is much appreciated. Thanks!

Instituting bowel care protocols or putting patient care supplies in the rooms instead of in one big stock room. Changing the visiting hours or a way of charting. It really could be anything. Mine was on adding privacy mechanisms to the rooms and reeducating the staff on therapeutic communication. Getting standing orders for ______ on your unit. Is there a need for the nurses to all be ACLS trained on that particular floor? Just kind of make up a list of everything that you saw that bugged you or was not great care and see if you can come up with a way to change it in a practical sense and you can support it with evidence based research and you should be good to go.

manofcare · Mar 9, 2008

How about time and order protocol for the retention of a urinary catheter to reduce the incidence of UAs? Kind of like a flowsheet to keep it in place. I believe some units remove them as a last resort before dc pt home. Standardization of VS times if the unit has different times. Anything to do with skin breakdown because of a change in payment for tx of nosocomially acquired pressure ulcers. Does your facilty use the Braden scale? What about protcol of the use of chlorprep swabs instead to alcohol for peripheral IV starts and the manner of cleaning. Not roundy round, but back and forth for the friction.

GmF17 · Mar 14, 2008

Thanks for your suggestions! I was thinking about doing it on pressure ulcers. I do not always see bedridden pts being turned every 2 hours and proper protocol being followed for skin breakdown. I had a pt who had a stage one ulcer and it was worsening. I went to get a air mattress and of course there was none and it took FOREVER for it to be delivered to the unit. You guys think that would be ok?

meggiepie24, BSN · Mar 15, 2008

at the hospital I work at has a skin care team. Team members are paired and assigned to a certain department. Within that unit they check everyone's feet, heels, and back to see if a pressure ulcer is developing. this is going to a major issue in the next year or so because medicare is going to stop covering pressure ulcers that developed at a hospital, so the hospital will have to pay for the treatment of the ulcer

Kelly_the_Great · Mar 15, 2008

Improving Call Light Management

Medscape just came out with an article on it with references ~ so it's EBP... :)

This is really an innovative approach to meeting patient needs with a change from traditionally answering calls when the patient rings to proactively anticipating and meeting patient needs by scheduled rounds with a focus.

My facility is considering using the "3 P" approach, focusing on the most common requests for calls: positioning (this goes back to your previous reference to patients needing more frequent turning), pottying (bowel & bladder needs) and pain.

Hey, if you decide to go with this approach, I'd LOVE to see it!

Good luck...:)

LaceyRN · Mar 17, 2008

Hello everyone!
I am a senior in my last semester of nursing school. I am currently taking a leadership class which requires a "change" paper that is due at the end of this month. For those who never heard of a change paper it is based on observation of issues or problems you see on any of the units you may have worked on that need change. An example is observing nurses who administer chemo or obtaining blood samples without wearing the proper gloves. Unfortunately, this topic is already being used by a classmate of mine. Can anyone offer any other suggestions? Any input is much appreciated. Thanks!

1. signing MAR before a med is given

2. not checking ID bracelet b/f giving med

3. leaving med (narcs) in med cup on pt. tray and leaving the room.

just a few things I witnessed on 1 floor all from the same nurse, all at the same time. :nono: