Change Model & Implementation Plan 2

Roger's diffusion of innovation theory

Diffusion refers to a process whereby communication of an innovation is done through given channels over a given time among social system members. It is thus a communication that involves disbursement of messages viewed as being new ideas.  Innovation refers to an idea that is viewed by a person as being new. The features contained in that innovation according to the perception of the said social system members determine its implementation rate (Basavanthappa, 2008). Therefore, the implementation of an Early Sepsis alert system to a great extent depends on how the users or the members of the system will define its characteristics and how they perceive or respond to it. Changes are thus needed on the innovation, how the changes will be communicated in the context of sepsis and how the social system will apply it to achieve a common goal of problem solving.  The common goal in this scenario is early system that will be used to monitor the risk of inpatient developing sepsis and thus raise the alarm for early care and reduce the overall mortality risk (Shiramizo, Marra, Durão, Paes, Edmond, & Santos, 2011).

Innovation in diffusion should be able to indicate various features that will determine the rate at which it will be adopted or implemented which consist of compatibility, relative advantage, trial ability, complexity and how observe the innovation is to the social system members.  Relative advantage refers to the extent in which the system will be viewed as being better than preceding idea(Basavanthappa, 2008).   The rate of adoption of Early Sepsis Alert system will be determined by how the nurses of medical staff view it as being advantageous in detecting sepsis early enough(Shiramizo et al. 2011). . If theses members perceive the system as being better in detecting early sepsis, they will adopt it at fast rate thus speeding up the implementation process (Schnegelsberg, Mackenhauer, Pedersen, Nibro, & Kirkegaard, 2014).  Compatibility refers to the extent to which the innovation is viewed as being in line with values, adopters’ needs and the past experiences. If the alerts are developed using the best available evidence over an extended period so that it is consistent with the clinical values and the nurses needs its implementation process will be very easy (Basavanthappa, 2008). This is because the users of the systems will viewed as being better as compared to past system when changes had not been introduced. Complexity refers to the extent to which the innovation is seen to be difficult to comprehend and thus to use. The Early Sepsis Alert System will be implemented faster if the social system members feel that it can be understood easily after the introduction of new changes. This is true if the nursing staff do not need new skills that will help in understanding.  Trial ability refers to how experiments can be done using the system on a limited basis. In case the detection of sepsis can be done in implementation plan of the alert system, it means that the members of the system will adopt it quite easily (Basavanthappa, 2008). Therefore, if the sepsis alert system can be trialable, there is less uncertainty to the nurses who are considering its adoption.  The ability of the innovation to produce results that are greatly visible to the users determines the success of its implementation. The visibility of the alert system results trigger the discussion on its effectiveness and other people may consider adopting it after information about its innovation-evaluation is given.

Communication in diffusion involves sharing of information with others in order to mutually reach at an understanding (Basavanthappa, 2008). The sepsis alert system would be evaluated on the basis of relayed information on its effectiveness. The system would be subjected to evaluations’ comparison among the near-pears who have implemented the system. Time in diffusion involves decision making process on the innovation, a person’s or unit’s innovativeness and adoption rate.  The decision process a mental procedure where a person or unit forms an attitude about the alert system and then decides to implement or reject it. Innovativeness relates whether a person or unit adopt the system earlier than fellow social system members (Schnegelsberg, 2008). Adoption rate relates to the sepsis alert systems’ speed of implementation. The social system relates to members or interrelated units engaged in systems problem solving to achieve evident early sepsis detection.

Implementation plan

The system uses a computerized tool that includes continuous laboratory  values and whose aim is to identify impending sepsis that can be used together with an automated fashion that combines  medical record system that is electronic.  The implementation process is to be done in a public hospital near an academic medical facility. In the process, a single medicine war is to be used as a control ward while at least four others are to be intervention wards.  Some patients in the control ward are to be used as the non-intervention group. The intervention group will involve all patients in intervention wards with sepsis alert generated at real-time. 

Development will take about two months .The implementation of the project will involve two bundles of time that consist of 3 hours and 6 hours. Within the first three hours   after the alert, the nurses should obtain lactate levels of the blood in order to identify the possibility of hypo-perfusion connected to sepsis and then evaluate necessary interventions for resuscitation.  Antibiotics are to be administered within an hour of sepsis recognition or septic shock. The bundle of 6 hours will involve the transition of the patient to a superior level of care provision. The intention will be to attain lowest possible mortality rate and none if possible. 

The implementation process will involve inter- professional sepsis team that comprises of experienced practicing nurse and clinical nurses, laboratory representatives, physicians and representatives from safety and quality program.  It will also involve the medical-surgical ICU, staffs from the emergency department since these members often deal encounter sepsis. The nurses and physicians will work closely with other group members to determine the alert systems management. They will thus serves as discipline and unit-based resources that will be involved in mentoring the implementation process.

The system will involve the generation and collection of real- time data. The information will be generated using the a prediction tool fitted in the system that consist of common values obtained from the laboratory whose monitoring will be closely done among the hospitalized patients who will be selected by the team members due to heir relevance to sepsis. This relevance involves the shock index, the arterial pressure and other relevant data which will be transferred automatically transferred into the electronic record automatically.

The electronically availed data will then be identifies as positive, where by an alert will be raised. Therefore , the nurse have to respond quickly to the alert , carry out an assessment on the patient The nurses are then to enquire from the physician of the interventions needed and then administer the interventions required.  The initial outcome will be aimed at actively administering diagnostic and therapeutic interventions that will have been assessed within 14 hours.

Any challenges encountered will have to be solved by involving the nurses who were monitoring the implementation process. Expected challenges such as alert fatigues the nurses and other team members will have to offer their feedback on the systems function ability in order to check the manner in which alerts were detected. The feedback will also help in determining the safest timeframes for the alerts.  Furthermore, the sepsis clinical assessment and concerns on the assessment will need to be maintained to avoid relying on this system alone.  

The implementation cost for the alert system will have absorbed into the workflows in the daily routine so that no major direct cost is expected to be incurred. The cost will involve the salaries for the team involved in the process which is expected to get better as the electronic health record is being implemented together with ability for capturing vital elements of data. The benefits arising from the system in form of mortality rate reduction is worth the cost. To maintain the system communication among the staff will have to be improved and sustained and feedback presented individually. Any addition training required for better understanding of the system will be offered to nurses and appreciates those who have endeavored to offer solution for upgrade.

References

Shiramizo, S., Marra, A., Durão, M., Paes, Â., Edmond, M., & Pavão dos Santos, O. (2011).   Decreasing Mortality in Severe Sepsis and Septic Shock Patients by Implementing a    Sepsis Bundle in a Hospital Setting. Plos ONE, 6(11), e26790.   http://dx.doi.org/10.1371/journal.pone.0026790

Schnegelsberg, A., Mackenhauer, J., Pedersen, M., Nibro, H., & Kirkegaard, H. (2014).    Delayed admission to the ICU is associated with increased in-hospital mortality in      patients with community-acquired severe sepsis or shock. Critical Care, 18(Suppl 1), P241. http://dx.doi.org/10.1186/cc13431

Basavanthappa, (2008). Community health nursing. Place of publication not identified: Jaypee Bros. Medical P.

 

 

 

 

 

 

 

 

 

 

 

Appendixes

Data collection tool

Details	Intervention	Non-intervention
Age
Time of alert
Septic shock no
Severe sepsis no.

 

Human resource list

1. Clinical nurse
2. Practicing nurse
3. Laboratory representatives
4. Quality program representatives
5. Physicians
6. Emergency department staff

Timeline

Time
2-3 months	Development
3 hour bundle		Data collection
6 hour bundle		Intervention  administration