This document outlines a nursing student's plan to implement a change project to reduce postoperative surgical site infections. Specifically, the student proposes prohibiting artificial nails among clinical staff members. The rationale is that artificial nails harbor pathogens and have been linked to outbreaks of similar infections in surgical patients. The student identifies relevant stakeholders, including nurses, technicians, managers, and administrators. The plan involves educating staff on the new policy, conducting audits to collect infection rate data before and after implementation, and reporting outcomes to stakeholders. If successful, the policy would become permanent. The goal is to improve patient outcomes and safety by reducing opportunities for infection transmission in the operating room.

1. 1
Week 6 Assignment: EBP Change Process form
ACE Star Model of Knowledge Transformation
Follow Nurse Daniel as your process mentor in the weekly
Illustration section of the lesson.Please do not use any of the
Nurse Daniel information for your own topic, nursing
intervention, or change project. Nurse Daniel serves as an
example only to illustrate the change process.
Name:
Star Point 1: Discovery (Identify topic and practice issue)
Identify the topic and the nursing practice issue related to thi s
topic. (This MUST involve a nursing practice issue.)
The topic of my nursing practice issue is reducing surgical
infection rate by prohibiting artificial nails among clinical staff
members.
Briefly describe your rationale for your topic selection. Include
the scope of the issue/problem.
Hospital Acquired Infections (HAIs) are a major concern for all
types of healthcare facilities. The Center for Disease Control
and Prevention states that on any given day, about one in 31
hospital patients has at least one healthcare-associated
infection. (2018). Hand hygiene is the most important method of
preventing infections and this is especially true in the
perioperative field. Outbreaks of similar infections cultured
from the surgical site can be traced back to individuals who
wear artificial nails. Infections are a major post-surgical
complication and costs the healthcare facility money and can
cost a patient their life.

2. Star Point 2: Summary (Evidence to support need for a change)
Describe the practice problem in your own words and formulate
your PICOT question.
Artificial nails are breeding grounds for bacteria, fungus and
viruses. Staff at my facility wear these nail enhancements and
studies reveal adverse patient outcomes when providing patient
care while having nail enhancements. Among surgical staff
members, would banning artificial nail enhancements lead to a
decrease in surgical site infections in postoperative adult
patients over a 3 month period?
List the systematic review chosen from the CCN Library
databases. Type the complete APA reference for the systematic
review selected.
Winslow, E, Jacobson, A. (2001 October). The case against
artificial nails. In Combating Infection. Retrieved from
:https://eds-b-ebscohost-
com.chamberlainuniversity.idm.oclc.org/eds/detail/detail?vid=1
&sid=8cf67705-a24d-462f-87a9-
13f8bcb8b5db%40sessionmgr103&bdata=JnNpdGU9ZWRzLWx
pdmUmc2NvcGU9c2l0ZQ%3d%3d#db=c8h&AN=106889325
List and briefly describe other sources used for data and
information. List any other optional scholarly source used as a
supplement to the systematic review in APA format.
Hand Hygiene in Healthcare Setting. (2020 January 31). The
Center for Disease Control and Prevention. Retrieved from:
https://www.cdc.gov/handhygiene/providers/index.html
Marchetti, A., Rossiter R. (2013 December).Economic burden of

3. healthcare-associated infection in US acute care hospitals:
societal perspective. J Med Econ;16(12):1399-404. doi:
10.3111/13696998.2013.842922. PMID: 24024988.
Briefly summarize the main findings (in your own words) from
the systematic review and the strength of the evidence.
This review was written to inform healthcare professionals
about the danger of wearing nail extensions in the workplace. It
references different root-cause analysis which revealed that the
patients who suffered a postsurgical infection in a specific time
period were all traced back to operating room staff whose
artificial nails were cultured to the corresponding infection.
This is evident of a direct correlation between nail extensio ns
and infections. Also, the review explains that even after
performing hand hygiene, more pathogens are cultured from
healthcare workers with artificial nails than those without.
Outline one or two evidence-based solutions you will consider
for the trial project.
The article referenced the CDC guidelines for all perioperative
team members to have short, clean nails free of any
enhancements. This evidence based solution helps prevent HAIs
by reducing the surface area of the fingernails which harbor a
flora of pathogens.
Star Point 3: Translation (Action Plan)
Identify care standards, practice guidelines, or protocols that
may be in place to support your intervention planning (These
may come from your organization or from the other sources
listed in your Summary section in Star Point 2).

4. Our facility policies on hand hygiene include using an alcohol -
based hand rub before donning and after doffing gloves and
between patient contact.
Team members that work inside the sterile field (surgeons and
operating room technicians) must scrub using a Chlorhexidine
hand scrub for 5 minutes prior to donning sterile gloves for the
surgical procedure.
The CDC, "recommended that healthcare providers do not wear
artificial fingernails or extensions when having direct contact
with patients at high risk (e.g., those in intensive-care units or
operating rooms)". (2020).
Keep natural nail tips less than ¼ inch long."
Avagard nail scrub must be used under the nails.
List your stakeholders (by title and not names; include yourself)
and describe their roles and responsibilities in the change
process (no more than 5).
Nurses and Operating Room Technicians- These are the most
hands-on team members whose' hand hygiene directly impacts
patient outcomes.
Nurse Managers - Enforce the policies and oversee their
compliance.
Director of Nursing - Creating new guidelines and policies with
respect to state and federal mandates and under the standards of
the accreditation organization, Joint Commission.
Compliance Manager - Reports to the state Department of

5. Health and the Center for Medicare & Medicaid Services all
reportable incidents including post-surgical infection rates.
What specifically is your nursing role in the change process?
Other nursing roles?
As an assistant nurse manager, it is my job to explain the new
policy to the staff members. I usually do this during in-service
meetings and open the floor for questions and concerns brought
up by my team. I also observe to see if the new policy is being
embraced by the staff. If not, I must investigate the motivations
behind the policy non-compliance. The staff nurses'
responsibility is to be the link in the prevention of infection
which starts with proper hand hygiene as explained in the new
policy. The Director of Nursing has a role to report occurrences
and infection rates to outside committees which oversee our
facility's accreditation.
List your stakeholders by position titles (charge nurse,
pharmacist, etc.).-Why are the members chosen (stakeholders)
important to your project?
Staff nurses, operating room technicians, surgeons, nurse
managers, director of nursing, compliance manager. These team
members are the most important stakeholders in implementing
this change. The clinical staff mentioned are the ones that
perform all hands-on care. They are the main catalysts in
spreading infection in the operating room. Middle management
is important in making sure that clinical staff members adhere
to the new policy and they are the ones that will report to upper
management. In turn, upper management uses this data when
compiling their quarterly reports for the Joint Commission and
this information will also be used in their annual report to CMS.

6. What type of cost analysis will be needed prior to a trial? Who
needs to be involved with this?
The cost analysis is leaning towards embracing the new policy
of banning nail extensions for clinical staff. The cost of not
adopting this policy would lead to an increase in infection rates
in postoperative patients. According to Marchetti and Rossiter,
"HAIs in US acute-care hospitals lead to direct and indirect
costs totaling $96-$147 billion annually." (2013). Not only do
HAIs burden the facility financially, they can threaten to shut
down the center. The Joint Commission is who accredits
ambulatory surgery facilities. Adverse patient outcomes such as
medication errors, surgical site infections and falls are reasons
for Joint Commission to withdraw accreditation. Without this
we cannot continue the day to day operations.
Star Point 4: (Implementation)
Describe the process for gaining permission to plan and begin a
trial. Is there a specific group, committee, or nurse leader
involved?
In order to implement change there must be a need for it. Seeing
that some staff members go against policy, this matter needs to
be brought to the nurse manager in charge of the unit. Then, she
will discuss this matter with the most senior nurse, the Director
of Nursing as well as the Medical Director. Ultimately, they are
the ones who will deem the policy necessary to implement.
Describe the plan for educating the staff about the change
process trial and how they will be impacted or asked to
participate.
In my facility, any changes in policy must be explained to the

7. staff during in-service meetings. This gives the staff that are
impacted by the policy a rationale for why this will lead to
better patient outcomes as well as giving them an opportunity to
voice their concerns over the proposed changes. Staff members
who chose to wear nail enhancements will be asked to have
them removed and begin working in accordance with policy.
Issues with non-compliance with the policy may warrant
grounds for termination of employment.
Outline the implementation timeline for the change process
(start time/end time, what steps are to occur along the timeline).
Week 1 - Compliance Manager must compile a statistical report
on all reportable incidents. Rates on infection must be singled
out. Nurse Manager and Director of Nursing have a meeting on
trial.
Week 2- In-service for staff about the need to remove artificial
nails.
Week 2 – Week 14- Nurse Manager conducts audits and collects
data on reportable incidences and infection rates.
Week 15- Compliance Manager assessed efficacy or failure of
initiative
Week 15- Director of Nursing compiles information to be
reported to Department of Health
Week 16- Policy is revisited by management and becomes
permanent policy or removed.
List the measurable outcomes based on the PICOT. How will
these be measured?
The measurable outcomes would be an increase or a decrease in
post-surgical infection rates. They will be measured by a patient
survey, in which one question asks "Have you had a surgical
site infection postoperatively?". To have a baseline for
measuring the effectiveness, the Compliance Manager must

8. compile a statistical report based on infection rates which
occurred during a period of time when clinical staff members
wore nail enhancements
What forms, if any, might be used for recording purposes during
the pilot change process. Describe.
All reportable incidents must be documented on a Quality
Assessment Form which the Compliance Manager keeps a
record of. This is the information that must be reported to the
Joint Commission and CMS.
What resources are available to staff (include yourself) during
the change pilot?
Nurse Managers are available as resources for the staff to voice
their concerns about the change. The managers are also there to
provide information about the process. Visual resources are a
great idea such as CDC posters on hand hygiene.
Will there be meetings of certain stakeholders throughout the
trial? If so, who and when will they meet?
The primary meeting of stakeholders is the only meeting
necessary due to the small size of the facility.
Star Point 5: (Evaluation)
How will you report the outcomes of the trial?
Outcomes of the trial will be reported to upper management by
the middle management (nurse managers). From there, it will
trickle down to the staff members where it will be reported to
them during another in-service meeting. A good idea would be
to present the ongoing evaluation of outcomes in a visual

9. representation such as a frequency chart. This will encourage
the staff to adhere to policy because they can visually see that
these interventions are making a difference.
What would be the next steps for the use of the change process
information?
This information would be used as a basis for hand hygiene
protocols in the surgery center. It will provide insight with
factual data about the efficacy of our trial. In addition, this
information can be used during the pre-employment on boarding
process where all newly hired staff must agree to the Dress
Code Policy which states that nail enhancements are not
permitted.
9.2019 Update. DLP
1
Week 6 Assignment: EBP Change Process form
ACE Star Model of Knowledge Transformation
Follow Nurse Daniel as your process mentor in the weekly
Illustration section of the lesson.Please do not use any of the
Nurse Daniel information for your own topic, nursing
intervention, or change project. Nurse Daniel serves as an
example only to illustrate the change process.
Name: ___Nataliya Izarova__________________
Star Point 1: Discovery (Identify topic and practice issue)
Identify the topic and the nursing practice issue related to this
topic. (This MUST involve a nursing practice issue.)
The topic of my nursing practice issue is reducing of patient’s

10. medications errors at home in post hospital 30 days period.
Briefly describe your rationale for your topic selection. Include
the scope of the issue/problem.
There is 10–20% of hospital admissions among older people are
associated with medication errors (Brekke et al. 2008). RN is
the first medical professional who patient meets at home after
hospital discharge. Medications reconciliation is # 1 nursing
issue in hand off process when nurse visited patient home. RN
must reconcile meds with discharged MD to make sure patient
has and willing to take proper medications and dosages. RN
must report any side effects or adverse reactions if any noted in
the patient’s to prevent further body( systems) damage and re-
hospitalization to correct the problem.
Star Point 2: Summary (Evidence to support need for a change)
Describe the practice problem in your own words and formulate
your PICOT question.
It is often happens visiting nurses document medications list
that is written in the discharge papers with no checking actual
medications that patient has at home. This problem may lead to
big discrepancies between medications that was recommended
by a doctor who discharge patient home and actual medications
at home.

11. PICOT question: Does timely nursing medications
reconciliation will improve patient’s medications compliance
and decrease risk of re-hospitalization during 30-days post
hospital discharge?
List the systematic review chosen from the CCN Library
databases. Type the complete APA reference for the systematic
review selected.
Berland, A., Bentsen, S. B.,. (2017, March 28). Medication
errors in home care: a qualitative focus group study. Journal of
Clinical Nursing, 26(21-22), pp. 3734-3741. Retrieved from
https://eds-a-ebscohost-
com.chamberlainuniversity.idm.oclc.org/eds/detail/detail?vid=1
&sid=9cd0736f-fe8f-425b-a17f-a478bca4f603%40sdc-v-
sessmgr03&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0
ZQ%3d%3d#AN=28152226&db=cmedm
List and briefly describe other sources used for data and
information. List any other optional scholarly source used as a
supplement to the systematic review in APA format.
Engelke, Z. (2018, April 13). Patient Education: Home Care --
Teaching Medication Self-Administration. Nursing Practice and
Skill. Retrieved from https://eds-a-ebscohost-
com.chamberlainuniversity.idm.oclc.org/eds/detail/detail?vid=2
&sid=6c2f560a-bbdb-4658-b167-fe6940399d46%40sdc-v-
sessmgr01&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0
ZQ%3d%3d#AN=T706566&db=nup
Briefly summarize the main findings (in your own words) from
the systematic review and the strength of the evidence.
The study reveals the important role of nursing to follow
agency’s policies and procedures in hands off process such as
timely( within 24 hours) communication with discharged

12. doctors, pharmacies. The study underlined the importance of
nursing competency in pharmacology such as knowlege of
generics and brands meds, to report any issues found in the
home medications to avoid medications errors and patient’s
taking unnecessary meds. Also, review stressed the importance
to have all necessary documentation from a hospital during the
first home visit as the references for medications reconciliation.
Outline one or two evidence-based solutions you will consider
for the trial project.
Proper communication with referring doctor will be a visiting
nurse priority to compare medications at home with medications
doctor discharged patient with. This evidence-based solution
will objectively provide accuracy in dosages and clear questions
if nurse have any. For example if patient has aspirin 81 at home
but doctor prescribed 325. Visiting nurse must confirm the
dosage or even ask MD what was the reason meds dosage
changed. In such situation the picture will be cleared with no
questions behind.
Star Point 3: Translation (Action Plan)
Identify care standards, practice guidelines, or protocols that
may be in place to support your intervention planning (These
may come from your organization or from the other sources
listed in your Summary section in Star Point 2).

13. List your stakeholders (by title and not names; include yourself)
and describe their roles and responsibilities in the change
process (no more than 5).
What specifically is your nursing role in the change process?
Other nursing roles?
List your stakeholders by position titles (charge nurse,
pharmacist, etc.). Why are the members chosen (stakeholders)
important to your project?
What type of cost analysis will be needed prior to a trial? Who
needs to be involved with this?
Star Point 4: (Implementation)
Describe the process for gaining permission to plan and begin a
trial. Is there a specific group, committee, or nurse leader
involved?
Describe the plan for educating the staff about the change
process trial and how they will be impacted or asked to
participate.

14. Outline the implementation timeline for the change process
(start time/end time, what steps are to occur along the timeline).
List the measurable outcomesbased on the PICOT. How will
these be measured?
What forms, if any, might be used for recording purposes during
the pilot change process. Describe.
What resources are available to staff (include yourself) during
the change pilot?
Will there be meetings of certain stakeholders throughout the
trial? If so, who and when will they meet?
Star Point 5: (Evaluation)
How will you report the outcomes of the trial?
What would be the next steps for the use of the change process
information?

15. 9.2019 Update. DLP
1