Enhancing the Sustainability of EBP initiatives: Comments
Comment #1: Betadine to Chlorhexidine
The switch from betadine to chlorhexidine was a thoughtful EBP initiative as the number of infection rates seen in the facility decreased after the implantation of the plan. Research studies that have examined the effectiveness of chlorhexidine and betadine have proven that chlorhexidine is associated with lower rates of infections when compared to betadine (Ayoub, Quirke, Conroy, & Hill, 2016; Chen, Chen, Guo, & Xu, 2020). The effectiveness of chlorhexidine when compared to betadine and the hospital’s decision to start ordering central line dressing kits that included chlorhexidine could explain why the staff working in the facility adopted to the change in the skin preparation solution easily. I agree with your choice of using Kotter and Cohen’s model of change as it is an effective method of ensuring that staff participate in the intended or implemented plan (Melnyk & Fineout-Overholt, 2019). The Kotter and Cohen change model could promote the implementation of your EBP initiative in other facilities.
Comment #2 Chest Pain Assessment
Early identification and intervention in the management of patients with chest pain can be an effective method of reducing high chest-pain related morbidity and mortality rates. The EBP initiative implemented in your healthcare facility to ensure that the triage nurse would assess patients who arrive at the facility and an EKG technician would conduct the EKG assessment before admission or other processes were considered, could also be effective in reducing misdiagnoses in such cases and limiting the time taken during assessments (Mokhtari, Dryver, Soderholm, & Ekelund, 2015). It is admirable that the facility has made it their norm and that it has data to support the initiative. Your choice of the Kotter and Cohen change model and your explanation on the systematic nature of the model illustrates how it could be an effective technique for promoting change in healthcare organizations (Melnyk & Fineout-Overholt, 2019). The model of change could be implemented in many clinical situations that require the use of EBP initiatives.
Ayoub, F., Quirke, M., Conroy, R., & Hill, A. (2016). Chlorhexidine-alcohol versus povidone-iodine for pre-operative skin preparation: A systematic review and meta-analysis. International Journal of Surgery Open, 1(C), 1-4. Retrieved from https://www.researchgate.net/publication/298340268_Chlorhexidine-alcohol_versus_povidone-iodine_for_pre-operative_skin_preparation_A_systematic_review_and_meta-analysis.
Chen, S., Chen, J. W., Guo, B., & Xu, C. (2020). Preoperative Antisepsis with Chlorhexidine Versus Povidone-Iodine for the Prevention of Surgical Site Infection: a Systematic Review and Meta-analysis. World Journal of Surgery, 44(5), 1412-1424. Retrieved from https://europepmc.org/article/med/31996985.
Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-Based Practice in Nursing and Healthcare. Wolters Kluwer.
Mokhtari, A., Dryver, E., Soderholm, M., & Ekelund, U. (2015). Diagnostic values of chest pain history, ECG, troponin and clinical gestalt in patients with chest pain and potential acute coronary syndrome assessed in the emergency department. Springer Open, 4,(219) 1-7. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4431985/pdf/40064_2015_Article_992.pdf.