Preoperative Screening as an Evidence-Based Practice

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This plan aims to improve the preoperative health status of orthopedic surgical patients to improve surgical outcomes in a hospital setting. The implementation plan will take 2 months as shown in the table below:

Activity	Time Duration
Systematic review	1 week
Creation of awareness	1 week
Gathering the resources	1 week
Collaborative modification of the hospitals preoperative assessment for orthopedic surgical patients	1 week
Quasi-experimental study design	One month
Analysis of the results	2 weeks
Informing practice to roll out a major change of the hospitals preoperative assessment policy	1 week

A systematic review will be used to guide this implementation plan because it is more informative. After all, it is a summary of existing studies so that only the best evidence is available to guide decision-makers (Smith, Devane, Begley, & Clarke, 2011). This review will target well-designed controlled trials only, regardless of randomization. The target population is the orthopedic surgical population; thus, only studies that have tested the efficacy of the MRSA screening protocol will be included in this review. In addition, the study will entail a comparison of the screened population using the MRSA tool to an unscreened population.

Articles published since 2006 (in the last 10 years) will be included in the study. Only studies that have adapted a controlled trial will be included in this review. A data extraction form will be used to determine the imperative facets of the different studies. Also, a quality appraisal checklist will aid in determining the quality of the studies included in this review. Upon reviewing the methodology, the precision, as well as generalizability of the results, only a certain number of studies will remain. A PRISMA flow diagram will be used to give a pictorial representation of the literature search process.

Two reviewers will be selected and briefed on how to select the studies about the inclusion and exclusion criteria. Differences between the two reviewers will be settled through discussion and consensus (National Heart, Lung, and Blood Institute, 2014). Subsequently, the identified studies will be tabulated, and a test for homogeneity will be carried to determine the need for meta-analysis. Significant results that highlight the need for MRSA screening will guide the rest of the process.

Integration of the significant findings will begin with awareness, where the findings would be communicated to the entire team involved including surgeons, lab personnel, nurses, and the quality improvement committee. Considering the associated barrier of time, the implementation agenda would be introduced to the staff during the routine meetings within the hospital and would entail demonstrations. To avoid poor communication and misinterpretation, a small test would be administered to the staff after discussing what each department would be required to do during the implementation of the MRSA screening protocol.

The library is the basic resource to aid in the gathering of the required articles for the systematic review. Nasal swabs and medication for decolonization are will help to identify MRSA infections and counteract their effects. Subsequently, the healthcare workers involved in the concerted efforts of implementing the solution are important. The location where the solution is to be implemented is in a hospital among orthopedic surgical patients. Time is another important resource that will need proper planning as shown in the table above.

The preoperative assessment procedure, which usually entails an array of activities as discussed by Akhtar, MacFarlane, and Waseem (2013), will change notably. The component of MRSA screening, which is lacking in the standard preoperative assessment process, will be incorporated into the hospitals policy after a pilot to determine the logistics and level of impact on the surgical outcomes.

Orthopedic surgical patients will be divided into two groups. The experimental group will be screened for MRSA and treated for the infection before surgery. The control group will undergo the usual routine that does not have the component of MRSA screening. Once the MRSA infection has cleared, the experimental group will undergo the surgery. Since this implementation plan seeks to determine the prevalence of MRS infections after the surgery, administration of a questionnaire will not be necessary (Mehta et al., 2013).

Nonetheless, two nurses will be used in the identification and decolonization of the MRSA. In addition, the two nurses will determine the occurrence of MRSA after surgery between the two groups for comparison. An independent t-test will be used to compare the means of the two groups as indicated by the University of West England (2016).

The nurses involved in the quasi-experimental study will be asked to uphold privacy about the treatment procedure. Patient information regarding the occurrence of MRSA infections will be noted in the patients files and will be useful for determining the prevalence of these infections. Another type of information required for the study will be kept anonymous and only used by individuals involved in the study and bound by the research code of ethics (Resnik, 2015). The proposed budget for this plan is as follows:

Item	Amount(Dollars)
Library access to aid in the systematic review	$200
Nasal Swabs for the medical screening of MRSA	$400
Decolonizing medication to resolve the MRSA infections	$1000
Travel expenses to and from the library and hospital during the implementation period	$300
Presentation development about writing, editing, and saving it in a computer-related device	$200
Total	$2100

The solution will be extended by scaling it up through a change in the hospitals preoperative assessment policy.

References

Akhtar, A., MacFarlane, R. J., & Waseem, M. (2013). Pre-operative assessment and post-operative care in elective shoulder surgery. The Open Orthopaedics Journal, 7, 316322.

Mehta, S., Hadley, S., Hutzler, L., Slover, J., Phillips, M., & Bosco, J. 3^rd. (2013). Impact of preoperative MRSA screening and decolonization on hospital-acquired MRSA burden. Clinical Orthopaedics and Related Research, 471(7), 2367-2371.

National Heart, Lung, and Blood Institute. (2014). Quality assessment of systematic reviews and meta-analyses. Web.

Resnik, D. B. (2015). What is ethics in research & why is it important? Web.

Smith, V., Devane, D.,Begley, C. M., & Clarke. M. (2011). Methodology in conducting a systematic review of systematic reviews of healthcare interventions. BMC Medical Research Methodology, 11(15). Web.

University of the West England. (2016). Independent samples t-test. Web.

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Preoperative Screening as an Evidence-Based Practice

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