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Clinical In CVAD Dressing And Maintenance

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Clinical In CVAD Dressing And Maintenance Question: Discuss about the Clinical In CVAD Dressing And Maintenance.     Answer: Introduction The CVAD (Central Venous Access Devices) are used for several short and long-term care interventions. The general use of CVAD devices are to provide different fluids, medicines, parental nutrition, blood products, to collect blood samples, the to obtain the central venous pressure monitoring. Dressing of these CVAD areas should be done properly as improper dressing of that site further could lead to Central Line Associated Blood Stream Infection (CLABSI (Unnithan et al. 2014). The objective of this clinical audit was to understand the level of acquiescence with that of the standard of dressing of the CVAD site available against the current practice and guideline that are implemented in the healthcare settings. The procedures of clinical audits are crucial in healthcare settings as these audits are important part of the professional practices and improvement of the quality. Every clinical setting should comply completely with the policy and procedures and the main aim of this clinical audit is to identify those areas that fails to comply with the policy and procedures. Further, the identification of such processes will be helpful in developing opportunities for the quality improvement of healthcare settings (Gillam and Siriwardena 2013). The prime aim of this report is to discuss the process of conducting a clinical audit regarding dressing change on the site of CVAD. This assignment is going to cover different aspects of clinical audit and will discuss the clinical risk and background of clinical audit. Further, a clinical audit tool will be developed and critique for it will be mentioned. Result of the audit and discussion about the result will be put up and the assignment will provide recommendations for improving the quality of healthcare system.    Background And Clinical Risk CVAD or the Central Venous Access Devices are small and flexible tubes that needs high quality care and maintenance as this tunnel provide food, medicine, blood and other important fluid to the body. Improper maintenance can lead to infections or injuries that extends the difficulty of the patient and the hospital stay also increases. There are several aseptic techniques and the insertion site should be protected from any kind of contamination such as microbial, chemical or biophysical contaminations (Moureau et al. 2013).  The Australian Government has several health promotional policies that are divided in different local versions of CVAD management and dressing policies such as NSW (New South Wales) CVAD policy, Melbourne CVAD policies and the healthcare facilities has to comply their CVAD care policies with that of the state’s CVAD policy (Central Venous Access Device Insertion and Post Insertion Care 2018). The prime purpose of these healthcare policies is to minimize the level of complications related to the insertion, management and access to the CVAD devices. Furthermore, by doing so these policies also protects the patient from the bacteremia blood stream infections. All the healthcare providers and the staffs that perform this CVAD insertion and management need to comply with the process and policies of these CVAD maintenance policies (Chong et al. 2013). The Audit Process And Tool With Critique Clinical audit is termed as a quality improvement process that helps to improve the quality of healthcare and its outcomes by reviewing the care provided to each patient through given criteria using systematic review processes. This process helps to implement necessary changes in the system and further monitors it to confirm the improvement in the healthcare system (Gillam and Siriwardena 2013). Therefore, this quality assurance process was carried out in the healthcare facility to monitor the level of compliance between the policy and procedures mentioned in the standard criteria and that in the healthcare facility. The policy of the Australian healthcare framework for dressing and maintenance if the CVAD site was assessed for the healthcare facility (Annal, Zahid and Tayyeb 2016). The hospital, in which the clinical audit was conducting, follows the Australian healthcare policy and the audit was aimed to observe that the hospital policy complies with that of the state policy of Australia especially in CVAD site dressing. The hospital had 33 beds and there were 28 patients, who had CVAD tubes inserted in their body. Therefore, for the clinical tool, those 28 patients were assessed. A new clinical audit tool was developed for the hospital, in which the audit is supposed to occur and the researchers set their questions to identify the topics or issues the hospital faces while providing care and maintaining the CVAD site of patients. The audit lasts for 24 hours and each of the patients were analyzed for the maintenance and dressing of the CVAD site. One of the auditor (myself) was obliged to perform the task in the first half of the working hour and after that, it was mandatory to answer 10 close-ended questions regarding the process and dressing techniques for CVAD. The qualities of the questions were high enough to obtain reliable answers and therefore the observer bias was reduced using explicit statements.    Results Within 24 hours of the clinical audit, each patient’s dressing, maintenance of the CVAD site was assessed, and the auditor was destined to produce 100 percent compliance to the audit criteria. However, the result, which was achieved, had 13 completely met results, 9 partially met results and 11 not met results. Within the not met results, 2 was resulted as the nursing and physician staff were unable to comply with that of the Australian CVAD site dressing procedure, 3 of them did not followed the sanitation and cleanliness policies and further 1 did not informed the family or the patient prior to the application of the intervention. Furthermore, 2 of the not met results were due to the lack in the documentation procedure of the dressing and, maintenance of the CVAD site (Quality and Patient Safety Directorate 2018). Handover Compliance with Standards Group of bed No of beds Met Partially met Not met Group of beds, in which completely met result was found 13       Group of bed in which partially met result was found 9       Group of bed, in which not met results were observed 6       Patients of those 13 beds were provided with all the safety measures and while changing the dressing of the CVAD site, the proper cleaning, maintenance and securement of the site was determined. Within those 13, 9 processes met the audit criteria and compliance with the process by 100 percent. Further, 4 of them missed very negligible points and therefore met the criteria with 93 percent. They did not ensured only two-closed site in the CVAD, in which one is close to the insertion site, therefore 93 percent compliance was assigned.    Discussion And Analysis The prime problem, which was observed while the clinical audit process for the dressing and maintenance of the clinical audit process was noncompliance to the dressing and maintenance process and policy of the Australian government. The registered nurses that were assigned with the duties of dressing of the CVAD site of patients of those 9 beds, were not able to recall the steps of dressing technique. They missed on sanitization and cleaning process. Further, involving the patients or families in the process prior to every dressing is mandatory, which was not done in 2 of the cases. Despite of these factors, there are evidences that better dressing and maintenance of the CVAD site and the patients can be saved from different infections such as bacterial infection, blood stream related infection and many more. Further, the documentation of these dressings can help in maintaining update information, and involving the patient and their families in the care giving process. However, according to Ulman et al. (2017), patient and the nursing staff are the constants of the care giving process therefore; the understanding between them should be clear and honest. The nursing staff should be provided with training of the dressing and maintenance techniques for CVAD site. Practice improvement is necessary for the expected standard of care. The partially met results also need to be analyzed as the steps, which was missed by the healthcare professionals while taking care of the CVAD site of 28 patients. Those steps were very crucial and could have become the reason for the deterioration of the health of the patient. Each of the audit process was carried out under surveillance of bias-less auditors and therefore, this much clinical faults were highlighted in this clinical process (Gillanders et al. 2012).    Quality Improvement And Recommendations The process of quality improvement is followed in any organization to improve the quality of the process by adhering to the current standards of the process and further provide service delivery to the customers or adjacent clients. Such quality improvement program should be properly designed, addressed for the users and should be monitored and evaluated by an authority of the organization (Broadhurst, Moureau and Ullman 2017). The change in the attitude is necessary for the hospital staff and registered nurses so that the high-risk activities like CVAD site dressing and maintenance can be done with proper dedication. Further, the improvement should be made in the process of dressing change. The associated workers should be provided with training and incentives so that they can stick to the core process and reduce their number of faults (Officer 2017). Two main stakeholders of the healthcare facility that is the end user or the patients and the care providers such as the registered nurses should be given with the power to implement changes that are beneficial for the entire care process. The opinions of the care providers or the nurses should be taken into consideration. The hospital authority should also come up with policies that can uplift the quality of the CVAD care and the nursing staff can learn the process within shorter time.  The clinical audit team recommended the hospital authority that they should take their role seriously by reviewing the processes and implementing necessary changes.  An evaluation plan should also be prepared so that the pre and post audit situation of the healthcare unit can be properly understood (Broadhurst, Moureau and Ullman 2017). Conclusion As mentioned earlier, audit is one of the vital processes that should be held in any productive organization to maintain the quality and understand the loopholes that prevent the organization to attain perfection. CVAD maintenance is one of the vital processes in clinical settings and the patients are vulnerable to different infections. Therefore to maintain the standards of CVAD care, dressing technique, sanitization process and maintenance, the Australian government has set out a policy, which is divided and adapted in different regions of Australia differently. This assignment discussed about a clinical; audit in healthcare setting and the audit was to identify and assess the CVAD dressing technique and care process. The results of the clinical audit indicated that the process contains some loopholes that need to be filled up within shorter period. A set of recommendations were provided for the same. This audit was about quality assurance and the prime aim was to comply the current process of CVAD dressing technique comply with the national standard completely.    References Annals, K.E.M.U., Zahid, B. and Tayyeb, R., 2016. Clinical Audit of hysterectomies. Annals of King Edward Medical University, 11(3). Broadhurst, D., Moureau, N. and Ullman, A.J., 2017. Management of Central Venous Access Device-Associated Skin Impairment: An Evidence-Based Algorithm. Journal of Wound, Ostomy, and Continence Nursing, 44(3), p.211. Central Venous Access Device Insertion and Post Insertion Care (2018). Central Venous Access Device Insertion and Post Insertion Care. [online] Available at: Chong, L.M., Chow, Y.L., Kong, S.S.C. and Ang, E., 2013. Maintenance of patency of central venous access devices by registered nurses in an acute ambulatory setting: an evidence utilisation project. International Journal of Evidence?Based Healthcare, 11(1), pp.20-25. Gillam, S. and Siriwardena, A.N., 2013. Frameworks for improvement: clinical audit, the plan-do-study-act cycle and significant event audit. Quality in Primary Care, 21(2). Gillam, S. and Siriwardena, A.N., 2013. Frameworks for improvement: clinical audit, the plan-do-study-act cycle and significant event audit. Quality in Primary Care, 21(2). Gillanders, L., Angstmann, K., Ball, P., O’Callaghan, M., Thomson, A., Wong, T. and Thomas, M., 2012. A prospective study of catheter-related complications in HPN patients. Clinical nutrition, 31(1), pp.30-34. Moureau, N., Lamperti, M., Kelly, L.J., Dawson, R., Elbarbary, M., Van Boxtel, A.J.H. and Pittiruti, M., 2013. Evidence-based consensus on the insertion of central venous access devices: definition of minimal requirements for training. British journal of anaesthesia, 110(3), pp.347-356. Officer, C.O., 2017. Care of Central Vascular Access Device:-Tunnelled. Policy. Quality and Patient Safety Directorate (2018). Clinical Audit – Ireland’s Health Service. [online] Ireland’s Health Service. Available at: Ullman, A.J., Cooke, M., Kleidon, T. and Rickard, C.M., 2017. Road map for improvement: Point prevalence audit and survey of central venous access devices in paediatric acute care. Journal of paediatrics and child health, 53(2), pp.123-130. Unnithan, A.R., Gnanasekaran, G., Sathishkumar, Y., Lee, Y.S. and Kim, C.S., 2014. Electrospun antibacterial polyurethane–cellulose acetate–zein composite mats for wound dressing. Carbohydrate polymers, 102, pp.884-892.

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