EVIDENCE- BASED PRACTICE PROPOSAL SECTION A2EVIDENCE- BASED PR.docx

EVIDENCE- BASED PRACTICE PROPOSAL SECTION A:2
EVIDENCE- BASED PRACTICE PROPOSAL SECTION A:7
Running head: EVIDENCE- BASED PRACTICE PROPOSAL
SECTION A:1
Evidence- Based Practice Proposal- Section A: Organizational
Culture and Readiness Assessment
Evidence based practice (EBP) should be fundamental in every
healthcare setting in the sense that it ensures decisions based on
the best evidence integrated with clinical experience and the
various expectations of patients within the healthcare setting
(Gale & Schaffer, 2009). The main objective and aim in
evidence-based practice protocols are to integrate the clinical
expertise with the patient’s perspective and the scientific
evidence in a bid to provide efficient and high quality
healthcare services which are based on the needs, values,
interests and culture of the patients served by the healthcare
organization in question. It should be noted that evidence-
based practice is essential as it does integrate the perspective of
the patient, including values and culture in providing higher
quality healthcare supported by research and scientific evidence
(Gale & Schaffer, 2009). In essence it ensures the provision of
quality and reliability of the healthcare services provided within

the healthcare setting.
In regards to the healthcare organization I am currently
employed by, and would opt for the implementation of EBP in,
the organization is ready for the implementation of EBP in the
sense that all stakeholders are in support of implementation of
EBP protocols in the various units. Considering the fact that my
organization is a very small critical access hospital in rural
Georgia, with very limited resources, the organization is ready
to fully adopt EBP. All stakeholders believe that such
implementation is critical and vital for ensuring quality, and
reliable healthcare service that is comprehensive and not only
meets but exceeds the needs and expectations of our clients.
According to the survey, some respondents were in full support
of the implantation of EBP, while others were not. It should be
noted that the category scores for the survey varied due to the
fact that respondents had a varied degree of preference when it
comes to the implementation of EBP, and changes to practice
within the facility. Most respondents responded higher in areas
pertaining to changes in providing educational strategies
according to EBP guidelines (Melnyk & Fineout-Overholt,
2015). Incorporating EBP within the facility basically requires
all the organizational stakeholders to develop a culture of
openness and inquiry since such implementation provides very
clear parameters for quality and efficient care (Melnyk &
Fineout-Overholt, 2015). Some of the notable barriers to the
full implementation of EBP include lack of managerial
commitment to the full implementation, lack of resources due to
the size and financial situation of the facility. Above all lack
of interest of upper management to assist staff in obtaining
adequate skill and expertise to fully comprehend and implement
EBP within the facility.
References
Gale, B. P., & Schaffer, M. A. (2009). Organizational readiness
for evidence-based practice. Journal of Nurssing
Administration, 39(2), 91-97. Retrieved from https://inf-

fussion.ca/media/nurseone/page-content/pdf-fr/organizational-
readiness-for-evidence-based-practice.pdf
Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-Based
Practice in Nursing & Healthcare: A Guide to Best Practice (3rd
ed.). Philadelphia: .
ECET-230 – Digital Circuits and Systems
Homework Assignment #4 Name 1. What is the output
frequency of Q1 in the circuit shown below?2. A synchronous
binary counter is used to divide a 1 MHz input frequency to
3.90625 kHz. What is the MOD number of the counter and how
many flip-flops are required?3. If the MOD-8 binary counter is
driven by a 10 MHz input clock with a 5% duty cycle, what is
the output frequency and duty cycle of the final stage?4.
Determine the output frequency for the cascaded counter
configuration shown below.
Output
100 kHz
DIV 8
DIV 16
DIV 4Design a circuit that will convert a 2 MHz input
frequency to a .5 MHz output frequency. You may submit a
Multisim worksheet or a neatly hand-written schematic.
9&10. Write the VHDL code to design the counter from the last
slide of the Week #4 lecture that produces the following
counting sequence: 12-13-14-15-16-17-12-13…
ECET-230Homework Assignment #4Page 2 of 2
EVIDENCE-BASED PRACTICE PROPOSAL- SECTION B:6
EVIDENCE-BASED PRACTICE PROPOSAL- SECTION B:4

Running head: EVIDENCE-BASED PRACTICE PROPOSAL-
SECTION B:5
Evidence-Based Practice Proposal- Section B: Problem
Description
Problem Definition
Evidence- based Practice or EBP can help change and improve
care in many different healthcare settings. It is essential
therefore to assess the organizational-wide problems that
require the most attention and implementation of EBP protocols.
In the case of my individual organization the major problem
that requires the most immediate attention is the problem of
inadequate provision of quality and efficient healthcare services
in the sepsis identified patient due to poor coordination among
healthcare providers, physicians, and other key stakeholders
within the facility. It should be noted that the major goal of
every healthcare organization is to provide quality and
reliability for patients seeking healthcare services (Melnyk &
Fineout-Overholt, 2015). Statistics show that one out of four
patients who become septic in the hospital will die due to the
illness (Surviving Sepsis Campaign Guidelines Committee
including the pediatric Subgroup [SSCGC], 2013). It is proven
to be detrimental that these patients are identified very early
and treated aggressively to decrease mortality, length of stay
and reduce the cost of care. Utilization of EBP protocols
during Emergency Department triage and care can provide safer,
better quality care, saving lives, reducing length of stay and

reducing cost of care for patients and third party payers. This
should be the guiding principle of every healthcare
organization, although it is the goal of this healthcare
organization it has become very difficult for this organization to
fully realize because of the lack of resources and poor
integration of departments within the facility as well as the lack
of coordination among healthcare providers, physicians and
other key stakeholders. The problem of poor coordination
among healthcare providers and physicians within the facility is
the main contributor to inadequate provision of quality and
reliable healthcare services within the facility. It is essential to
adopt EBP with the facility to ensure quality and efficient care
for all patients.
Stakeholders/change agents
Successful implementation of EBP requires efficient
coordination of all units and cooperation among all stakeholders
within the facility. These stakeholders form part of the change
agent and they include individual providers, practitioners,
nurses, patients, nurse managers and other key stakeholders
within the facility. These change agents play an important role
in facilitating change since they coordinate the flow of
information about the proposed change (Melnyk & Fineout-
Overholt, 2015). It is also important to note that these change
agents support and champion for the innovation and help
overcome any resistance to the proposed changes (Melnyk &
Fineout-Overholt, 2015).
PICOT Question
In Emergency Department patients, over eighteen years of age,
what impact does implementing sepsis evidence-based protocols
have on the level of compliance among nurses with best practice
recommendations (early identification, diagnosis and treatment,
utilizing the use of lactate levels, cultures, and the sepsis
bundle) in comparison to no protocol use?
The project purpose and objective
The main purpose and objective of this project is to ensure
effective provision of quality, reliable patient care through the

adoption of EBP sepsis protocols that 1) ensure efficient and
effective coordination of care among nurses and other key
stakeholders within the facility 2) establish patient potential for
sepsis early 3) implement sepsis adult evidence based protocols
within one hour.
Supportive rationale
Sepsis has been one of leading causes of death in healthcare
facilities around the world for many years. Even with the many
campaigns and availability of evidence for the early
identification and treatment there is a continued higher death
rate associated with cases of sepsis (McClelland & Moxon,
2014). Efficient coordination of nurses and other key change
agents enables effective provision of quality care within the
facility which results in more than adequate care and improved
health and safety of patients within the facility (Melnyk &
Fineout-Overholt, 2015). Adopting EBP sepsis protocols will
result in several changes including a more engaged facility,
improved communication among healthcare providers and staff
and all around improved patient care. The problem of lack of
coordination among healthcare providers and other healthcare
staff has resulted in poor quality of healthcare services within
this facility. Implementing EBP sepsis protocols will ensure
higher coordination among providers and physicians which will
result in improved sepsis identification and patient care.
References
McClelland, H., & Moxon, A. (2014). Early identification and
treatment of sepsis. Nursing Times, 110(4), 14-17. Retrieved
from www.nursingtmes.net/download?ac=1275356
Surviving Sepsis Campaign Guidelines Committee including the
pediatric Subgroup. (2013, February). Surviving sepsis
campaign: international guidelines for management of severe
sepsis and septic shock: 2012. Critical Care Medicine, 41(2),

580-637. http://dx.doi.org/doi:10.1097/CCM.0b013e31827e83af
EVIDENCE BASED PRACTICE PROPOSAL- SECTION C6
EVIDENCE BASED PRACTICE PROPOSAL- SECTION C4
Running head: EVIDENCE BASED PRACTICE PROPOSAL-
SECTION C5
Evidence Based Practice Proposal- Section C
Search Method:
An extensive literature search for the most pertinent best
practice evidence on providing care for the sepsis Patient was
conducted, utilizing the following search engines; a) Cochrane
Library, b) Cumulative Index to Nursing and Allied Health
(CINAHL) via Grand Canyon University (GCU) Fleming
Library, d) Proquest via GCU Fleming Library, e) Pubmed via
National Center for Biotechnology (NCBI). The key words that
were searched were categorized into three groups: a) by disease-
utilizing, sepsis, septic and severe sepsis, b) Interventions
utilizing, early identification, diagnosis, alert, guidelines,
bundles, protocols, c) population utilizing, emergency room,
emergency department, ED, ER all terms were consistently used
throughout the data bases to ensure search consistency.
Inclusion/Exclusion Criteria:
Inclusion criteria included peer-reviewed articles, scholarly

articles published in the English language with publications
dated 2012 or later. Articles pertaining to adult patient
population, with focus on early identification, diagnosis and
treatment of sepsis patients in the Emergency department,
identified or initiated performance improvement or other
protocols with included interventions consistent with
recommendations in the 2012 Surviving Sepsis Guidelines, or
discussed barriers to implementing sepsis protocols in the
Emergency department.
Exclusion criteria included articles that focused on the
advanced care of sepsis patients in intensive care units, focus on
obstetric patients or pediatric patients, focused on guidelines
written prior to 2012, and most articles published before 2012.
Search results returned 10 articles, Cochrane Library returned
not evidence meeting criteria, CINAHL returned 22 articles,
Proquest returned 16 articles (after the removal of duplicates)
38 articles were reviewed and 10 articles were included. All
studies included were appraised following the hierarchy of
evidence, the majority of studies are level II as they are
randomized control trials, or cohort studies, one level I
systematic review and Meta-analysis study as well as one
nonexperimental study and Clinical Practice Guidelines.
Summary of Research
The research found supports the clinical question and has been
utilized in developing protocols for early identification and
treatment of sepsis utilizing lactate levels, and sepsis bundles.
All studies identified sepsis as being a time-critical medical
emergency, requiring early intervention, making early
identification and treatment with sepsis bundles key to patient
survival. Mortality rates for sepsis is identified at 28% to 50%
with a 7.6% increase for every hour without directed and
specific interventions (Perman, Goyal, & Gaieski, 2012).
Studies reviewed showed use of protocols in the emergency
department increased education and awareness in emergency
department nurses leading to an increased use of sepsis of
sepsis guidelines, further proving nurses are vital to identifying

patients presenting with sepsis and to early intervention and
treatment protocols that demonstrated early screening
interventions lead to expedited delivery of interventions and
care for sepsis identified patients. Each study identified
screening criteria including systemic inflammatory response
syndrome (SIRS) including systolic blood pressure < 90mmHg,
heart rate > 90 bpm, respiratory rate> 20, temperature > 38C or
<36C, and presence of suspected or known infection (Hayden et
al., 2015). All studies reviewed combined early warning scores
(EWS) and introduction of evidence-based protocols, with early
intervention using serum lactate levels, obtaining appropriate
cultures and intravenous fluid resuscitation and early treatment
with antibiotics can significantly reduce mortality in patients
with severe sepsis and septic shock (McClelland & Moxon,
2014). The studies revealed that education alone was able to
improve nurses compliance and adherence to resuscitation and
management bundles, and reduced mortality rates. The
inclusion of evidence based protocols and changes were
associated with even more reduction in mortality rates (Damiani
et al., 2015)
Limitations of Research studies
Limitations include some studies lacked generalizability, due to
being single site, retrospective studies that the original
information was not documented for the purpose of the study.
One study although information was collected and documented
for the study only a single site was included in the study. One
study all the included studies were observational investigations
and cannot support connection between performance
improvement, increase in bundle compliance and decrease in
patient mortality with uncomplicated septic shock or severe
sepsis.
External validity as well generalizability of the different
versions of protocols and resuscitation bundles was established.
Patient populations of studies were representative of the adult
emergency department patient population. The patient
populations and data collected was typical of emergency

department adult sepsis patient. Goal- directed therapy and
protocols early was shown to decrease cost of care, significantly
reduce mortality, and increase clinician adherence to clinical
guidelines and modification of clinician behavior associated
with identification of the sepsis patient.
The author expertise was unassailable, all recommendations are
supported by high quality evidence and clinical guidelines.
Most studies were observational and were dedicated to
educating emergency department nurses on the importance of
compliance with sepsis guidelines through the use of protocols
(Gatewood, Wemple, Greco, Kritek, & Durvasula, 2015).
References
Damiani, E., Donati, A., Serafini, G., Rinaldi, L., Adrario, E.,
Pelaia, P., ... Girardis, M. (2015, May 6, ). Effect of
performance improvment programs on compliance with sepsis
bundles and mortality: A systematic review and meta-analysis
of oberservational studies. PLOS One, 10(5).
http://dx.doi.org/doi:10.137/journal.pone.0125827
Gatewood, M. O., Wemple, M., Greco, S., Kritek, P. A., &
Durvasula, R. (2015, August 6,). A quality improvement project
to improve early sepsis care in the emergency department. The
Health Foundation Inspiring Improvement, 787-795.
http://dx.doi.org/doi:10.1136/bmjqs-2014-003552
Hayden, G. E., Tuuri, R. E., Scott, R., Losek, J. D., Blackshaw,
A. M., Schoenling, A. J., ... Hall, G. A. (2015). Triage sepsis
alert and sepsis protocol lower times to fluids and antibiotics in
the ED. American Journal of Emergency Medicine, (), .
http://dx.doi.org/Retrieved from
Perman, S. M., Goyal, M., & Gaieski, D. F. (2012). Initial
emergency department diagnosis and management of adult
patients with severe sepsis and septic shock. Scandinavian
Journal of Trauma, Resusitation & Emergency Medicine,

20(41). http://dx.doi.org/doi:10.1186/1757-7241-20-41
Please be sure to separate the two sections into separate parts
and please remember to add the timeline and the change modes
to be added to the appendix as is stated in the assignment
In 500-750 words (not including the title page and reference
page), apply a change model to the implementation plan.
Include the following: Section E the change model
1. Roger's diffusion of innovation theory is a particularly good
theoretical framework to apply to an EBP project. However,
students may also choose to use change models, such as Duck's
change curve model or the transtheoretical model of behavioral
change. Other conceptual models presented such as a utilization
model (Stetler's model) and EBP models (the Iowa model and
ARCC model) can also be used as a framework for applying
your evidence-based intervention in clinical practice.
2. Apply one of the above models and carry your
implementation through each of the stages, phases, or steps
identified in the chosen model.
3. In addition, create a conceptual model of the project.
Although you will not be submitting the conceptual model you
design in Topic 5 with the narrative, the conceptual model
should be placed in the appendices for the final paper.
Prepare this assignment according to the APA guidelines found
in the APA Style Guide, located in the Student Success Center.
An abstract is not required.
page), provide a description of the methods to be used to
implement the proposed solution. Include the following:
1. Describe the setting and access to potential subjects. If there
is a need for a consent or approval form, then one must be
created. Although you will not be submitting the consent or
approval form(s) in Topic 5 with the narrative, the consent or
approval form(s) should be placed in the appendices for the
final paper.
2. Describe the amount of time needed to complete this project.

Create a timeline. Make sure the timeline is general enough that
it can be implemented at any date. Although you will not be
submitting the timeline in Topic 5 with the narrative, the
timeline should be placed in the appendices for the final paper.
3. Describe the resources (human, fiscal, and other) or changes
needed in the implementation of the solution. Consider the
clinical tools or process changes that would need to take place.
Provide a resource list. Although you will not be submitting the
resource list in Topic 5 with the narrative, the resource list
4. Describe the methods and instruments, such as a
questionnaire, scale, or test to be used for monitoring the
implementation of the proposed solution. Develop the
instruments. Although you will not be submitting the individual
instruments in Topic 5 with the narrative, the instruments
5. Explain the process for delivering the (intervention) solution
and indicate if any training will be needed.
6. Provide an outline of the data collection plan. Describe how
data management will be maintained and by whom.
Furthermore, provide an explanation of how the data analysis
and interpretation process will be conducted. Develop the data
collection tools that will be needed. Although you will not be
submitting the data collection tools in Topic 5 with the
narrative, the data collection tools should be placed in the
appendices for the final paper.
7. Describe the strategies to deal with the management of any
barriers, facilitators, and challenges.
8. Establish the feasibility of the implementation plan. Address
the costs for personnel, consumable supplies, equipment (if not
provided by the institute), computer related costs (librarian
consultation, database access, etc.), and other costs (travel,
presentation development). Make sure to provide a brief
rationale for each. Develop a budget plan. Although you will
not be submitting the budget plan in Topic 5 with the narrative,
the budget plan should be placed in the appendices for the final

paper.
9. Describe the plans to maintain, extend, revise, and
discontinue a proposed solution after implementation.
in the APA Style Guide, located in the Student Success Center.
The following are the sections I have completed with the
references please use intext citations and please be sure to
create the time line And the change Model separate from each
paper to be added in the appendix at the end
Evidence- Based Practice Proposal- Section A: Organizational
Culture and Readiness Assessment
Evidence based practice (EBP) should be fundamental in every
healthcare setting in the sense that it ensures decisions based on
the best evidence integrated with clinical experience and the
various expectations of patients within the healthcare
setting (Gale & Schaffer, 2009). The main objective and aim in
evidence-based practice protocols are to integrate the clinical
expertise with the patient’s perspective and the scientific
evidence in a bid to provide efficient and high quality
healthcare services which are based on the needs, values,
interests and culture of the patients served by the healthcare
organization in question. It should be noted that evidence-
based practice is essential as it does integrate the perspective of
the patient, including values and culture in providing higher
quality healthcare supported by research and scientific
evidence (Gale & Schaffer, 2009). In essence it ensures the
provision of quality and reliability of the healthcare services
provided within the healthcare setting.
In regards to the healthcare organization I am currently
employed by, and would opt for the implementation of EBP in,
the organization is ready for the implementation of EBP in the
sense that all stakeholders are in support of implementation of
EBP protocols in the various units. Considering the fact that my
organization is a very small critical access hospital in rural
Georgia, with very limited resources, the organization is ready
to fully adopt EBP. All stakeholders believe that such

implementation is critical and vital for ensuring quality, and
reliable healthcare service that is comprehensive and not only
meets but exceeds the needs and expectations of our clients.
According to the survey, some respondents were in full support
of the implantation of EBP, while others were not. It should be
noted that the category scores for the survey varied due to the
fact that respondents had a varied degree of preference when it
comes to the implementation of EBP, and changes to practice
within the facility. Most respondents responded higher in areas
pertaining to changes in providing educational strategies
according to EBP guidelines (Melnyk & Fineout-Overholt,
2015). Incorporating EBP within the facility basically requires
all the organizational stakeholders to develop a culture of
openness and inquiry since such implementation provides very
clear parameters for quality and efficient care (Melnyk &
Fineout-Overholt, 2015). Some of the notable barriers to the full
implementation of EBP include lack of managerial commitment
to the full implementation, lack of resources due to the size and
financial situation of the facility. Above all lack of interest of
upper management to assist staff in obtaining adequate skill and
expertise to fully comprehend and implement EBP within the
facility.
References part A
Gale, B. P., & Schaffer, M. A. (2009). Organizational readiness
for evidence-based practice. Journal of Nurssing
Administration, 39(2), 91-97. Retrieved from https://inf-
fussion.ca/media/nurseone/page-content/pdf-fr/organizational-
readiness-for-evidence-based-practice.pdf
Evidence-Based Practice Proposal- Section B: Problem
Description
Problem Definition
Evidence- based Practice or EBP can help change and improve
care in many different healthcare settings. It is essential

therefore to assess the organizational-wide problems that
require the most attention and implementation of EBP protocols.
In the case of my individual organization the major problem
that requires the most immediate attention is the problem of
inadequate provision of quality and efficient healthcare services
in the sepsis identified patient due to poor coordination among
healthcare providers, physicians, and other key stakeholders
within the facility. It should be noted that the major goal of
every healthcare organization is to provide quality and
reliability for patients seeking healthcare services (Melnyk &
Fineout-Overholt, 2015). Statistics show that one out of four
patients who become septic in the hospital will die due to the
illness (Surviving Sepsis Campaign Guidelines Committee
including the pediatric Subgroup [SSCGC], 2013). It is proven
to be detrimental that these patients are identified very early
and treated aggressively to decrease mortality, length of stay
and reduce the cost of care. Utilization of EBP protocols during
Emergency Department triage and care can provide safer, better
quality care, saving lives, reducing length of stay and reducing
cost of care for patients and third party payers. This should be
the guiding principle of every healthcare organization, although
it is the goal of this healthcare organization it has become very
difficult for this organization to fully realize because of the lack
of resources and poor integration of departments within the
facility as well as the lack of coordination among healthcare
providers, physicians and other key stakeholders. The problem
of poor coordination among healthcare providers and physicians
within the facility is the main contributor to inadequate
provision of quality and reliable healthcare services within the
facility. It is essential to adopt EBP with the facility to ensure
quality and efficient care for all patients.
Stakeholders/change agents
Successful implementation of EBP requires efficient
coordination of all units and cooperation among all stakeholders
within the facility. These stakeholders form part of the change
agent and they include individual providers, practitioners,

nurses, patients, nurse managers and other key stakeholders
within the facility. These change agents play an important role
in facilitating change since they coordinate the flow of
information about the proposed change (Melnyk & Fineout-
Overholt, 2015). It is also important to note that these change
agents support and champion for the innovation and help
overcome any resistance to the proposed changes (Melnyk &
Fineout-Overholt, 2015).
PICOT Question
In Emergency Department patients, over eighteen years of age,
what impact does implementing sepsis evidence-based protocols
have on the level of compliance among nurses with best practice
recommendations (early identification, diagnosis and treatment,
utilizing the use of lactate levels, cultures, and the sepsis
bundle) in comparison to no protocol use?
The project purpose and objective
The main purpose and objective of this project is to ensure
effective provision of quality, reliable patient care through the
adoption of EBP sepsis protocols that 1) ensure efficient and
effective coordination of care among nurses and other key
stakeholders within the facility 2) establish patient potential for
sepsis early 3) implement sepsis adult evidence based protocols
within one hour.
Supportive rationale
Sepsis has been one of leading causes of death in healthcare
facilities around the world for many years. Even with the many
campaigns and availability of evidence for the early
identification and treatment there is a continued higher death
rate associated with cases of sepsis (McClelland & Moxon,
2014). Efficient coordination of nurses and other key change
agents enables effective provision of quality care within the
facility which results in more than adequate care and improved
health and safety of patients within the facility (Melnyk &
Fineout-Overholt, 2015). Adopting EBP sepsis protocols will
result in several changes including a more engaged facility,
improved communication among healthcare providers and staff

and all around improved patient care. The problem of lack of
coordination among healthcare providers and other healthcare
staff has resulted in poor quality of healthcare services within
this facility. Implementing EBP sepsis protocols will ensure
higher coordination among providers and physicians which will
result in improved sepsis identification and patient care.
References section B
Surviving Sepsis Campaign Guidelines Committee including the
pediatric Subgroup. (2013, February). Surviving sepsis
campaign: international guidelines for management of severe
sepsis and septic shock: 2012. Critical Care Medicine, 41(2),
580-637. http://dx.doi.org/doi:10.1097/CCM.0b013e31827e83af
Search Method:
An extensive literature search for the most pertinent best
practice evidence on providing care for the sepsis Patient was
conducted, utilizing the following search engines; a) Cochrane
Library, b) Cumulative Index to Nursing and Allied Health
(CINAHL) via Grand Canyon University (GCU) Fleming
Library, d) Proquest via GCU Fleming Library, e) Pubmed via
National Center for Biotechnology (NCBI). The key words that
were searched were categorized into three groups: a) by disease-
utilizing, sepsis, septic and severe sepsis, b) Interventions
utilizing, early identification, diagnosis, alert, guidelines,
bundles, protocols, c) population utilizing, emergency room,
emergency department, ED, ER all terms were consistently used
throughout the data bases to ensure search consistency.
Inclusion/Exclusion Criteria:
Inclusion criteria included peer-reviewed articles, scholarly
articles published in the English language with publications
dated 2012 or later. Articles pertaining to adult patient

population, with focus on early identification, diagnosis and
treatment of sepsis patients in the Emergency department,
identified or initiated performance improvement or other
protocols with included interventions consistent with
recommendations in the 2012 Surviving Sepsis Guidelines, or
discussed barriers to implementing sepsis protocols in the
Emergency department.
Exclusion criteria included articles that focused on the
advanced care of sepsis patients in intensive care units, focus on
obstetric patients or pediatric patients, focused on guidelines
written prior to 2012, and most articles published before 2012.
Search results returned 10 articles, Cochrane Library returned
not evidence meeting criteria, CINAHL returned 22 articles,
Proquest returned 16 articles (after the removal of duplicates)
38 articles were reviewed and 10 articles were included. All
studies included were appraised following the hierarchy of
evidence, the majority of studies are level II as they are
randomized control trials, or cohort studies, one level I
systematic review and Meta-analysis study as well as one
nonexperimental study and Clinical Practice Guidelines.
Summary of Research
The research found supports the clinical question and has been
utilized in developing protocols for early identification and
treatment of sepsis utilizing lactate levels, and sepsis bundles.
All studies identified sepsis as being a time-critical medical
emergency, requiring early intervention, making early
identification and treatment with sepsis bundles key to patient
survival. Mortality rates for sepsis is identified at 28% to 50%
with a 7.6% increase for every hour without directed and
specific interventions (Perman, Goyal, & Gaieski, 2012).
Studies reviewed showed use of protocols in the emergency
department increased education and awareness in emergency
department nurses leading to an increased use of sepsis of
sepsis guidelines, further proving nurses are vital to identifying
patients presenting with sepsis and to early intervention and
treatment protocols that demonstrated early screening

interventions lead to expedited delivery of interventions and
care for sepsis identified patients. Each study identified
screening criteria including systemic inflammatory response
syndrome (SIRS) including systolic blood pressure < 90mmHg,
heart rate > 90 bpm, respiratory rate> 20, temperature > 38C or
<36C, and presence of suspected or known infection (Hayden et
al., 2015). All studies reviewed combined early warning scores
(EWS) and introduction of evidence-based protocols, with early
intervention using serum lactate levels, obtaining appropriate
cultures and intravenous fluid resuscitation and early treatment
with antibiotics can significantly reduce mortality in patients
with severe sepsis and septic shock (McClelland & Moxon,
2014). The studies revealed that education alone was able to
improve nurses compliance and adherence to resuscitation and
management bundles, and reduced mortality rates. The inclusion
of evidence based protocols and changes were associated with
even more reduction in mortality rates (Damiani et al., 2015)
Limitations of Research studies
Limitations include some studies lacked generalizability, due to
being single site, retrospective studies that the original
information was not documented for the purpose of the study.
One study although information was collected and documented
for the study only a single site was included in the study. One
study all the included studies were observational investigations
and cannot support connection between performance
improvement, increase in bundle compliance and decrease in
patient mortality with uncomplicated septic shock or severe
sepsis.
External validity as well generalizability of the different
versions of protocols and resuscitation bundles was established.
Patient populations of studies were representative of the adult
emergency department patient population. The patient
populations and data collected was typical of emergency
department adult sepsis patient. Goal- directed therapy and
protocols early was shown to decrease cost of care, significantly
reduce mortality, and increase clinician adherence to clinical

guidelines and modification of clinician behavior associated
with identification of the sepsis patient.
The author expertise was unassailable, all recommendations are
supported by high quality evidence and clinical guidelines.
Most studies were observational and were dedicated to
educating emergency department nurses on the importance of
compliance with sepsis guidelines through the use of
protocols (Gatewood, Wemple, Greco, Kritek, & Durvasula,
2015).
References Section C
Damiani, E., Donati, A., Serafini, G., Rinaldi, L., Adrario, E.,
Pelaia, P., ... Girardis, M. (2015, May 6, ). Effect of
performance improvment programs on compliance with sepsis
bundles and mortality: A systematic review and meta-analysis
of oberservational studies. PLOS One, 10(5).
http://dx.doi.org/doi:10.137/journal.pone.0125827
Gatewood, M. O., Wemple, M., Greco, S., Kritek, P. A., &
Durvasula, R. (2015, August 6,). A quality improvement project
to improve early sepsis care in the emergency department. The
Health Foundation Inspiring Improvement, 787-795.
http://dx.doi.org/doi:10.1136/bmjqs-2014-003552
A. M., Schoenling, A. J., ... Hall, G. A. (2015). Triage sepsis
alert and sepsis protocol lower times to fluids and antibiotics in
the ED. American Journal of Emergency Medicine, (), .
http://dx.doi.org/Retrieved from
Journal of Trauma, Resusitation & Emergency
Medicine, 20(41). http://dx.doi.org/doi:10.1186/1757-7241-20-
41

Evidence Based Practice Proposal- Section D
Proposed
Solution
Quality of care for septic patients can improve through
implementing simple low-cost EBP care bundles (Perman,
Goyal, & Gaieski, 2012). This plan for changes in the early
identification and treatment of adult sepsis patients > 18 years
of age in the ED with best practice recommendations for
identification and treatment with utilization of the International
Guidelines for Management of Severe Sepsis and Septic Shock:
2012. The proposed change will add an EBP protocol for
changes in how the emergency department triage nurse and staff
will screen adult patients for signs of sepsis Utilizing early
warning scores (EWS) that trigger systems within the computer
based program. For the EWS this protocol will follow the
standardized national EWS or NEWS that was introduced in the
UK. The use of NEWS for patients presenting with sepsis in the
ED shows a positive correlation with increased NEWS scores
during triage and adverse patient outcomes including Intensive
Care Unit (ICU) admission and increased mortality (Keep et al.,
2015). Utilizing systemic inflammatory response syndrome
(SIRS) criteria, per the most recent Surviving Sepsis Campaign

Guidelines. With a NEWS score of 3 or > triggering the
initiation of the sepsis protocol, beginning with obtaining blood
samples including; compete blood count (CBC), serum lactate,
complete metabolic panel, cardiac isoenzymes, blood cultures,
urine cultures and sputum cultures as needed, along with chest
radiographs as defined by the Surviving Sepsis Campaign
Guidelines of 2012 and initiation of intravenous fluid (IVF)
resuscitation, antibiotics, and the sepsis bundles also defined by
the guidelines (Dellinger et al., 2013). NEWS score of 3 is 92%
effective in predicting patients at risk for severe sepsis and
septic shock, with a specificity of 77% making NEWS the best
potential trigger for use in early identification of potential
sepsis (Keep et al., 2015). The activation of triggers will begin
a series of steps that includes immediate transfer of the patient
to an ED room, activation of codes sepsis alerting providers,
and ancillary departments of a potential sepsis patient. ED staff
will be educated on the policy and prior to implementation. ID
badge clips that highlight all steps in the sepsis protocol will be
given to all staff in the ED. The major changes will occur with
the addition of NEWS score triggers within the computer based
emergency department triage, and the addition of down time
sepsis screening tools, alerting nurses to a NEWS score of < 3.
Due to lack of resources only point of care blood glucose
testing is available, all laboratory testing will be marked sepsis
protocol, and be done in the hospital lab with a turn- around

time of > 1 hour.
Organization Culture
This proposed plan will be implemented in Monroe County
Hospital. The project is planned to begin an organizational
initiative regarding sepsis, and to improve the care and
outcomes of sepsis patients. The proposed plan can create a
sense of urgency among staff regarding the timely and
appropriate treatment of patients identified as potentially septic.
Another possible strength is through success in the Emergency
Department a hospital wide protocol can receive administrative
support.
Expected Outcomes
The primary outcomes expected are; 1) increased staff
compliance with NEWS score triggers, and sepsis EBP
protocols that are defined by the Surviving Sepsis Guidelines.
2) Decreased patient mortality resulting from increased staff
compliance with sepsis protocols and guidelines. 3) Decreased
patient length of stay resulting from the increased compliance.
4) Facility wide sepsis protocols to increase the early
identification and treatment of sepsis patient previously
admitted following the guidelines defined in the Guidelines for
Surviving Sepsis 2012 (SSGL 2012).
Methods to achieve Outcomes
Achieving the outcomes will begin with introduction of the
NEWS screening tool, introduction of Systemic Inflammatory

Response Syndrome (SIRS) criteria. Sepsis is confirmed by 3 or
more clinical indicators, known infection or both.
The educational strategies will begin with group educational
inservice meetings. Requiring that all nurses fulltime, part time
and PRN or as needed staff attend and are educated on the
NEWS score, SIRS criteria, blood samples and testing, cultures,
and IVF resuscitation, antibiotic therapy and sepsis bundles. All
nurses will have a group educational training session with
computer training on computer changes, the NEWS triggers as
activated by SIRS criteria. This will include the education and
training of physicians, ancillary staff, and other providers on
the NEWS Triggers, SIRS criteria, code sepsis alerts, IVF
resuscitation and all other sepsis guidelines and testing to be
included in the sepsis EBP protocol. There will be one on one
training with all triage trained nurses in the ED ensuring their
understanding of SIRS criteria and NEWS triggers. Education
on the importance of early identification as the key to survival,
good clinical assessments and history to ensure accurate
diagnosis and early intervention (Tromp et al., 2010). There
will be an ongoing educational training phase that will include
the training of all other nurses and any newly trained triage
nurses and newly hired nurses on all the same information the
initial triage nurses were given.
Barriers
Barriers to be assessed are limited to laboratory and radiology

staff, by implementing and training on the code sepsis all
departments will be alerted, there will be mock drills done to
train all involved departments in preparation of protocol
implementations. Physician buy in is another barrier, this will
be eliminated through education on SSGL 2012 and through
passing the protocol through the Medical Executive Committee.
Quality care improvement and patient centered quality care-
Quality of care will be improved through early identification of
potential sepsis, decreasing time to appropriate antibiotics and
IVF resuscitation (Hayden et al., 2015). Early intervention is
proven to significantly reduce patient mortality, length of stay,
and cost of care. Studies are showing implementing nurse-
driven care bundles based on the 2012 guidelines, followed with
training and performance improvement feedback results in early
identification and treatment of patients presenting to the ED
with sepsis or severe sepsis and shock (Tromp et al., 2010).
Efficiency of Processes
One of the JCAOH National Patient Safety Goals for 2016
identified effective communication as one of the goals, the
update includes get important information to the correct staff in
30 minutes or less. Initiation of sepsis care bundles and code
sepsis alerts all staff, physicians and other departments, of the
patient arrival decreasing time to test results and time to
treatment interventions. Increasing knowledge of sepsis
screening and providing knowledge of communication will

support nurses in providing positive sepsis screening to
providers in a timelier manner (Drahnak, Hravnak, Ren, Haines,
& Tuite, 2016).
Environmental changes
Environmental changes include an increased awareness of sepsis
throughout the facility, increasing the possibility of
implementing protocols for early detection of severe sepsis on
Medical Surgical Units reducing patient mortality and reducing
the need for admission to the need for admission to
ICU (Westphal et al., 2011).
Professional Expertise
By increasing nurses’ knowledge and awareness of sepsis and
treatment protocols for sepsis, there is positive effects on
professional expertise. Nurses will be introduced to best
practice guidelines and best available research on sepsis
identification and treatment, increasing the awareness and
expertise in the care of sepsis patients. Providing tools and
education for ancillary staff and physicians will also produce
professional expertise in other care areas and providers.
References Section D
Dellinger, R. P., Levy, M. M., Rhodes, A., Annane, D., Gerlach,
H., Opal, S., ... Moreno, R. (2013). Surviving Sepsis Campaign:
International Guidelines for Management of Severe Sepsis and
Septic Shock:2012. Retrieved from
www.sccm.org/Research/Quality/Pages/Surviving-Sepsis-

Campaign.aspx?gclid=cotcw_qcbdECFRc7gQod0M8POQ
Drahnak, D. M., Hravnak, M., Ren, D., Haines, A. J., & Tuite,
P. (2016, July-August). Scripting nurse communication to
improve sepsis care. Medsurge Nursing , 25(4), 233-239.
Retrieved from
https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com
e/login.aspx?direct=true&db=ccm&AN=117499579&site=eds-
live&scope=site
A. M., Schoenling, A. J., ... Hall, G. A. (2015, April 27). Triage
Sepsis alert and sepsis protocol lower times to fluids and
antibiotics in the ED. American Journal of Emergency
Medicine, 34, 1-9.
http://dx.doi.org/http://dx.doi.org/10.1016/j.ajem.2015.08.039
Keep, J., Messmer, A., Burrell, N., Pinate, R., Tunnicliff, M., &
Glucksman, E. (2015). National early warning score at
Emergency Department triage may allow earlier identificaion of
patients with sever sepsis and septic shock: a retrospective
observational study. Emergency Medicine Journal, 33, 37-41.
http://dx.doi.org/doi:10.1136/emermed-2014-204465
Journal of Trauma, Resusitation & Emergency
Medicine, 20(41).

2 days ago
and please remember to
add the timeline and the change modes to be added to the
appendix as is stated in the
assignment
In 500
-
750 words (not including the title page and reference page),
apply a change model to the
implementation plan. Include the following:
Section E the change model
1.
Roger's diffusion of innovation theory is a particularly good
theoretical framework to apply to an EBP
project. However, students may also choose to use change
models, such as Duck's change curve
model or the transtheoretical model of behavioral change. Ot

her conceptual models presented such
as a utilization model (Stetler's model) and EBP models (the
Iowa model and ARCC model) can also
be used as a framework for applying your evidence
-
based intervention in clinical practice.
2.
Apply one of the above models a
nd carry your implementation through each of the stages,
phases, or
steps identified in the chosen model.
3.
In addition, create a conceptual model of the project. Although
you will not be submitting the
conceptual model you design in Topic 5 with the narrati
ve, the conceptual model should be placed in
the appendices for the final paper.
in the APA Style Guide, located
in the Student Success Center. An abstract is not required.

In 500
-
750 words (not
including the title page and reference page), provide a
description of the
methods to be used to implement the proposed solution. Include
the following:
1.
Describe the setting and access to potential subjects. If there is
a need for a consent or approval
fo
rm, then one must be created. Although you will not be
submitting the consent or approval form(s)
in Topic 5 with the narrative, the consent or approval form(s)
should be placed in the appendices for
the final paper.
2.
Describe the amount of time needed to c
omplete this project. Create a timeline. Make sure the

timeline is general enough that it can be implemented at any
date. Although you will not be submitting
the timeline in Topic 5 with the narrative, the timeline should
be placed in the appendices for th
e final
paper.
3.
Describe the resources (human, fiscal, and other) or changes
needed in the implementation of the
solution. Consider the clinical tools or process changes that
would need to take place. Provide a
resource list. Although you will not be submit
ting the resource list in Topic 5 with the narrative, the
resource list should be placed in the appendices for the final
paper.
4.
Describe the methods and instruments, such as a questionnaire,
scale, or test to be used for
monitoring the implementation of th
e proposed solution. Develop the instruments. Although you
will

not be submitting the individual instruments in Topic 5 with the
narrative, the instruments should be
placed in the appendices for the final paper.
5.
Explain the process for delivering the (inte
rvention) solution and indicate if any training will be
needed.
6.
Provide an outline of the data collection plan. Describe how
data management will be maintained and
by whom. Furthermore, provide an explanation of how the data
analysis and interpretation pro
cess
will be conducted. Develop the data collection tools that will be
needed. Although you will not be
narrative, the data collection tools should be
7.

De
scribe the strategies to deal with the management of any
8.
Establish the feasibility of the implementation plan. Address the
costs for personnel, consumable
supplies, equipment (if not provided by the institute), compu
ter related costs (librarian consultation,
database access, etc.), and other costs (travel, presentation
development). Make sure to provide a
brief rationale for each. Develop a budget plan. Although you
will not be submitting the budget plan in
Topic 5 wi
th the narrative, the budget plan should be placed in the
appendices for the final paper.
and please remember to
add the timeline and the change modes to be added to the
appendix as is stated in the
assignment
page), apply a change model to the

implementation plan. Include the following: Section E the
change model
1. Roger's diffusion of innovation theory is a particularly good
theoretical framework to apply to an EBP
project. However, students may also choose to use change
models, such as Duck's change curve
model or the transtheoretical model of behavioral change. Other
conceptual models presented such
as a utilization model (Stetler's model) and EBP models (the
Iowa model and ARCC model) can also
be used as a framework for applying your evidence-based
intervention in clinical practice.
2. Apply one of the above models and carry your
implementation through each of the stages, phases, or
steps identified in the chosen model.
3. In addition, create a conceptual model of the project.
Although you will not be submitting the
conceptual model you design in Topic 5 with the narrative, the
conceptual model should be placed in
in the APA Style Guide, located
in the Student Success Center. An abstract is not required.
page), provide a description of the

methods to be used to implement the proposed solution. Include
the following:
1. Describe the setting and access to potential subjects. If there
is a need for a consent or approval
form, then one must be created. Although you will not be
submitting the consent or approval form(s)
in Topic 5 with the narrative, the consent or approval form(s)
should be placed in the appendices for
the final paper.
2. Describe the amount of time needed to complete this project.
Create a timeline. Make sure the
timeline is general enough that it can be implemented at any
date. Although you will not be submitting
the timeline in Topic 5 with the narrative, the timeline should
be placed in the appendices for the final
paper.
3. Describe the resources (human, fiscal, and other) or changes
needed in the implementation of the
solution. Consider the clinical tools or process changes that
would need to take place. Provide a
resource list. Although you will not be submitting the resource
list in Topic 5 with the narrative, the
resource list should be placed in the appendices for the final
paper.
4. Describe the methods and instruments, such as a

questionnaire, scale, or test to be used for
monitoring the implementation of the proposed solution.
Develop the instruments. Although you will
not be submitting the individual instruments in Topic 5 with the
narrative, the instruments should be
5. Explain the process for delivering the (intervention) solution
and indicate if any training will be
needed.
6. Provide an outline of the data collection plan. Describe how
data management will be maintained and
by whom. Furthermore, provide an explanation of how the data
analysis and interpretation process
will be conducted. Develop the data collection tools that will be
needed. Although you will not be
narrative, the data collection tools should be
7. Describe the strategies to deal with the management of any
8. Establish the feasibility of the implementation plan. Address
the costs for personnel, consumable
supplies, equipment (if not provided by the institute), computer
related costs (librarian consultation,
database access, etc.), and other costs (travel, presentation

development). Make sure to provide a
brief rationale for each. Develop a budget plan. Although you
will not be submitting the budget plan in
Topic 5 with the narrative, the budget plan should be placed in

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