CNA613 Project Management For Health Professionals

Question: 1 Provide a clear project Problem statement (or aspiration) ensure that it provides a clear statement related to the issue and why it needs addressing. 2 Write a clear project goal. 3 Write a project justification to support your project problem statement and goal – provide references and work place experience to establish an evidence-based approach to the identified need for the project and why this should be funded by your organisation. Answer: When possible, the arteriovenous fistula (AVF) is preferred as the first choice for the hemodialysis vascular access. However, the cannulation is one the major causes of AVF failure and complications(Brouwer, 2011). Puncturing blood vessels with a needle usually causes tissue injury thus triggering leucocytes adhesion, smooth muscles cells mitigation from the media to the intima and finally proliferation(Lok and Foley, 2013). This cascade usually leads to venous stenosis through blood vessel thickening and hyperplasia thus acting as the most frequent cause of access failure(Melnick, 2016). In addition, needle –induce vessel injury can also lead to hematoma, infiltration, AVF loss and aneurysms. One of the most significant complications from vessel induced injury is infiltration(Santoro et al., 2014). Studies suggest that, one infiltration can lead to more than three extra months of catheter dependency and that the approximately annual infiltration rate is more than 5.5%(Vale, Lopez-Vargas and Polkinghorne, 2012). A risk for infection in patients with AVF is also a major issue that needs to be addressed. For Nurses and medical health care professional to minimize the AVF injuries and infections, effective cannulation techniques must be used(Melnick, 2016). This includes the use of ascetic techniques, paired and right needles and required skills in order to meet individual patient needs(Santoro et al., 2014). Therefore, using of needles that help to reduce vessel injuries is important. Other than that, it is important to control pain and maintain the patient physical integrity of the cannulated site(Melnick, 2016). In addition, one cannot discount the need of controlling infections and reduction of anxiety in patients undergoing cannulation. Project Goal The major goal of this project is to enforce all nurses and medical health professionals in a dialysis unit with the knowledge and skills of AVF cannulation. This knowledge is intended to train dialysis nurses and equip them with confidence and skills prior to cannulating patients. Therefore, nurses will be able to perform cannulation procedures, control infections and enhance professionalism competencies during their clinical practice in a safe and stress-free environment thus improving quality and safe care of patients. Problem Justification Proper hemodialysis treatment in the dialysis units depends on how well a vascular access is functioning. This is determined by excellent patency, good blood flow and potential for a repetitive cannulation with two needles(Schinstock et al., 2011). The use of AVF is crucial as it provides a chance for longevity and reduction of morbidity and mortality. According to Kidney Health Australia 2012, infections, stenosis, and thrombosis are the three major complications of AVF in hemodialysis patients (Vale, Lopez-Vargas and Polkinghorne, 2012). About 50% of mortality is reduced when patients switch to AVF than those who remain in catheter dependant thus proper preservation of AVF is an important aspect of care to increase patient’s survivor(Vale, Lopez-Vargas and Polkinghorne, 2012). Due to that reason, it is of importance for nurses to develop proper skills and professional standards when performing AVF cannulation. Infections form one of the major mortality and morbidity factor for patients undergoing dialysis. In 2010, about 11% of deaths in patients undergoing dialysis in the world were due to infections (Vale, Lopez-Vargas and Polkinghorne, 2012). The Canadian Morbidity Study shows that AVF and AVG related infections are at a rate of 4.5% and 19.7% annually. In addition, infections have been the leading cause of admissions accounting for 102 admissions per 1000 patients per year(Vale, Lopez-Vargas and Polkinghorne, 2012). Other than that, repeated cannulation of AVF places patients at risk for infection. This is due to the fact that, during the procedure, bacteria can be either be directly introduced to the blood circulation or through the local access(Melnick, 2016). Adhering to infection control policies is crucial as it helps to reduce access sites infections. Therefore proper cannulation and care of AVF in patients undergoing dialysis is significant as it can minimize the chances of hospitalization. Needle infiltration of new fistulas is usually one of the major complications that are most common in aged patients. One infiltration can prolong catheter dependence by more than three months(Lee, Barker and Allon, 2006). Therefore, needle infiltration can only be reduced by good cannulation techniques. Effective cannulation techniques, proper fistula examination, and control of infections form a basis for effective vascular access with minimal risks thus improving the overall patient quality and safe care(Saha and Allon, 2017). Project Objectives To improve nurses and medical care professionals with knowledge and skills regarding AVF cannulation procedures and protocols. This, in turn, will enhance career development and improve nursing clinical practice in a dialysis unit. To reduce needle induce vessel injuries and related complications such as thrombosis and aneurysm. This will lead to reduced pain and psychological effects on patients such as anxiety thus improving quality and safe care. To eliminate and minimize AVF related infections through the use of proper cannulation procedure, reduce chances of frequent cannulation, and by ensuring safety precaution and asceptic techniques are always observed. Project Outputs Use of literature review summaries- Literature reviews will be used to evaluate what studies say about the effects of poor cannulation, incidents, and statistics of AVF, and most common related infections and microorganisms involved . Procedure assessment tools which will be used to measure the level of practical understanding. National guidelines, standards, and policies A report Verbal and written presentation References Brouwer, D. J. (2011) ‘Cannulation Camp: Basic needle cannulation training for dialysis staff’, Dialysis and Transplantation. doi: 10.1002/dat.20622. Lee, T., Barker, J., and Allon, M. (2006) ‘Needle Infiltration of Arteriovenous Fistulae in Hemodialysis: Risk Factors and Consequences’, American Journal of Kidney Diseases. doi: 10.1053/j.ajkd.2006.02.181. Lok, C. E., and Foley, R. (2013) ‘Vascular access morbidity and mortality: Trends of the last decade’, Clinical Journal of the American Society of Nephrology. doi: 10.2215/CJN.01690213. Melnick, D. M. (2016) ‘Vascular access for hemodialysis’, in Illustrative Handbook of General Surgery: Second Edition. doi: 10.1007/978-3-319-24557-7_41. Saha, M. and Allon, M. (2017) ‘Diagnosis, treatment, and prevention of hemodialysis emergencies’, Clinical Journal of the American Society of Nephrology, pp. 357–369. doi: 10.2215/CJN.05260516. Santoro, D.Benedetto, F. ,Modello, P., Pipito, N., Barrrila,.D and Cernaro, V. (2014) ‘Vascular access for hemodialysis: Current perspectives’, International Journal of Nephrology and Renovascular Disease. doi: 10.2147/IJNRD.S46643. Schinstock, C. A. Albright, R.C., Williams, A., Dilon,J and Jensen, B (2011) ‘Outcomes of arteriovenous fistula creation after the fistula first initiative’, Clinical Journal of the American Society of Nephrology. doi: 10.2215/CJN.11251210. Vale, E., Lopez-Vargas, P. and Polkinghorne, K. (2012).Nursing Care of Arteriovenous Fistula/Arteriovenous Graft. 1-23. Available at: https://www.cari.org.au/Dialysis/dialysis%20vascular%20access/Nursing_care_of_AVF_AVG.pdf.

CNA613 Project Management For Health Professionals

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