Introduction and Approval
For this particular research, the organization would need to provide the relevant support needed to make it a success. Moreover, more support would be required from fellow staff. This step would be vital in ensuring that the entire healthcare centre is a part of the study.This essay includes strategies that would be used to train nurses on the basics concerning earlier administration of therapeutic hypothermia to patients suffering cardiac arrest. In this essay, the methods of carrying out the research would be outlined in details. In addition, all the strategies involved and their outcomes will be looked into. For this study to be a full success, consent is sought from a relevant physician. Most of the time, the physician is the one referred to in the case of a post cardiac arrest order. Nurses as well as EMS require the basic knowledge on this issue since most patients who encounter cardiac arrest fail to recover. Others take a longer time to recover from this state. Neural development is also curbed, hence, with current studies done and compiled by different authors, it appears that post cardiac arrest orders can be reduced or even prevented.
The nurses under practice would have an obligation of following a certain procedure. This procedure is outlined below. Most of the things that nurses and EMS should know are outlined below.
Issue of Focus
The problem being addressed in this essay is the lack of administration of Therapeutic Hypothermia prior to patient going into the ICU. This policy has not been in use and I would like to advocate for its application in the hospital. There are certain vital procedures to be followed when handling a hypothermia case. In this case, these procedures need to be followed carefully for the benefit of the patient going into the ICU. First, the clinicians have to consider revising the Clinical Practice Guidelines that form the basis of this activity. These would be immensely helpful in ensuring that the problems are identified and the solutions are found in good time. Secondly, a physician order is required before the initiation of the therapeutic hypothermia on an adult patient. This is the case for an Adult Induced Hypothermia Status Post Cardiac Arrest Orders. The main aim for this procedure is to ensure that the adult achieves a temperature of about 32- 34 degrees Celsius of temperature. Moreover, this should be done within the first two hours of this protocol. Moreover, the temperature should be maintained for the next 24 hours. The 24 hours would be from the time cooling was initiated.
Once the patient has been seen to be ready for treatment, the hypothermia administration is initiated. This is done regardless of whether some of the diagnostic studies are still pending. Neurological assessment is done before the initiation of protocol. This is done to achieve the baseline for the entire exercise. Other routine neurological assessments and BIS should not be done until the paralytic is stopped. In addition, they should only be done when the patient reaches normothermia.
Description of the implementation process
In this procedure, the patient needs to be incubated and mechanically ventilated. This part should also be done prior to the initiation of the therapeutic hypothermia. Some of the practices that would require a physician order before administration include NS PIV boluses, cold water OGT/NGT lavages, and bladder irrigation. Re- warming would be carried out at least 24 hours of the initiation of the cooling phase. Re- warming is mainly done to attain a certain target rev-warming body temperature of 35 degrees Celsius. This temperature limit should be attained within a time limit of 6- 8 hours of the start of the re- warming phase. Furthermore, the temperature should be maintained to not more than 34. 5 degrees Celsius within the first 24 hours of hypothermia initiation. One vital precaution in this procedure is that the patients should not be bathed during cooling and re- warming procedures. In order to maintain the required body temperature for hypothermia initiation, the patient should not be administered with Peritoneal Dialysis. These precautions are immensely fundamental in making sure that hypothermal initiation is carried out in the perfect temperature range.
Another attempt that would help in regulating the required temperature needed for hypothermal therapy would include turning off the blood- warmer. Moreover, the patient can be administered with hemodyalisis to achieve the same goal.
Nurses should be well distributed in this unit. Most probably, it is crucial to check on the nurse to patient ratio at different times of the procedure. Within the first 6 hours, the respective ration should be 2:1. However, in the remaining part of the procedure, the ratio would be at 1:1. The most appropriate ratio for both periods since they occur considering the severity of each period. Hypothermia is then initiated in the Emergency Department. Immediately a bed is found available in the ICU, the patient is shifted there.
Rationale for Proposed Solution
The reasons for this particular implementation plan include the fact that it is basic for patients going to the ICU. Patients who get to hospital tend to lack the right methods of treatment before attending the ICU. Mostly, this has been caused by the lack of relevant education of the nurses and other EMS workers. Hence, it is vital to note the basic principles and procedures involved in hypothermia administration before the patient gets into the ICU. Patients who receive therapeutic hypothermia earlier tend to encounter a quicker recovery that those who do not get it.
Evidence
This has been proven in different researches carried out in various hospitals. It is evident checking into the outline literature that patients administered with therapeutic hypothermia 6 hours before recover faster than those given 6 hour after. In this case, there was a defiant difference recovery and neural development of the patients who received therapeutic hypothermia before treatment. This study was conducted using the electronically stored details of patients who attained out- patient cardiac arrest and VF. This also happened to patients who had TH initiated in the field. These cases were shifted to the Mayo Clinic Florida in November, 2006- April, 2009.
Nurses and EMS under practice would also have the obligation of checking on the hygiene involved in all the operations. This step is largely fundamental in ensuring that the patients are in a clean and safe environment. Bacteria that may cause more infection are prevented. This implementation goal has to be integrated into the hospital. In addition, there are certain personalities who would be vital in making this integration a success. Hypothermia has been viewed by the authors as the best method of handling patients who have suffered cardiac arrest. In addition, it provides the best results inpatients’ recovery and neural development when administered earlier. The number of patients who have survived cardiac arrest before being taken to the ICU is still low. Hence, it should be a law that hypothermal induction should be administered earlier to the patient. For this to be initiated, the change should be integrated into the current organization structure as soon as possible. This would be fundamental in ensuring that the training of the nurses and the EMS workers goes hand in hand with the implementation. In this way, this trend would be absorbed into the culture of the healthcare centers. This would also make it easier for implementation to the patients.
However, before any serious implementation is carried out on the patients, a thorough research would have to be carried out. In this research, groups would be examined on therapeutic hypothermal for results. If the results appear positive, then this would be deemed the best way to handle cardiac arrest patients. The appropriate protocol would also have to be followed when seeking verification for the implementation of this procedure. This is a vital strategy that should be well- known the government and signed. Hence, the government should be informed in official terms. Aside from that, the top administrators in all hospitals should be informed. This should go together with the education of the nurses and the EMS workers. Patients attending the hospital for related cases should also be well informed on the procedures involved. Informing the patients would also be crucial since they are the actual recipients of the treatment. Therefore, they would be in better position to identify the impacts of the therapy. Another benefit of this would be getting to know the negative implications if the therapy.
It would be instrumental for the government to initiate this change in all the hospitals in the country. This would be a good step since the government has departments hat would generally handle the case. In addition, it would be able to give standard procedures and education to the hospital personnel. This would also allow all the government hospitals to be able to provide this service to their patients.
Resources for the Implementation
For the implementation process to be complete, there are some vital tools required. These include the nurses and the EMS workers. These are the vital members needed aside from the doctors since they handle the patients directly constantly. Enough educational material would also be required. These include pamphlets and power point presentation. Surveys and questionnaires would be needed for the assessment work. Tests would have to be carried out before and after the experimentation for further assessment. This part would be done to assess the knowledge of the participants at baseline. Relevant technology would be used in the research. For instance, the right software would be applied for the assessment. Online information would also be vital for the study. The research would basically cost a lot of money and resources. Hence, the government’s hand in this implementation plan would help reduce the total amount of funds that would be used. The government would also be in a better position to provide the necessary equipment for the plan and research. Most of the items needed may be costly. Finally, it would be the sole role of the staff to initiate, oversee and evaluate the change. In case the results of the initiation are not satisfactory, then the rightful measures would be taken to rectify the situation. A constant evaluation of the results would be vital in checking whether the results are as per the expectations.
Conclusion
In conclusion, nurses and EMS require basic knowledge on the benefits of administering therapeutic hypothermia to their patients. This would be vital in curbing the rising cases post cardiac arrest. Most patients who encounter cardiac arrest may not be able to recover. This has been the case for so many years. However, with current research carried out by different scientists, it appears that patients have a possibility of recovering for the cardiac arrest. This is done through administration of the therapeutic hypothermia earlier. The statistics have also shown that patients who get induced with therapeutic hypothermia earlier have a better recovery and neural development than those who get it later. As such, the right implementation procedures should be put in place to ensure that a larger number of patients survive cardiac arrest. This research study and education would go a long way in reinforcing the nurses with the basic knowledge concerning how to handle a post cardiac arrest order. Finally, the morbidity and mortality rates would be reduced immensely if the procedures are followed accordingly.
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