Task 1: Healthcare Improvement Project – Introduction and Project Initiation
Stakeholder Identification
How were the stakeholders identified for this healthcare improvement project?
The process of stakeholder identification began with compiling a comprehensive list of key personnel, including leadership, decision-makers, and staff specialized in infection control at the healthcare facility. The focus was primarily on individuals responsible for infection prevention and early detection of sepsis among oncology patients. After a detailed review of roles and experience, three principal stakeholders were chosen due to their expertise and contribution potential: the Sepsis Coordinator, the Assistant Manager of Urgent Care, and the Urgent Care Charge Nurse.
| Stakeholder | Experience & Responsibilities | Contribution to Project |
|---|---|---|
| Sepsis Coordinator | Over 5 years in infection prevention; Co-Chair of Sepsis Committee | Provides leadership and expert guidance |
| Assistant Manager of Urgent Care | Participates in sepsis improvement efforts; manages data and educates staff | Organizes data, trains staff, implements process changes |
| Urgent Care Charge Nurse | Experienced ER nurse; active in hospital committees | Tracks milestones, updates staff, manages timelines |
The Sepsis Coordinator offered expert leadership, while the Assistant Manager took charge of data management and staff training related to new screening protocols. The Urgent Care Charge Nurse contributed clinical insights and facilitated ongoing communication and project tracking.
Needs Assessment
What process was used to assess the needs for the healthcare improvement project?
The project lead conducted individual meetings with each stakeholder, either in person or virtually, to gather suggestions for possible improvement areas within the Moffitt Cancer Center. Each stakeholder proposed one or two project ideas, which were then compiled into a list and distributed for group evaluation. A structured 30-minute Zoom session was held where stakeholders anonymously ranked the ideas through an online questionnaire utilizing the Nominal Group Technique.
The top three ideas emerging from this process were early sepsis identification, enhancement of patient transfers of care, and strategies to reduce nurse burnout and improve staff retention. After further discussion, the group reached consensus to prioritize early sepsis identification, recognizing the significant risks sepsis poses to oncology patients.
Problem Identification
What is the primary problem addressed by the project?
The central issue tackled by this project is the high incidence and severity of sepsis among adult oncology patients at Moffitt Cancer Center. These patients often have weakened immune systems due to cancer treatments, making them more vulnerable to sepsis—a condition with mortality rates twice as high in cancer patients compared to non-cancer patients (Chae, Kim, & Lee, 2020). Sepsis also leads to treatment delays, extended hospital stays, and increased healthcare expenses (Mert et al., 2021).
This project aims to find the most suitable sepsis screening tool specifically tailored for oncology patients in the Urgent Care setting. The ideal tool would detect unique signs of infection that differ from typical presentations, such as altered vital sign thresholds and lab markers, to enable quicker and more accurate diagnoses.
Problem Description
Why is an early sepsis identification screening tool necessary at Moffitt Cancer Center?
The Infection Prevention and Sepsis Committee identified significant gaps in sepsis management within the Urgent Care Department. Chart reviews highlighted delays in initiating sepsis protocols for patients meeting criteria, underscoring the absence of an effective screening mechanism. Implementing a dedicated early sepsis screening tool is crucial to support timely diagnosis and treatment, which are essential to reducing mortality rates and improving patient outcomes.
Impact Analysis
What are the potential benefits and risks associated with the project?
The project’s potential impacts were analyzed across two primary categories: Patient Satisfaction and Decreased Length of Stay. Each category was evaluated for benefits and risks, with impact scores ranging from 1 (low) to 3 (high):
| Category | Benefits (Examples) | Impact Score | Risks (Examples) | Impact Score |
|---|---|---|---|---|
| Patient Satisfaction | Improved communication; timely care | 3 | Resistance to change; staff training demands | 2 |
| Length of Stay | Reduced hospitalization duration; faster recovery | 3 | Implementation delays; data accuracy concerns | 3 |
The total benefit score was 11, while risks totaled 9. With an impact ratio of 1.2 (benefits divided by risks), the analysis indicates that the anticipated benefits outweigh the potential risks, supporting the project’s implementation.
SWOT Analysis
How was the organizational readiness assessed?
Organizational readiness was evaluated through a SWOT analysis conducted collaboratively by stakeholders. Each participant prepared an individual SWOT focusing on internal factors such as leadership strength and staff morale, and external factors including stakeholder engagement and knowledge transfer. These preliminary assessments were refined during a 45-minute group discussion followed by voting.
| SWOT Component | Internal Criteria | External Criteria | Key Findings |
|---|---|---|---|
| Strengths | Strong leadership | Active stakeholder involvement | Committed leadership and engaged stakeholders |
| Weaknesses | Variable staff morale | Limited best practice uptake | Concerns regarding staff burnout and knowledge gaps |
| Opportunities | Training programs | External partnerships | Potential for education and collaborative efforts |
| Threats | Staff turnover | Regulatory changes | Risks related to turnover and changing compliance |
This analysis affirmed the project’s feasibility and identified critical areas requiring proactive management to ensure success.
Ethical Considerations
What ethical standards support this healthcare improvement project?
The project aligns with Moffitt Cancer Center’s Code of Ethics, which mandates delivering high-quality, safe, and patient-centered care (Moffitt Cancer Center, 2018). Emphasizing timely and equitable care, particularly for immunocompromised oncology patients, the project embodies these ethical principles by focusing on early detection and intervention for sepsis—a condition that disproportionately affects vulnerable populations.
Task 2: Healthcare Improvement Project – Project Purpose and Review of Scholarly Sources
Purpose Statement
The project’s core objective is to integrate an early sepsis identification tool within the Urgent Care Department, designed to expedite the recognition and treatment of sepsis symptoms in oncology patients. Incorporating this tool into triage processes aims to improve clinical outcomes by enabling prompt and effective intervention.
Review of Relevant Scholarly Sources
Research underscores the elevated risk and mortality rate of sepsis among cancer patients, necessitating specialized screening tools tailored to this population (Chae et al., 2020; Mert et al., 2021). Studies also demonstrate that nurse-led sepsis protocols and community screening tools enhance early sepsis recognition and improve patient outcomes (Baker, 2022; Moore et al., 2019). These evidences support the rationale for the project and guide its implementation strategy.
Appendix D: SMART+C Goal Worksheet
| SMART+C Criteria | Question | Answer |
|---|---|---|
| Specific | What is the specific project? | Implement an early sepsis screening tool in Urgent Care to accelerate intervention. |
| Measurable | What indicators will be measured? | Increase in timely initiation of sepsis protocols by December 2022 based on collected data. |
| Achievable | How feasible is the project? | Highly feasible, supported by impact and SWOT analyses and the patient risk profile. |
| Relevant | How worthwhile is the project? | Expected to reduce mortality, shorten hospital stays, and enhance patient satisfaction. |
| Time-Bound | What are the project timelines? | Project starts June 2022 and completes December 2022. |
| Challenge | What is the stretch goal? | Develop a cancer-specific sepsis screening tool using identified clinical indicators. |
SMART+C Goal:
To implement an early sepsis identification tool in the Urgent Care Department to improve response times for sepsis protocols and treatment in oncology patients by December 2022.
Expected Outcome:
The project expects to generate data supporting the development of an oncology-specific sepsis screening tool, which will contribute to reduced mortality, shorter hospital stays, lower healthcare costs, and improved patient satisfaction.
References
Baker, E. (2022). Improving sepsis recognition through use of the Sepsis Trust’s community screening tool. British Journal of Community Nursing, 27(2), 69–75. https://doi.org/10.12968/bjcn.2022.27.2.69
Chae, B.-R., Kim, Y.-J., & Lee, Y.-S. (2020). Prognostic accuracy of the sequential organ failure assessment (SOFA) and quick SOFA for mortality in cancer patients with sepsis defined by systemic inflammatory response syndrome (SIRS). Supportive Care in Cancer, 28(2), 653–659. https://doi.org/10.1007/s00520-019-04869-z
Mert, D., Merdin, A., Kandemir, N., Çakar, M. K., Dirim, E., Çeken, S., Altuntaş, F., & Ertek, M. (2021). Evaluation of risk factors and causative pathogens in bloodstream infections in cancer patients. Gulhane Medical Journal, 63(1), 42–51. https://doi.org/10.4274/gulhane.galenos.2020.1320
D030 HIP Paper Template
Moffitt Cancer Center. (2018). Code of Ethics and Professional Conduct. https://moffitt.org/about-moffitt/corporate-compliance/code-of-ethics-and-professional-conduct/
Moore, W. R., Vermuelen, A., Taylor, R., Kihara, D., & Wahome, E. (2019). Improving 3-Hour Sepsis Bundled Care Outcomes: Implementation of a Nurse-Driven Sepsis Protocol in the Emergency Department. Journal of Emergency Nursing, 45(6), 690–698. https://doi.org/10.1016/j.jen.2019.05.005