Phillip December 11, 2025 No Comments

D226 Assessment Task 1: Enhancing Sterilization Protocols to Reduce SSIs

Name

Western Governors University

D226 BSNU Capstone

Prof. Name

Date

What are Surgical Site Infections (SSIs) and Why Are They Significant in Healthcare?

Surgical Site Infections (SSIs) refer to infections that develop in the area of the body where a surgical procedure was performed. These infections can range from superficial involvement of the skin to deeper infections affecting tissues, organs, or even implanted medical devices. SSIs represent a significant burden in healthcare, as they contribute substantially to patient morbidity, lengthen hospital stays, increase healthcare expenditures, and can sometimes lead to patient mortality. The Centers for Disease Control and Prevention (CDC, 2023) report that SSIs constitute nearly 20% of all healthcare-associated infections among hospitalized individuals. Preventing and managing SSIs is therefore essential to improving patient safety, facilitating quicker recovery, and aligning with healthcare models that emphasize quality care while controlling costs.

BSNU Capstone Course Task One: Healthcare Change Proposal

This document serves as Task One in the BSNU Capstone Course and focuses on developing a detailed healthcare change proposal. The primary objective is to secure an organizational sponsor who will review, endorse, and authorize the proposed initiative. The proposal incorporates feedback from the sponsor, presents evidence supporting the change, and provides a rationale explaining how the initiative aligns with principles of value-based care improvement.

In addition to defining the change, this proposal identifies critical stakeholders, lays out a strategic plan for implementation, and includes a reflective discussion highlighting the author’s leadership role as a catalyst for clinical transformation.

Organizational Context

The proposed initiative is planned for implementation at the Mike O’Callaghan Military Medical Center (MOMMC), a military treatment facility governed by the Defense Health Agency (DHA) and the Department of Defense (DoD). MOMMC is situated on Nellis Air Force Base in Las Vegas, Nevada, and offers both emergency and specialty healthcare services to active-duty personnel, their dependents, and other DoD beneficiaries.

The author works as a civilian contractor and registered nurse within MOMMC’s Emergency Department (ED), which comprises twenty beds and two trauma bays. The ED team is composed of military members, civilian staff, and contractors. Due to its Trauma Level III designation, MOMMC handles both military and civilian trauma cases. While workforce stability is generally solid, military deployments occasionally disrupt staffing. Approximately 40% of the ED staff consists of civilian and contract workers, providing crucial coverage during military personnel rotations.

Change Proposal Description

Current Process

Currently, patients arriving at the ED must first register at a front desk staffed by two registration technicians who complete the entire registration process before patients receive triage or medical assessment. Although thorough administratively, this process can delay care for patients with urgent conditions such as chest pain or cardiac distress.

Proposed Change

The proposed change involves repositioning registration technicians to the back area of the ED to focus on administrative tasks. At the front desk, a medical technician and a registered nurse (RN) would be assigned to perform rapid symptom screening and expedite patient registration.

This modification places clinical triage as the initial point of contact, ensuring that patients exhibiting ST-Segment Elevation Myocardial Infarction (STEMI) symptoms are promptly identified and prioritized for treatment.

Purpose of the Change

The initiative aims to decrease the “door-to-EKG” time for patients presenting with cardiac symptoms. The American Heart Association (AHA) and the American College of Cardiology (ACC) recommend obtaining a 12-lead EKG within 10 minutes of arrival at the ED (Dechamps et al., 2016). At MOMMC, this goal is currently met in only 40–60% of cases.

By placing clinically trained personnel at the initial patient interface, the ED can improve early detection and intervention for cardiac emergencies, enhancing survival rates and compliance with national care standards.

Impact of Proposed Change

Aspect	Current State	Proposed Change	Expected Outcome
Staffing at Front Desk	Two registration technicians	One medical technician + one RN	Faster symptom identification and EKG prep
Door-to-EKG Time (STEMI)	40–60% compliance with 10-minute standard	Target 100% compliance with 10-minute goal	Improved clinical outcomes and guideline adherence
Patient Flow	Registration delays	Streamlined triage and registration	Reduced waiting times and increased satisfaction
Role of Registration Techs	Full patient registration	Back-end administrative support	More efficient use of staff expertise

This staffing restructure ensures clinical expertise is aligned with the patients’ immediate needs, enhancing both efficiency and safety in emergency cardiac care.

Feedback from Organizational Sponsor

Brian Hubbard, RN, BSN, MPA, was chosen as the organizational sponsor because of his expertise in intensive care, cardiac catheterization, and nursing leadership at MOMMC. He supported the new staffing approach and recommended implementing a 60–90-day pilot phase before full-scale adoption. Mr. Hubbard highlighted potential challenges, such as additional shifts for nurses and medics and minor resistance from staff. He stressed the importance of open communication and engaging staff to demonstrate the connection between the change and improved patient outcomes.

Potential Barriers and Strategies

Barrier	Description	Mitigation Strategy
Staff Resistance	Increased workload and schedule changes	Encourage open dialogue, involve staff in planning, emphasize patient safety benefits
Administrative Resistance	Hesitancy from DoD or DHA to adjust staffing models	Present data-backed outcomes and compliance with cardiac guidelines
Skill Gaps	Lack of familiarity with rapid registration	Provide formal training programs and mentorship

Successful implementation relies on effective leadership and empowering staff to understand the long-term advantages of the new approach.

Value-Based Care Enhancement

This proposal embodies the core principles of value-based care by boosting clinical efficiency, patient safety, and satisfaction without imposing additional costs. Specific benefits include:

Reduced door-to-EKG time for cardiac patients.
Earlier identification and management of life-threatening conditions.
Strengthened collaboration among nursing, medical, and administrative staff.
Increased patient throughput and satisfaction.

Optimizing workforce placement and workflow allows MOMMC to deliver superior care quality while maintaining cost-effectiveness.

Key Stakeholders and Collaboration

Stakeholder	Role in Implementation
Staff Nurses and Medics	Perform rapid triage and conduct EKGs
Registration Technicians	Handle back-end administrative tasks
Emergency Room Nurse Manager	Oversee workflow and staffing
Emergency Department Medical Director	Provide clinical oversight
Registration Director	Manage registration processes
Chief Nurse	Support policy alignment and resource allocation
Hospital Commander	Endorse organizational support
Staffing Chief	Approve staffing modifications

Monthly meetings will be held to review data from the Genesis charting system, focusing on metrics such as door-to-EKG times, patient length of stay, and satisfaction indicators.

Resources and Cost Considerations

This change leverages existing resources without requiring additional financial investments. Military personnel salaries are fixed, so shifting workloads temporarily does not increase payroll expenses. Key resource requirements include staff training, performance monitoring, and engagement sessions, all manageable within current operational frameworks.

Implementation Plan

Phase	Description
Planning	Engage stakeholders, finalize logistics, and define trial scope
Milestones	Monitor weekly and monthly door-to-EKG data
Implementation	Train staff and launch the rapid registration pilot
Evaluation	Conduct a 90-day review assessing success metrics

Ongoing evaluation will rely on data to ensure lasting improvements and inform future staffing decisions.

Expected Outcomes

Outcome	Description
100% Compliance	All eligible patients receive EKG within 10 minutes
Improved Patient Outcomes	Quicker interventions decrease cardiac complications
Increased Patient Satisfaction	Shorter wait times enhance patient experience
Financial Benefits	Improved throughput leads to better resource use
Accreditation Maintenance	Consistent adherence to AHA and DoD standards

These outcomes enhance patient care quality while supporting ethical nursing principles like nonmaleficence and fidelity.

Use of Technology

The Genesis Electronic Health Record (EHR) system will be central to monitoring and analyzing performance data. It enables real-time tracking of patient flow, EKG completion, and triage efficiency. Visualization dashboards can facilitate leadership oversight, fostering transparency and accountability in the department.

Measuring Success

Success will be gauged through a combination of quantitative and qualitative measures, including:

Continuous improvement in key performance indicators.
Positive patient satisfaction survey results.
Enhanced staff morale and adaptation to new workflows.

Maintaining consistent communication and engagement will help sustain improvements and recognize achievements.

Reflection on Change Agent Role

With over 20 years of experience as an emergency nurse, the author has witnessed inefficiencies that compromise timely patient care. By applying evidence-based practices, leadership skills, and fostering interdisciplinary cooperation, the author acts as a change agent dedicated to elevating healthcare quality. Advocacy, education, and data-driven decision-making are key strategies to nurture a culture of continuous quality improvement within the emergency care environment.

Potential for Broader Application

If successful, this rapid registration and triage model could be expanded to other military treatment facilities across the United States. Widespread adoption within the DoD healthcare system may improve response times, reduce mortality related to cardiac events, and enhance readiness for both military and civilian patient populations.

References

Butt, T. S., Bashtawi, E., Bououn, B., Wagley, B., Albarrak, B., Sergani, H. E., Mujtaba, S. I., & Buraiki, J. (2020). Door-to-balloon time in the treatment of ST segment elevation myocardial infarction in a tertiary care center in Saudi Arabia. Annals of Saudi Medicine, 40(4), 281–289. https://doi.org/10.5144/0256-4947.2020.281

Centers for Disease Control and Prevention. (2023). Healthcare-associated infections: Surgical site infections (SSI). https://www.cdc.gov/hai/ssi/