NURS 4221 Week 4 Assignment 1: Applying the FADE model

NURS 4221 Week 4 Assignment 1: Applying the FADE model

NURS 4221 Week 4 Assignment 1: Applying the FADE model

Leadership Competencies in Nursing and Healthcare Sample Paper

A measurable patient-centered practice problem related to quality or safety that is relevant to my practice setting that I will focus on in my Capstone paper is healthcare-acquired infections (HAIs).  HAIs are given to the patient by healthcare staff while in the hospital, and they are detected at least 48 hours after admission (Kundus, M., 2015).  There are multiple types of HAIs such as surgical site infections, catheter-related bloodstream infections, urinary tract infections, and pneumonia.  HAIs are spread from the lack of handwashing, failure to comply with isolation protocols, and the transfer of germs on an HCP clothing.

I selected HAIs as the measurable patient-centered practice problem because over the years there have been attempts to decrease them in my facility with some success.  Therefore, more achievements are needed at all levels of healthcare to stop infections from spreading to patients completely.  As I spoke with the CNO and ACNO in regards to this matter, they both also agreed that we could continue to improve in this area and continue to emphasize the importance of preventing HAIs.

HAIs are sicknesses that can prolong a patient’s hospital stay.  They are also detrimental financially for the facility because insurance companies will not pay for diseases/infections acquired while in the hospital, especially preventable ones.  HAIs can have different effects on patients.  Some patients may acquire them while in the hospital and then discharge with no complication, but others may have complications and possibly die.  On any given day, approximately one in 25 US patients have at least one infection contracted during their hospital stay, demonstrating the need for improved infection control in US healthcare facilities.

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Central line-associated bloodstream infection (CLABSI) is defined as a laboratory-confirmed bloodstream infection not related to an infection at another site that develops within 48 hours of central line placement.  Of all the healthcare-associated infections, CLABSIs are the costliest, accounting for approximately $46,000 per case. CLABSIs lead to prolonged hospital stays and increase health care costs and mortality.  An estimated 250,000 bloodstream infections occur annually, and most are related to the presence of intravascular devices.  In the United States, the CLABSI rate in intensive care units (ICU) is estimated to be 0.8 per 1000 central line days.  Most cases are preventable with proper aseptic techniques, surveillance, and management strategies (Haddadin Y. & Regunath H., 2018).

After speaking with my nursing supervisor and the ACNO, I found that they had a system in place for identifying and tracking HAIs.  HAIs tracking is done weekly and starts with nursing staff then we pass it on to the nursing supervisor, and she passes this information on to the infection control nurse who in turns reports certain data to state and national levels.  Our interventions utilized to decrease or stop CLABSIs in the facility is:

  • Weekly sterile dressing changes and as needed dressing changes.
  • Proper use of the Swab caps.
  • Maintaining a sterile field before, during, and after insertion until dressing applied to the site.
  • Timely removal of the central line when it is no longer necessary.
  • Timely removal of central line upon expiration.
  • Practicing good hand hygiene.

Studies have shown that implementation of a passive disinfection cap (swab caps) resulted in a 34% decrease in hospital-wide HA-CLABSI rates (combined baseline rate of 2.66–1.75 per 1,000 catheter days at the end of the study period).  This reduction occurred only among high-risk patients and not among general oncology patients (Kamboj, M., Blair, R., Bell, N., et al., 2015).  Also, the use of the passive disinfection cap resulted in decreases of 63% (HRUs) and 51% (general oncology units) in blood culture contamination, with an estimated reduction of 242 BCCs with CONS.  The reductions in HA-CLABSI and BCC correspond to an estimated annual savings of $3.2 million in direct medical costs (Kamboj, M., Blair, R., Bell, N., et al., 2015).

In my opinion, I have confidence that my facility could continue having great CLABSI rates by continuing education on central lines insertion and proper care.  Staff education could also be a time where nurses could note the cost of CLABSIs.  After discussing decreasing CLABSI with co-workers, we concluded that it would be more helpful to complete a dressing change on the same day weekly. Nurses need to be more aware of the infection rates on their units.  Having this information makes them more aware and more in tune to what is going on in their unit.

The quality improvement process I have chosen to apply to my practicum problem central line-associated bloodstream infections (CLABSI) is the Six Sigma Model.  According to Spath (2013), the Six Sigma model is a disciplined methodology for process improvement that deploys a wide set of tools following a rigorous data analysis to identify sources of variation in performances and ways to reduce the variations.  Further review and study of the model describes Six Sigma as a process improvement strategy comprising various tools and strategies that concentrates on 1) improving the quality of a process by decreasing the “defects” (errors) rate, and 2) reducing variability in the production process (Pinney, Page, Jevsevar, & Bozic, 2015).  The Six Sigma design comprises a continuous effort to decrease procedural differences, the obligation to measure and evaluate outcomes, and administrative approval and embracing of its philosophy for it to work (Pinney et al., 2015).  It also requires a medical “champion.”  A medical “champion” will lead the project and has been identified as an essential factor for helping to decrease process variations such as CLABSIs in the intensive care unit.  Successful incorporation of Six Sigma process improvement requires a series of “champions” within each organization.  Champions are often credentialed depending on their experience and demonstrated knowledge of the Six Sigma process (Pinney et al., 2015).

The tools that used in Six Sigma process include analysis of variance, cause and effect diagrams, and cost-benefit analysis (Pinney et al., 2015).  The underlying methodology follows a standardized format called a DMAIC (define, measure, analyze, improve, control) approach (Pinney et al., 2015).  American Society for Quality [ASC], (2018), describes DMAIC as the acronym for the five phases that make up the Six Sigma process, which is:

  • Define the problem, improvement activity, opportunity for improvement, the project goals, and customer requirements.
  • Measure process performance.
  • Analyze the process to determine root causes of variation, poor performance (defects).
  • Improve process performance by addressing and eliminating the root causes.
  • Control the improved process and future process performance.

The Six Sigma process was selected as the process to use with my practicum problem CLABSI because of its benefits, credibility, and reliability.  The benefits of using Six Sigma is improved work productivity, less waste which will improve cost and advance process value. Another benefit is the influence it will have on different areas in healthcare (i.e., infection control and medication administration) (Kooy & Pexton, n.d.).  Nearly 1 in 5 of the more than 1,100 physician leaders used Six Sigma to improve healthcare performance (Spath, 2013) which makes it credible.  Last, but not least, a reduction of errors may be achieved through implementation of the Six Sigma program (Vanker, Wyk, Zemlin, & Erasmus, 2010).


American Society for Quality. (2018). The define measure analyze improve control (DMAIC) process. Retrieved from

Haddadin, Y. & Regunath, H. (2018). Central line-associated bloodstream infections (CLABSI). Treasure Island (FL): StatPearls Publishing.

Retrieved from

Kamboj, M., Blair, R., Bell, N., Son, C., Huang, Y. T., Dowling, M., Lipitz-Snyderman, A., Eagan, J., & Sepkowitz, K. (2015). Use of disinfection cap to reduce central-line–associated bloodstream infection and blood culture contamination among hematology-oncology patients. Infection control and hospital epidemiology; 36(12), 1401-1408. doi: 10.1017/ice.2015.219

Kooy, M.V. & Pexton, C. (n.d.). Using six sigma to improve clinical quality and outcomes. Retrieved from

Kundus, M. (2015). Nosocomial infections: Important facts to know. Retrieved from

Pinney, S., Page, A., Jevsevar, D., & Bozic, K. (2015). Current concept review: Quality and process improvement in orthopedics. Orthopedic Research and Reviews Journal, 2016(8), 1-11. Retrieved from

Spath, P. (2013). Introduction to healthcare quality management (2nd ed.). Chicago, IL: Health Administration Press.

Vanker, N., Wyk, J., Zemlin, A. E., & Erasmus, R. T. (2010). A six sigma approach to the rate and clinical effect of registration errors in a laboratory. Journal of Clinical Pathology, 63(5), 434. doi:10.1136/jcp.2009.072058

NURS 4221 Week 4 Assignment 1: Applying the FADE model

For the problem that I will be addressing using the FADE process, pain management in the terminally ill, I will be considering the aspects previously stated and giving an explanation as to why it will work. The process of FADE was selected to help to analyze and implement a plan that could change the score on the satisfaction survey to indicate that the patients who were dying were without pain. The FADE model is an advancement of the original PDSA/PDCA improvement cycle (Spath, 2013). The steps of the model are focus, analyze, develop, and execute. NURS 4221 Week 4 Assignment 1: Applying the FADE model

NURS 4221 Week 6 Assignment 1 (Walden)

The Management of Pain in the Terminally Ill Patient

Leadership and Competencies in Nursing and Healthcare; NURS-4221-19

The Management of Pain in the Terminally Ill Patient

​The topic that I chose for this paper is the management of pain the terminally ill patient.

Measurable Quality Indicator, Pain Management in the dying Patient

The quality indicator that I have chosen is pain management in the dying patients. Quality indicators were developed by the America Nurses Association (ANA), taking the reports,

The Management of Pain in the Terminally Ill Patient

The purpose of this paper is to note that we do have a problem with patients who are dying and the families reporting that they had pain when dying and finding measures to increase

Literature Review

1. Use of Opioids and Sedatives at End-of-Life

2.Perspectives of Asians living in Texas on pain management in the last days of life

3. Evaluation of Therapeutic Choices for the Treatment of Pain in the Terminal Oncologic Patient Before and During Hospice Admission

4. Limits and Responsibilities of Physicians Addressing Spiritual Suffering in Terminally Ill Patients

5. Pain relief, spiritual needs, and family support: Three central areas in intercultural palliative care

Applying the FADE Model



Week 2 Group A Practice Experience Discussion

Practice Experience: Applying Measurement Tools to a Practice Problem

Conduct a collaboration interview with two or three key leaders in your practice setting to determine the measures for your practice problem and associated challenges impacting measurement for your practice problem (include confidentiality, anonymity, access issues, etc.). Perform an existing evidence review on your practice problem and search for evidence that demonstrates how your practice problem is measured across the country.

By Day 4

Post a description of the measures identified from the interviews, the challenges to obtaining the data that were discussed, and a summary of how this quality indicator is measured in the literature. Discuss any gaps in the data that were identified and additional sources that might be needed to obtain this data. Be sure to support your practice problem with the literature that indicates the relevance of this problem for nursing practice. Provide evidence from practice and data that is available.

By Day 7Read and respond to two or more of your colleagues’ postings from the Discussion question. Provide feedback on the quality of data that was obtained and recommendations on where additional sources of data might be found. As a member of a community of practice, help each other refine and clarify the patient-centered Practice Experience Project.

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