1. Title of the Change Project
Student ID.
MSc in Healthcare Management,
Institute of Leadership, Royal College of Surgeons in Ireland
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Introducing the availability of CPAP for use on infants with bronchiolitis in a PHDU.
Elaine Sweeney (MSc Leadership)
Abstract
This dissertation describes a project that aimed to introduce the availability of Continuous Positive Airway Pressure (CPAP) for use on infants with respiratory illness in a Paediatric High Dependency Unit (PHDU). This project was implemented to allow for improved care of infants with bronchiolitis in a paediatric unit of a large Dublin teaching hospital where a gap in care was identified. The introduction of this treatment option also allowed for staff skill enhancement through training and development. The Health Service Executive organisational development model was used to guide the change. It allowed for active engagement of stakeholders at all stages, and encouraged open communication and evolvement. A transformational leadership approach was take throughout the process which allowed the author guide the change by sharing the vision. The project was evaluated using the Context Input Process Product (CIPP) model. This allowed the change be evaluated against the SMART objectives set at the beginning of the project. Overall the aim of the project was met, and CPAP in now available for use in the PHDU. However due to a number of challenges throughout the change process not all objectives had been fully met at the end date of this project. A dissemination plan for the future has been created allowing for further development of this project in the future.

2. Introduction & Background Organisational Impact
Introducing the availability of CPAP for use on infants with bronchiolitis in a PHDU.
Elaine Sweeney (MSc Leadership)
Introduction & Background
Methodology
Evaluation
Bronchiolitis is broadly defined as a clinical syndrome that occurs in children less than 2 years of age, it is characterized by upper respiratory symptoms followed by lower respiratory infection with inflammation1 The most common treatment for bronchiolitis is humidified oxygen therapy and minimal handing, however a percentage of infants develop severe bronchiolitis. These infants require the next level of support known as continuous positive airway pressure, this is a treatment that uses mild air pressure to keep the airways open.
Drivers of Change
Gap in care identified.
To reduce numbers of external transfers.
To improve staff knowledge and skills.
To improve the experience in the PHDU for parents and carers.
The HSE change model2 was used to guide the change (Figure 1).
Initiation: A number of organisational development tools were under taken here to aid the process including Stakeholder Analysis, SWOT and Force Field Analysis.
Planning: Meeting of stakeholders.
Communication with staff.
Application for funding.
Buy in from the organisation.
Figure 1
Implementation: Ordering of equipment and consumables.
Staff support requirements identified. (Figure 2)
Staff training commenced.
Drafting of care plans and policies.
Figure 2.
Mainstreaming: Auditing data.
Embedding the change in the organisation.
Ongoing education and support.
The Stufflebeam model3, also known as the CIPP model was used to guide the evaluation process. (Figure3).
Main Results.
Funding obtained for purchase of new equipment.
Nursing care plan and policy document now available for use.
Staff training and auditing of CPAP use ongoing
Figure 3.
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Organisational Impact
Organisation now enabled to provide CPAP as a treatment option for infants with bronchiolitis.
Staff upskilled to provided this care, with an increased knowledge base.
Predicted financial savings in the future, with a reduction in number of infants requiring transfer to another hospital.
Aims & Objectives
Aim to have Continuous Positive Airway Pressure (CPAP) therapy available for use on infants with respiratory illness in a paediatric high dependency unit.
Objectives
To secure funding to the value of €17,000, for the purchase of new CPAP equipment by September 2014.
To ensure 100% attendance by nursing staff from the unit at CPAP training by 31st of January 2015.
To have a policy in place for the use of CPAP developed by the respiratory consultant that meets best practice guidelines by March 2015.
To develop a nursing care plan for the use of CPAP in HDU by February 2015.
To record the number of patients placed on CPAP, and compare data to previous years by March 2015.
Conclusion
This change project highlighted the importance of using a recognised change management and evaluation tool to aid the change process in a busy hospital environment.
CPAP is a recognized intervention for the treatment of bronchiolitis and needs to be available in paediatric units.
References
1)McDougall, P. (2011). Caring for bronchiolitic infants needing continuous positive airway pressure. Paediatric Care, 23(1), ) HSE (2008). Improving our services: A user's guide to Managing Change in the Health Service Executive. Dublin, HSE. 3) Stufflebeam, D. L., & Shinkfield, A. J. (2007). Evaluation theory, models, and applications. Jossey-Bass San Francisco.