Identify one (1) individual indicator of quality or safety. Define your indicator and discuss how the indicator is used to evaluate care in a chosen healthcare setting. Your response should include details about the indicator, how it is measured and the setting. Provide a summary of the literature on your chosen indicator. Use this indicator to solve a clinical problem, using a PDSA quality cycle. Outline how you would evaluate your PDSA cycle.

Hazardous assessment

An evaluation of the hazardous nature of surgical site infection is vital since it points out the complications that are likely to arise. Improvement of care and counteracting the identified complications can be best done when a proper hazard appraisal is done. The danger of surgical site infection is that it increases the dangers of endogenous and exogenous contamination of the wound. In addition, the resistance and ability of the patient to fight the infection is compromised. According to Dreacky (2014) persons who exhibit surgical site infection following any form of an operative procedure do not only experience pain for an extended period, but also stays longer in hospital. As such, apart from health implications surgical site infection also causes economic challenges, in terms of additional bills to the patient.

Experiences of patients on Surgical site infections

Surgical site infection is mostly encountered by patients who undergo large bowel surgeries. Bremk (2018) conducted a study to determine the effects of surgical site infection on the patients and their families. The study findings indicated that the post operative infections had significant emotional and economical effects on the patients and their families. The patient mainly reported a feeling of pain and dissatisfaction with the services offered by the surgeons. On the other hand, the family reported a feeling of insecurity and dissatisfaction with the services offered. Smith (2018) has also pointed out that most patients who were reported to have developed surgical site infection, were not aware of the condition. Concerns have thus been raised on the need to create awareness to both the patients and their families on the existence of the condition and its possibility of occurrence for various pre conditions to be undertaken.

In my placement as a nurse at the maternity ward in Ramsey, I witnessed several cases of surgical site infection. The incidence of surgical site infection following caesarean section was 9.1% in our unit. The surgical site infections mainly occurred following prolonged obstructed labor, long operation time and heavy blood loss. Staphylococcus aureus was the most frequently isolated pathogen in the infections that were reported. I used the  London Protocal questions to analyze the situation I experienced at Ramsey hospital .

The London protocol questions has a set of queries that include

What happened?

The surgical site infection occurred within 24 hours after the caesarean section

Who was involved?

Patients who were underwent a caesarean section. The major factors that contributed to the infection included the patient risk factors, clinical interventions and the nature of the physical environment under which the surgery was being conducted.

When did it happened

The infection occurred at the post-operation stage

Where did it happen?

At the maternity ward

From the literature conducted and my personal experience, it is ascertained that surgical site infection has adverse effects on the patients and the family. Most patients are unaware of the condition thus in most cases do not take the necessary preconditions to prevent the same. It is this important that proper care is provided to the patients during and after the caesarean section to minimize their chances of developing surgical site infections.

Plan for Improving Care (PDSA cycle)

The plan is designed to improve quality care in relation to surgical site infection. Since I worked as a nurse in the maternity unit, the care plan will be to improve quality care for women who develop surgical site infection following a caesarean section. From my experience in this setting, as much as patient’s factors contributes to the occurrence of the infection, the preoperative practices, clinical interventions strategies and the nature of the environment under which the surgery is conducted contributed significantly towards the occurrence of surgical site infection. I observed that even patients who did not have the risk factors associated with the development of surgical site infection also reported serious cases of post operative infection. As such, the infection could only be attributed to the preoperative practices including preparation of the patient and the surgical room, or clinical interventions (use of antiobiotic prophylaxis, limiting the surgery period)