Decision-making is a critical process in healthcare settings that requires careful consideration of various factors to ensure effective and high-quality care. In nursing practice, decisions to change procedures or practices are often made to improve patient outcomes, enhance efficiency, or adhere to evidence-based practices. This discussion aims to share an example from my nursing practice setting regarding a decision to change a procedure or practice, the steps used in the decision-making process, the evidence considered, and the effectiveness of the change.
In my practice setting, we recently faced a challenge with the administration of medication to patients with dysphagia. Dysphagia is a swallowing disorder that can significantly impact a patient’s ability to safely swallow medications. Previously, our unit had been using oral medication administration for these patients, but this often presented risks and complications, such as medication getting lodged in the throat or aspiration leading to respiratory distress.
To address this issue, a decision was made to explore alternative routes for medication administration in patients with dysphagia. The decision-making process began with a thorough assessment of the current practice and the identification of potential risks and concerns. This initial step allowed us to understand the extent of the problem and the need for change.
The next step involved gathering evidence from various sources. Our team conducted a comprehensive literature review to explore evidence-based practices for medication administration in patients with dysphagia. We consulted reputable resources, such as clinical practice guidelines, research articles, and expert opinion, to gather a comprehensive understanding of the available evidence.
The evidence we considered highlighted several alternative routes for medication administration in patients with dysphagia. These included sublingual administration, transdermal patches, rectal suppositories, and enteral tube feeding. Each route was evaluated based on its safety, efficacy, patient acceptability, and feasibility in our practice setting.
After considering the evidence, we conducted a pilot study to assess the feasibility and effectiveness of one specific alternative route – enteral tube feeding. This involved selecting a sample of patients with dysphagia and administering medications through an enteral tube, such as a nasogastric or gastrostomy tube. We monitored for any adverse reactions, assessed patient satisfaction, and collected data on medication absorption and therapeutic outcomes.
The pilot study demonstrated positive outcomes, with patients reporting improved medication tolerance and fewer complications related to swallowing difficulties. Additionally, medication absorption was found to be comparable to oral administration, suggesting the effectiveness of enteral tube feeding as a viable alternative route for medication administration in patients with dysphagia.
Based on the evidence gathered and the positive outcomes of the pilot study, a decision was made to implement the change in practice. This involved updating the medication administration policy and providing education and training to healthcare providers on the new procedure. The implementation phase also included ongoing monitoring and evaluation to ensure adherence to the new practice and to identify any potential issues or areas for improvement.
In conclusion, the decision to change the medication administration procedure in patients with dysphagia involved a systematic and evidence-based approach. The decision-making process included a thorough assessment of the current practice, gathering and evaluating evidence, conducting a pilot study, and implementing the change. The decision was supported by the positive outcomes of the pilot study, demonstrating the effectiveness of enteral tube feeding as an alternative route for medication administration. Regular monitoring and evaluation are ongoing to ensure the sustainability of the change and identify any further improvements.
