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Reducing Blood Culture Contamination Using the Data-Information-Knowledge-Wisdom Continuum
The data-information-knowledge-wisdom (DIKW) continuum is a concept introduced by Blum in 1986 as a structure to better understand clinical informatics and how it affects health care (American Nurses Association, 2015). The DIKW framework in nursing helps nurses improve understanding on how wisdom can be applied in their clinical practice from all available data which are organized into information, then synthesized to form relationships known as knowledge. By discussing the interrelationships within the DIKW continuum, the framework has become a vehicle in transporting and educating the health care industry towards making nursing interventions visible (Charlene, Currie, & Rodney, 2016). Data-information-knowledge-wisdom (DIKW) continuum essay.
Nursing has undergone changes in the recent years and now, there are high expectations from nurses to keep their practice up to date to improve nursing processes. Questions are developed in the clinical areas seeking for answers to help enhance the quality of patient care. The use of the DIKW paradigm in solving clinical questions assists nurses to practice with wisdom and apply wisdom to practice. The purpose of this paper is to identify a clinical question relevant to the emergency department and discuss the answer through the progression of the methods of the DIKW framework Data-information-knowledge-wisdom (DIKW) continuum essay. Applying the knowledge obtained from this method in the clinical setting will demonstrate how informatics is instrumental to gain wisdom.
Clinical Question
Blood cultures are laboratory tests to discern the presence of microorganisms in the blood and identify the disease-causing agents for the infection (Reed, 2017). Contaminated blood cultures have negative impact to patients and hospitals in terms of unnecessary antibiotic therapy, superfluous hospitalization, and an extended hospital length of stay. In my area of practice, the blood culture contamination rate for November is more than three percent. Current national average of contamination rates is between two to three percent (Bentley, Thakore, Muir, Baird, & Lee, 2016). The clinical question to explore in this paper is: What are the best ways to reduce blood culture contamination rates in the emergency department? It is necessary to find out the factors that affect the elevated contamination rate so that interventions could be implemented to reduce or eliminate the problem. Data-information-knowledge-wisdom (DIKW) continuum essay.
Using the DIKW Continuum to Address the Clinical Question
The DIKW continuum first utilizes data, which is defined as facts obtained through observation with no interpreted meaning (McGonigle & Mastrian, 2018). The November data of the blood culture contamination rate in the emergency department and the national average are two distinct data that are available at this stage of the paradigm.
Using the Walden Library, I conducted a search using Cinahl Plus with Full Text from the six recommended nursing databases. I chose this database because it contains peer-reviewed literatures and evidence-based articles that have full texts as described in the database description. The key words that were used were blood culture contamination that yielded 103 articles. The search was further narrowed down to 52 after limiting the time period from 2013-2018. To obtain articles that are relevant to my specialty field, emergency department were used as additional key words that produced 14 articles. From the last selection, I researched the titles that would help obtain information to answer the clinical question.Data to Information
Information are gathered by integrating data points to give structure to the group of data that are available (McGonigle & Mastrian, 2018). Data for blood culture contamination from the infection control department of the hospital showed that emergency department has the following contamination rates: September- 3.24%, October- 3.76%, and November- 3.89%. The information showed an upward trend. The national average rate is between two to three percent, thus, compared to the national standards, the department’s rate is high in the past three months. Additional information learned from the infection control department said poor site preparation is the main cause of the problem. Lack of education on proper blood culture collection was also identified as another cause. Data-information-knowledge-wisdom (DIKW) continuum essay The data reveals the information that there are two main factors that caused the increased contamination rates in the department.
Information to Knowledge
Knowledge is derived from the synthesis of cluster of information where patterns and relationships are established (McGonigle & Mastrian, 2018). The information gathered leads to the conclusion that improper insertion site preparation in obtaining blood culture and lack of education in proper blood culture collection caused the upward trend of the department’s contamination rate. From the articles reviewed in the nursing database, best practices were identified regarding blood culture collection. It is necessary to look for strategies that are evidence-based to overcome the issues identified in the department. Some of the recommendations in the research study by Constance, Coleman, and Cunningham (2015) said that staff education with return demonstration, use of sand timers to provide accurate time for cleaning blood culture collection site, and utilization of a blood culture kit are effective strategies in reducing contamination rates. Another article recommended the use of optimum skin antisepsis, sterile glove protocol, and training a set of dedicated staff members who will draw blood culture specimens (Denno & Gannon, 2013). The use of knowledge in answering the clinical question is done through analyzing which best practice is relevant to the department based on the main factors that were causing the problem.
Knowledge to Wisdom
Wisdom is the use of knowledge to implement solutions to the problem (McGonigle & Mastrian, 2018). This step is the application of the knowledge obtained from the interpreted and organized data and information. There were two identified causes of the problem. To apply knowledge into wisdom, the best practices that were identified which should be implemented in the emergency department based on practicality and cost-effectiveness are the use of blood culture kits and implementation of staff education on proper blood culture collection followed by a return demonstration to verify competencies of the nurses and emergency department technicians. There is no single cause for blood culture contamination, thus, facilities need to identify the unique contributors to contamination and develop a tailored strategy based on the available resources.
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Summary
The American Nurses Association (2015) recognizes the significance of data, information, knowledge, and wisdom to nurses in all specialty areas. Utilizing the DIKW continuum, decision-making process is facilitated to arrive at a sound nursing judgment when faced with a clinical problem. Nursing informatics, as a nursing specialty, helps gain wisdom in nursing practice. Answering the clinical question on the best method of reducing blood culture contamination was made intelligently through the progression of the DIKW paradigm. In my future practice as an acute care nurse practitioner, the DIKW model will be used to guide me in my clinical practice and decision-making. Data-information-knowledge-wisdom (DIKW) continuum essay.
References
American Nurses Association. (2015). Nursing informatics: Scope and standards of practice (2nd ed.). Silver Spring, MD: Author.
Bentley, J., Thakore, S., Muir, L., Baird, A., & Lee, J. (2016). A change of culture: Reducing blood culture contamination rates in an emergency department. BMJ Quality Improvement Reports, 5(1). doi: 10.1136/bmjquality.u206760.w2754
Bowen, C. M., Coleman, T., & Cunningham, D. (2015). Reducing blood culture contaminations in the emergency department: It takes a team. Journal of Emergency Nursing, 42(4), 306-311. doi:10.1016/j.jen.2015.10.021
Denno, J., & Gannon, M. (2013). Practical steps to lower blood culture contamination rates in the emergency department. Journal of Emergency Nursing, 39(5), 459-464. https://doi.org/10.1016/j.jen.2012.03.006
McGonigle, D., & Mastrian, K. G. (2018). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones and Bartlett Learning.
Ronquillo, C., Currie, L. M., & Rodney, P. (2016). The evolution of data-information-knowledge-wisdom in nursing informatics. Advances in Nursing Science, 39(1), e1-e18. doi: 10.1097/ANS.0000000000000107 Data-information-knowledge-wisdom (DIKW) continuum essay
Steed, L. L. (2017). Reducing blood culture contamination. Clinical Lab Product. Retrieved from http://www.clpmag.com/2017/08/reducing-blood-culture-contamination/
Nursing has undergone changes in the recent years and now, there are high expectations from nurses to keep their practice up to date to improve nursing processes. Questions are developed in the clinical areas seeking for answers to help enhance the quality of patient care. The use of the DIKW paradigm in solving clinical questions assists nurses to practice with wisdom and apply wisdom to practice. The purpose of this paper is to identify a clinical question relevant to the emergency department and discuss the answer through the progression of the methods of the DIKW framework Data-information-knowledge-wisdom (DIKW) continuum essay. Applying the knowledge obtained from this method in the clinical setting will demonstrate how informatics is instrumental to gain wisdom.
Data to Information
Information are gathered by integrating data points to give structure to the group of data that are available (McGonigle & Mastrian, 2018). Data for blood culture contamination from the infection control department of the hospital showed that emergency department has the following contamination rates: September- 3.24%, October- 3.76%, and November- 3.89%. The information showed an upward trend. The national average rate is between two to three percent, thus, compared to the national standards, the department’s rate is high in the past three months. Additional information learned from the infection control department said poor site preparation is the main cause of the problem. Lack of education on proper blood culture collection was also identified as another cause. Data-information-knowledge-wisdom (DIKW) continuum essay The data reveals the information that there are two main factors that caused the increased contamination rates in the department.
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