REPLY1 Understanding the health care system at a local level means that you are aware of the culture that resides within and what causes and effects are in place for that local community. This is important when implementing evidence-based practice to ensure the health care system is functioning and providing to address the needs in a local, community, and on a neighborhood level. In the community and facility selected for the change project, as evidenced by my preceptor there are over 200 children that have asthma most using and needing controlled medication. This information is generated through a combined department of health and education system, which can filter and scan for children with health needs, based on diagnosis entered in the system. In speaking with several parents there are many who state their child are not asthmatic, and they just have colds, or that their childs symptoms occurred only once or twice in their lifetime. Although incidents of asthma can occur once their diagnosis goes on in the system throughout their lifetime as children. School health officials get notification alerts (shown to me by the preceptor) of prior hospitalizations and diagnosis of asthma. This system allows the nurses within the school to address and follow up with children and their caretakers. Research tells us there are 770 visits to the emergency department in relation to asthma in Washington Heights (Pichardo, 2016). The department of health continues to make parents aware through campaigns such as Your Childs Asthma Is Always There, Even When They Seem Perfectly Fine, to help them understand and remind them that asthma is a disease process that can be triggered at any given time, and not all children experience the same symptoms of severity, many children can live life without the use of controller medication whereas others need it to keep asthma in a dormant phase. Taking proper measures is important in the prevention of flare ups and hospitalizations. Families with the understanding that their children do not have asthma, because their symptoms have temporarily left them, can many times place their child at risk for emergency calls while in school, if they do not have inhalers or medication to keep them controlled. The Washington Heights/Inwood network has a mission to find and help treat children with asthma in the community, schools, clinics, and daycare organizations (Asthma Community Network, n.d.). As you can see, the community has some resources that aims to help children with asthma, and helping these children go deeper than the outside community it start in the home and within the school system to address these concerns. Together I hope to reinforce teaching and come up with solutions and/or strengthening the ones already in place by finding and filling gaps. References Asthma Community Network. (n.d.). Washington Heights/Inwood network for asthma, New York presbyterian hospital snapshot. https://www.asthmacommunitynetwork.org/node/3331 Pichardo, C. (2016, November 25). Take these 2 steps to protect your asthmatic child, city says. Washington Heights & Inwood. Dna info. https://www.dnainfo.com/new-york/20171027/norwood/woman-raped-during-bronx-drug-deal-police REPLY2 It is very important to understand the health care system at a local level because this will aid the nurse in determining if the new EBP will apply to the health care setting. Evidence-based practice significantly improves the quality and safety of healthcare, enhances patient outcomes, and reduces cost. EBP includes lifelong problem-solving approaches to how healthcare is delivered and integrates the best evidence from high quality studies. When planning an evidence based practice implementation, we must first understand and identify the challenges facing the healthcare system. Inadequate and delayed implementation of current evidence into practice has contributed to medical errors, safety issues, and patient deaths (Harris et al., 2015). In talking to my preceptor about the increased rates in central venous catheter infections, she agreed that this is a recurring problem in many dialysis clinics, as she rounds in 8 different clinics. She has observed nurses performing inadequate catheter care, and has stopped to correct and guide them as to what they are missing or doing wrong. Other times she has asked patients questions about their plan for the catheter removal, catheter care, or access placement and the patients are clueless and unaware of what needs to be done, or the reason why it needs to be removed or well cared for. She agrees that this is a topic that needs to be addressed thoroughly with nurses and patients as well. References Harris, C., Garrubba, M., Allen, K., King, R., Kelly, C., Thiagarajan, M., Farjou, D. (2015). Development, implementation and evaluation of an evidence-based program for introduction of new health technologies and clinical practices in a local healthcare setting. BMC Health Services Research, 15, 575. http://doi.org/10.1186/s12913-015-1178-4
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