NR 669 Week 5 Progress Brief Example

Progress Brief: Hours, Objectives Running and Stalled, What Now Exists That Did Not and the Plan for the Remaining Weeks in a Skilled Nursing Facility Immersion

Student Name

College of Nursing, Chamberlain University

NR 669: Advanced Nursing Role Immersion Part 3

Instructor Name

Month Day, Year

Progress Brief: Hours, Objectives Running and Stalled, What Now Exists That Did Not and the Plan for the Remaining Weeks in a Skilled Nursing Facility Immersion

Position, in Numbers

Hours logged in my own record: 96 of the 144 in my approved immersion plan. Objectives: five in the plan, of which three are running, one has been narrowed and one was exchanged in week 2. Surveillance weeks completed: 6. Hand hygiene observations: 80. Antibiotic starts reviewed: 17.

Movement, as Things That Now Exist

An infection line list kept current every Monday and Friday for six weeks, with 26 suspected infections entered and each marked against the revised surveillance definitions (Stone et al., 2012).

A hand hygiene audit summary for September and early October, two units, 80 observations, showing 58% adherence at room entry and exit in September and 69% in the first two weeks of October, after feedback at shift report began.

A one-page summary of 17 antibiotic starts against the minimum criteria for initiation (Loeb et al., 2001), prepared for the medical director's October visit.

A 15-minute teaching session on noticing and passing on changes that might mean infection, given to 19 certified nursing assistants at two shift reports on 6 and 8 October.

A script for in-the-moment hand hygiene reminders, added to the audit instructions.

Stalls, With Their Causes

The infection control committee presentation, narrowed out in week 2: the committee meets quarterly and its next meeting falls after the immersion.

The October quality committee presentation: scheduled, then moved to November by the administrator because of a state survey visit. Cause: the survey takes precedence over all meetings.

Feedback on antibiotic starts to prescribers: the medical director's October visit was cut to one day because of the survey. The summary was left with the director of nursing to pass on.

Each stall comes from the facility's calendar or regulators, not from a lack of willingness. The survey visit, in particular, absorbed the IP for most of a week.

What the Audits Show in More Detail

The 80 observations split evenly between the two long-term units. Most misses were at room exit after contact with the resident's surroundings, not at entry. Day shift and evening shift did not differ much. The rise after feedback began is encouraging, but the audits were not blinded and staff knew when they were happening; international guidance on hand hygiene notes the same limitation of direct observation (World Health Organization, 2009).

What the Antibiotic Review Shows So Far

Of 17 antibiotic starts reviewed, 11 were for suspected urinary infections, and most fell short of the consensus thresholds for beginning antibiotic treatment in residents. The review does not judge individual prescribers; it describes a pattern in how calls are made and answered, which the week 6 write-up examines.

What the IP Has Taken On

The IP now enters cases on the line list on days I am not there, using the same format. The IP has asked the director of nursing to keep Friday afternoons free of floor coverage when possible, which has held for three of the last four weeks. That small agreement is the most important change of the immersion so far, because it protects the hours in which the line list and audits get done, whether or not a student is present.

The Plan for the Remaining Weeks

Weeks 6 and 7: continue surveillance and audits; second round of the change-in-condition in-service for evening staff on 20 October; meet with the medical director by phone on 22 October to discuss the antibiotic summary.

Week 7: draft a one-page decision aid for nurses calling a prescriber about a suspected urinary infection, based on the antibiotic review.

Week 8: hand over the line list and audit tool use to the IP; final summary.

Each date is set against the facility's calendar: the survey team left on 9 October; the next quality committee is 12 November.

How the Remaining Weeks Protect What Has Been Built

The final weeks focus on handing over rather than adding. The line list format is already in the IP's hands. The audit tool will be left with completed examples and the in-the-moment script. The antibiotic summary will go to the medical director with the decision aid draft. The goal is that nothing produced during the immersion depends on my continuing presence, since the facility has no one else to carry it.

What Has Changed in My Own Practice Since the Last Brief

I now ask what I am permitted to do before each new task, since the hand hygiene episode. I bring one-page summaries rather than longer reports to people who need to act on them. And I check the facility's calendar for survey windows and committee dates before promising any date, which the October stalls taught me. Each change came from a stall or an episode in the first five weeks, and each would have been hard to learn from reading alone. Together they amount to a way of working inside an organization whose calendar I do not control, which is most of what an advanced role requires.

Risks to the Plan

Another survey visit, an outbreak or a run of staff call-outs would each pull the IP away and could stall the handover. If that happens, the handover materials will be left in the IP's binder with a one-page guide, so they can be picked up later without me.

One Request

That the director of nursing allow me to attend the 22 October phone call with the medical director, so that the antibiotic summary is discussed with the person who can act on it.

What the Numbers Do Not Show

Whether surveillance and audits will continue when I leave. The IP has said the line list will be kept, but the IP also covered three nursing shifts in the past two weeks. The progress depends partly on my being an extra pair of hands, which the final weeks need to address. Nursing home infection preventionist time is limited nationally (Stone et al., 2020), and my hours are a temporary addition to it.

Hours Note

The hours figure is reported once, at the top, because the brief's purpose is position, not attendance. Hours, encounters and the preceptor's signatures are my own records in the program's system. This brief reports only the total.

References

Loeb, M., Bentley, D. W., Bradley, S., Crossley, K., Garibaldi, R., Gantz, N., McGeer, A., Muder, R. R., Mylotte, J., Nicolle, L. E., Nurse, B., Paton, S., Simor, A. E., Smith, P., & Strausbaugh, L. (2001). Development of minimum criteria for the initiation of antibiotics in residents of long-term-care facilities: Results of a consensus conference. Infection Control & Hospital Epidemiology, 22(2), 120-124. https://doi.org/10.1086/501875

Stone, N. D., Ashraf, M. S., Calder, J., Crnich, C. J., Crossley, K., Drinka, P. J., Gould, C. V., Juthani-Mehta, M., Lautenbach, E., Loeb, M., MacCannell, T., Malani, P. N., Mody, L., Mylotte, J. M., Nicolle, L. E., Roghmann, M.-C., Schweon, S. J., Simor, A. E., Smith, P. W., . . . Bradley, S. F. (2012). Surveillance definitions of infections in long-term care facilities: Revisiting the McGeer criteria. Infection Control & Hospital Epidemiology, 33(10), 965-977. https://doi.org/10.1086/667743

Stone, P. W., Agarwal, M., & Pogorzelska-Maziarz, M. (2020). Infection preventionist staffing in nursing homes. American Journal of Infection Control, 48(3), 330-332. https://doi.org/10.1016/j.ajic.2019.12.010

World Health Organization. (2009). WHO guidelines on hand hygiene in health care. World Health Organization.