Clinical Microsystem Assessment


This essay aims at critically discussing various aspects of the clinical microsystem assessment such as the background of the 5Ps, the theme involved in microsystems improvement, the global aim statement, a process flow chart, specific aim statement of theCentral Venous Catheter (CVC) removal protocol in a hospital setting and cause and effect using the fishbone diagram.

Description of Background of 5 P’s

For most of the broader health care organizations and the entire health system, the clinical microsystems are fundamental pillars or building blocks since they are responsible for the value-added work within an organization and provide a common place where care teams, patients and their families can meet(Smith, 2012). A group of staff and clinicians working together with a shared clinical purpose to the provision of high-quality care make up the clinical microsystem. According to the National Association of Clinical Nurse Specialists, the microsystem concept provides a reliable organizational framework that can be used by the concerned organizations to provide and improve the care of patients through making the 5Ps explicit(Gurzick & Kesten, 2010). These 5Ps make up the key goals of any of the microsystem, and they include:

Purpose: it helps in outlining the primary use of a given clinical microsystem and demonstrates how this purpose effectively fit in the overall mission and vision of the healthcare organization.

Patients: provides a clear explanation and justification of the target group or people that this microsystem focuses on within the organization whereby patients form the target group in a clinical setting (Smith, 2012).

Professionals: this P demonstrates the critical individual or staff who are supposed to work in the concerned microsystem (Smith, 2012).

Processes: this P explains the various support and caregiving processes that are employed within the microsystem in the effort of providing care services to the clients or target group (Smith, 2012).

Patterns: it illustrates the different trends of models that can be used to describe the overall functioning of the microsystem (Smith, 2012).


The best way in which an organization can attract helpful resources for the changes that it is seeking is through aligning its microsystem’s improvement themes with the strategic priorities of its macro system (Proust & Drucker, 2014). This approach further facilitates improved performance of the concerned microsystem and supports entity-wide achievement of important goals (Proust & Drucker, 2014). Taking into consideration aspects such as the strategic goals and priorities of the company, the existing performance metrics and gaps between the results realized and the best-practice results and the different views of the clinical staff on what can be considered as intolerable in the daily practice can all help an organization develop ideas for worthy themes (Proust & Drucker, 2014).

In the past three decades, most of the professional groups have continuously adopted essential visionary goals that are aimed at serving as essential microsystem improvement themes in a healthcare organization. For instance, the Cystic Fibrosis Foundation is one of the known professional groups worldwide in provision of quality health care and it has created various goals such as maintaining adult's nutrition as near normal as possible, ensuring full collaboration between cystic fibrosis (CF) care teams and patients affected by this disease and making sure that there exists a reliable CF team that is providing care to patients severely affected(Moran et al., 2010). All these goals are meant to act as a guide towards continued improvement of care delivery across all cystic fibrosis centers.

Global Aim Statement

The process involved in evaluating and improving the protocol that is customarily used by nursing staff when removing the Central Venous Catheter (CVC) in a three-hundred and fifty-bed urban teaching hospital is the actual global aim of this Quality Improvement (QI) project. The clinical location of this hospital is a large metropolitan area. This process will begin with reviewing fifty different charts with the goal of evaluating is there were any adverse related events and determining whether the staff documented the CVC removal according to current hospital protocol (Nucci et al., 2010). Correlation of the current protocol with the results of the collected data to determine the efficiency of charting by the nursing staff during the project will mark the end of this process. Some of the key benefits of this process include effectively identifying all the existing strengths and weaknesses in the current protocol and minimizing the potential for serious complications that may put the patient's life into danger during the removal, use or placement of the CVC (Nucci et al., 2010).

Process Flow Chart

The below chart illustrates the process that is usually followed during the use, removal, and replacement of the Central Venous Catheter (CVC) in patients who have non-functional veins.

Figure 1: CVC Removal Process Flow Cha

Source: (Al Raiy et al., 2010)

Below is the discussion of various procedures that are employed by the nurses when removing central venous catheters from the veins of the patient after critically assessing the current medical condition of the patient during his or recovery process as illustrated in the above flow chart. Firstly, the nurse is required to ensure that the patient is hemodynamically stable before the removal of the CVC (Al Raiy et al., 2010). Secondly, the nurse should ensure that the amount of platelet counts is more significant than 50mm. Thirdly, in the effort of acquiring the verbal consent of the patient, the nurse is required to provide a comprehensive explanation of the removal procedure that is going to be employed (Al Raiy et al., 2010). The fourth step is ensuring that the patients lie on a 45 degrees angle or less while the procedure starts, and this then followed by the patient washing hands, removing the dressing from the site of the CVC insertion, sterilize the gauze swabs and cover with one side the insertion site while the other one removes the CVC(Al Raiy et al., 2010). After the CVC is removed, the nurse should press the insertion site with the sterilized swan for 5 minutes and then apply air-occlusive dressing which should remain the for the next 24 hours (Al Raiy et al., 2010). Culture and sensitivity sessions are used in case the patient exhibits signs of infection.

Specific Aim

The specific process and aim of the revised protocol that will be realized along with 50 chart audits will basically be determining the adherence to the CVC removal protocol in the hospital, the documentation patterns followed and facilitating the effective tracking of adverse occurrences and improvement of overall patient outcome (Nucci, et al., 2010). About 25% to 75% reduction in adverse events that are associated with the removal of CVL will be expected to be achieved by August 1, 2019.

Cause and Effects

The fishbone diagram is often used to describe and capture the different ideas and opinions of the using a team approach to problem-solving and stimulate the brainstorming exercise of such a team on the root cause of a particular problem and the possible effects(Dobrusskin, 2016). The below image illustrates the fishbone diagram.

Figure 2: Fishbone Diagram

Source: (Dobrusskin, 2016).

Some of the critical causes of the use of Central Venous Catheter (CVC) protocol within the hospital setting is due to the occurrence of pulmonary complications, damage to the central veins in the body of a patient, infection and cardiac complications(Chang, 2015). Such incidents have drastic effects such as continued bleeding that results in hematoma swelling that is composed of clotted blood. Other effects include regular pains in the affected organs of the body, reduced quality of health and even death when the condition becomes severe (Chang, 2015). After continued brainstorming amongst the staff in the clinical settings, the multidisciplinary team has realized that the use of CVC has numerous positive effects such as enabling the physicians to administer nutrients, the right fluids, medicine, and blood products right into the patient's blood at easy when the veins in the patient's body become non-functional (Chang, 2015). Moreover, this device assists the clinicians in removing blood from the body of the patient for lab tests.

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