NURS FPX 6218 Assessment 1 Proposing Evidence-Based Change

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Capella university

NURS-FPX 6218 Leading the Future of Health Care

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Date

Proposing Evidence-Based Change

Allergic Contact Dermatitis (ACD) is a common, life-altering skin condition caused by contact with allergens and chemicals and is a type IV hypersensitivity (Nassau & Fonacier, 2020). It can result from pre-existing skin conditions, genetic factors, and irritant exposure. Nurses play a crucial role in managing ACD through skin care, topical treatments, and patient education (Thyssen et al., 2022). The focus will be on exploring and implementing effective ACD management strategies at North Central Health Care (NCHC), Wisconsin.

Executive Summary

Proposed Change

Healthcare institutions like NCHC need to make changes in order to ensure better healthcare outcomes for ACD patients. Through teaching patients about their condition, they can identify their allergic triggers and make behavioral adjustments to help reduce the disease’s inflammatory reaction. People allergic to synthetic rubber should choose a variety of gloves, including a rubber accelerator that they are not allergic to, such as carbamates or another substance (Hansen et al., 2021).

The most effective treatment for ACD is identifying and eliminating the causative agent. In some instances, nurses at NCHC may be able to manage severe allergic contact dermatitis with antihistamines and dermal or oral corticosteroids. Once identified, avoiding the allergen is essential to prevent a recurrence (Lipman & Tosti, 2021). ACD greatly affects the quality of life, particularly when it impacts specific body areas. It has been demonstrated that ACD patients who are identified early have better results. This is an urgent issue for medical professionals worldwide (Silverberg et al., 2024).

Local or Regional Health Care System for the Proposed Change

Living with ACD can be difficult because the condition frequently interferes with sleep, damages interpersonal relationships, and even jeopardizes employment (Xi et al., 2022). One local healthcare system that needs to revise its approach to ACD is the NCHC system in Wisconsin (NCHC, 2023). In particular, when it comes to ACD, the NCHC needs to follow the interventions and strategies used by the Mayo Clinic (Mayo Clinic, 2023). The patient must know common allergens, such as nickel, fragrances, and preservatives in cosmetics and personal care items. According to Uter et al. (2020), ACD can significantly reduce patients’ quality of life by causing itching, redness, swelling, and blisters.

Patients should be educated on identifying and avoiding common allergens in the NCHC system to address ACD. They should revise patient education and environment, as well as how to properly care for their skin to minimize the risk of developing ACD. In addition, healthcare providers should be trained to recognize the signs and symptoms of ACD and to provide appropriate treatment and referrals as needed (Haque et al., 2022). Moreover, it is also possible to use social media platforms to inform patients about avoiding allergens to lower the prevalence of ACD (Nguyen et al., 2021). Nurses can be extremely important in organizing and carrying out patient training. They can emphasize the immunologic basis of ACD, safeguards against allergies, and how corticosteroids should be used (Thyssen et al., 2022).

Expectations

Understanding how a disease operates does not always result in changes in patient behavior. It is crucial to take the person’s growth stage, prior knowledge, and interaction with healthcare experts into account in order to inspire them to act better. Successful results are more likely to be obtained in this way. Clear standards should be defined to enhance the healthcare system and teach people how to manage their allergic contact dermatitis. This involves educating people about the condition, including the source of the allergic response, the symptoms it causes, and the most effective course of therapy. Healthcare professionals should emphasize preventive measures, such as wearing protective garments and hypoallergenic skin care products, to lower the chance of recurrence (Uter et al., 2020).

Desirable Outcomes 

The desired patient outcomes include several key objectives. Firstly, it is crucial to determine the toxins or triggers that induce ACD in each patient. Identifying these allergens allows for targeted avoidance strategies, which can significantly reduce the occurrence and severity of allergic reactions. Prevention from allergens is a primary goal, as minimizing exposure is essential to managing and mitigating the symptoms of ACD effectively. Another important outcome is achieving high levels of patient satisfaction. This can be gauged by evaluating the patient’s experience with the medication’s delivery technique and the duration of treatment. Satisfaction also encompasses the patient’s comfort and confidence in managing their condition, which can be enhanced through proper education and support (Conway et al., 2024).

The interdisciplinary team at the institution plays a vital role in improving patient results. While physicians are responsible for prescribing treatment when necessary, consulting a pharmacist regarding drug choice and dosage ensures that the medication regimen is safe and effective. Customizing treatment plans to the patient’s specific needs and the affected body area is essential. This personalized approach should be complemented by ongoing education and regular follow-ups with specialists to monitor progress and make any necessary adjustments to the treatment plan (Kersh et al., 2021).

Limiting Factors

The achievement of desired outcomes for ACD is constrained by the rising cost of healthcare in the United States and the limited insurance coverage for treatment. Many insurance companies need to cover the total cost, leaving patients with significant out-of-pocket expenses. These financial burdens can be especially challenging for patients with limited financial resources (Herman et al., 2021).

Who will Pay for the Care

The cost of care for ACD is ultimately borne by the patient, who must pay for the diagnosis, treatments, and medications associated with the condition. This expense can be challenging for those without health insurance, as they need access to the same treatments or medications as those insured. Furthermore, the lack of health insurance can lead to delayed diagnosis, which can cause the condition to worsen and increase the cost of care (Conway et al., 2024).

The Rationale for the Proposed Change

Making specific changes can lead to improved outcomes for ACD patients at NCHC because they can reduce the severity and frequency of the symptoms caused by their allergic reactions. For instance, by avoiding contact with allergens that cause ACD, patients can reduce the inflammation and discomfort that comes with the condition. Furthermore, early detection of ACD patients and educating patients about the allergens can result in more effective treatment and faster healing, which may significantly improve their quality of life (Silverberg et al., 2024).

The expected improvements in outcomes at NCHC include a reduction in the severity and frequency of the symptoms caused by ACD, improved treatment outcomes, and improved quality of life. These improvements can be justified by research, such as a study by the National Institutes of Health (NIH), which found that early detection and avoidance of allergen contact can reduce inflammation and discomfort associated with ACD (Goossens & Aerts, 2022).

Comparative Analysis of the Healthcare System

As described in Table 1 of the Appendix, England, India, and the USA each offer comprehensive strategies for managing ACD, including identifying triggers, avoiding allergens, and ensuring patient satisfaction. The National Institute for Health and Care Excellence (NICE) in England, Allergy Care India (ACI), and the National Institute of Allergy and Infectious Diseases (NIAID) in the USA all provide valuable resources and support for ACD management. NCHC can learn from these approaches to enhance its care quality by understanding patient needs and implementing effective strategies. To measure outcomes, NCHC should collect data on the number of patients identifying ACD triggers, the percentage avoiding allergens, and patient satisfaction through surveys (Maury et al., 2023).

Lessons Learned

The healthcare systems of England, India, and the USA have demonstrated successful strategies for managing ACD, such as NICE’s guidelines for identifying triggers, Allergy Care India’s education on allergen avoidance, and NIAID’s interventions for patient satisfaction. Lessons from these systems include the need for national guidelines and databases for ACD triggers, comprehensive patient education on allergen avoidance, and robust patient satisfaction programs. By applying these lessons from NICE, ACI, and NIAID, North Central Health Care can enhance patient outcomes and deliver high-quality care (Garg et al., 2021).

Financial and Health Implications

Making the proposed changes at NCHC for better ACD patient outcomes has significant financial and health implications. Early detection can reduce treatment costs by avoiding expensive antihistamines and corticosteroids (Silverberg et al., 2024). Early diagnosis enables appropriate treatment and lifestyle adjustments, improving quality of life and reducing long-term treatment costs (Herman et al., 2021). Conversely, not implementing these changes could lead to more severe ACD cases, necessitating intensive treatments like systemic steroids and increasing costs for individuals and the healthcare system.

Lack of early detection can worsen patients’ quality of life, impacting their ability to work and perform daily activities. A U.S. study found that patch testing reduced ACD treatment costs and improved patient quality of life (Goldenberg et al., 2020). The initial investment in patch testing and education programs may be costly, but the benefits include long-term healthcare cost savings and better patient outcomes. Short-term effects involve implementation expenses, while long-term effects promise sustainable cost reductions and enhanced health outcomes for ACD patients (Garg et al., 2021). These changes are likely to provide significant benefits for individuals and the NCHC, Wisconsin community.

Conclusion

The proposed changes for better ACD patient outcomes can lead to cost savings and improved quality of life. Strategies from the UK, India, and the US show that early detection and allergen management reduce treatment costs and enhance patient satisfaction. Implementing these changes is likely to yield significant financial and health benefits.

References

ACI. (2023, September). Allergy Care India (India) – Global Allergy & Airways Patient Platform. Global Allergy & Airways Patient Platform. https://gaapp.org/?organizations=india-allergy-care-india 

Conway, A. E., Lieberman, J., Codispoti, C. D., Mahdavinia, M., Anagnostou, A., Hsu Blatman, K. S., Lang, D. M., Oppenheimer, J., Mosnaim, G. S., Bukstein, D., & Shaker, M. (2024). Pharmacoequity and biologics in the allergy clinic: Providing the right care, at the right time, every time, to everyone. The Journal of Allergy and Clinical Immunology. In Practice, 12(5), 1170–1180. https://doi.org/10.1016/j.jaip.2024.02.039 

Garg, V., Brod, B., & Gaspari, A. A. (2021). Patch testing: Uses, systems, risks/benefits, and its role in managing the patient with contact dermatitis. Clinics in Dermatology, 39(4), 580–590. https://doi.org/10.1016/j.clindermatol.2021.03.005 

NURS FPX 6218 Assessment 1 Proposing Evidence-Based Change

Goldenberg, A., Ehrlich, A., Machler, B. C., & Jacob, S. E. (2020). Patch test clinic start-up. Dermatitis, 1. https://doi.org/10.1097/der.0000000000000559 

Goossens, A., & Aerts, O. (2022). Contact allergy to and allergic contact dermatitis from formaldehyde and formaldehyde releasers: A clinical review and update. Contact Dermatitis, 87(1), 20–27. https://doi.org/10.1111/cod.14089 

Hamza, M., Alam, S., Rizwan, M., & Naz, A. (2022). Health risks associated with arsenic contamination and its biotransformation mechanisms in environment: A review. Emerging Contaminants and Associated Treatment Technologies, 241–288. https://doi.org/10.1007/978-3-030-96523-5_11 

NURS FPX 6218 Assessment 1 Proposing Evidence-Based Change

Hansen, A., Brans, R., & Sonsmann, F. (2021). Allergic contact dermatitis to rubber accelerators in protective gloves: Problems, challenges, and solutions for occupational skin protection. Allergologie Select, 5, 335–344. https://doi.org/10.5414/ALX02265E 

Haque, M. Z., Rehman, R., Guan, L., & Kerr, H. (2022). Recommendations to optimize patient education for allergic contact dermatitis: Our approach. Contact Dermatitis. https://doi.org/10.1111/cod.14269 

Herman, A., Uter, W., Rustemeyer, T., Matura, M., Aalto‐Korte, K., Duus Johansen, J., Gonçalo, M., White, I. R., Balato, A., Giménez Arnau, A. M., Brockow, K., Mortz, C. G., Mahler, V., & Goossens, A. (2021). Position statement: The need for EU legislation to require disclosure and labelling of the composition of medical devices. Journal of the European Academy of Dermatology and Venereology, 35(7), 1444–1448. https://doi.org/10.1111/jdv.17238 

Kersh, A. E., Johansen, M., Ojeaga, A., & de la Feld, S. (2021). Hand dermatitis in the time of COVID-19: A review of occupational irritant contact dermatitis. Dermatitis, 32(2), 86–93. https://doi.org/10.1097/der.0000000000000721 

NURS FPX 6218 Assessment 1 Proposing Evidence-Based Change

Krishna, M. T., Mahesh, P. A., Vedanthan, P., Moitra, S., Mehta, V., & Christopher, D. J. (2020). An appraisal of allergic disorders in India and an urgent call for action. World Allergy Organization Journal, 13(7), 100446. https://doi.org/10.1016/j.waojou.2020.100446 

Lipman, Z. M., & Tosti, A. (2021). Contact dermatitis in nail cosmetics. Allergies, 1(4), 225–232. https://doi.org/10.3390/allergies1040021 

Maury, C. A., Gruson, K. I., Tabeayo, E., Gruson, L. M., & Rodriguez, C. (2023). Allergic contact dermatitis (ACD) to topical products in orthopedic surgery: Clinical characteristics and treatment strategies. PubMed, 11(10), 604–616. https://doi.org/10.22038/abjs.2023.70444.3303 

Mayo Clinic. (2023). Contact dermatitis – Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/contact-dermatitis/symptoms-causes/syc-20352742 

Nassau, S., & Fonacier, L. (2020). Allergic contact dermatitis. Medical Clinics of North America, 104(1), 61–76. https://doi.org/10.1016/j.mcna.2019.08.012 

NCHC. (2023). North Central Health Care. NCHC. https://www.norcen.org/ 

Nguyen, M., Case, S., Botto, N., & Liszewski, W. (2021). The use of social media platforms to discuss and educate the public on allergic contact dermatitis. Contact Dermatitis, 86(3), 196–203. https://doi.org/10.1111/cod.14004 

NURS FPX 6218 Assessment 1 Proposing Evidence-Based Change

NIAID. (2024). NIH: National Institute of Allergy and Infectious Diseases | Leading research to understand, treat, and prevent infectious, immunologic, and allergic diseases. Nih.gov. https://www.niaid.nih.gov/ 

NICE. (2019). Dermatitis – contact | National Institute for Health and Care Excellence. https://cks.nice.org.uk/topics/dermatitis-contact/ 

Silverberg, J. I., Patel, N., Warshaw, E. M., DeKoven, J. G., Belsito, D. V., Atwater, A. R., Taylor, J. S., Sasseville, D., Reeder, M. J., Houle, M.-C., DeLeo, V. A., Maibach, H. I., Fowler, J. F., Zug, K. A., Pratt, M. D., Yu, J., Mowad, C. M., Botto, N. C., & Adler, B. L. (2024). Patch testing with nickel, cobalt, and chromium in patients with suspected allergic contact dermatitis. Dermatitis, 35(2), 152–159. https://doi.org/10.1089/derm.2023.0139 

Spergel, A. K. R., & Togias, A. (2020). Observational human studies in allergic diseases: Design concepts and highlights of recent National Institute of Allergy and Infectious Diseases-funded research. Current Opinion in Allergy and Clinical Immunology, 20(2), 208. https://doi.org/10.1097/ACI.0000000000000620 

Thyssen, J. P., Schuttelaar, M. L. A., Alfonso, J. H., Andersen, K. E., Angelova‐Fischer, I., Arents, B. W. M., Bauer, A., Brans, R., Cannavo, A., Christoffers, W. A., Crépy, M., Elsner, P., Fartasch, M., Filon, F. L., Giménez‐Arnau, A. M., Gonçalo, M., Guzmán‐Perera, M. G., Hamann, C. R., Hoetzenecker, W., & Johansen, J. D. (2022). Guidelines for diagnosis, prevention, and treatment of hand eczema. Contact Dermatitis, 86(5), 357–378. https://doi.org/10.1111/cod.14035 

NURS FPX 6218 Assessment 1 Proposing Evidence-Based Change

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Appendix

Table 1

Desired Outcomes	England The National Institute for Health and Care Excellence (NICE)	India Allergy Care India (ACI)	United States National Institute of Allergy and Infectious Diseases (NIAID)
Determining the toxins or triggers that induce ACD	NICE provides guidelines to assist healthcare professionals in determining the toxins or triggers that induce ACD. (NICE, 2019)	India has ACI, which research and studies the toxins or triggers that induce ACD (Krishna et al., 2020)	NIAID has an extensive database of ACD triggers and toxins (NIAID, 2024).
Allergens avoidance	NICE provides resources to help patients identify and avoid allergens. (Wise, 2022)	ACI educates the public about allergen avoidance (ACI, 2023)	NIAID has the Allergen Avoidance Program (AAP) to help people identify and avoid allergens. (Spergel & Togias, 2020)
Patient Satisfaction	NICE has developed a range of interventions to help ensure patients receive the best possible care for ACD (Wise, 2022).	ACI work helps a lot to improve patient satisfaction in India dealing with allergies and dermatitis (ACI, 2023).	NIAID has a huge role in patient satisfaction to help improve patient quality of life (NIAID, 2024).

NURS FPX 6218 Assessment 1 Proposing Evidence-Based Change