Before completing this template, thoroughly consider the Course Project Milestone 3 Guidelines, paying special attention to the document's name and all rubric requirements. After you've saved the document to your computer, input your responses directly on this template and save again. This assignment is due at the conclusion of Week 6 on Sunday at 11:59 p.m. Mountain Time.
Catheter-Associated Urinary Tract Infections (CAUTIs) are a serious nursing care problem in any health care setting. Saint et al. conducted research (2013). shows that Catheter-Associated Urinary Tract Infections are among the healthcare-acquired infections that affect an estimated number of 1,700,000 patients in the United States of America to date. A urinary catheter is a primarily used device in hospital centers, but they are inappropriately cared for in health care centers.
In many instances, catheter insertions might result in potentially avoidable CUATIs leading to significant distress in patients, discomfort, embarrassment, activity restrictions, pain, care burden, hospitalization, and associated costs.
Multifaceted approaches and interventions are therefore necessary to prevent and reduce challenges patients with catheters face, especially about the prevention and reduction of CAUTIs.
Interventions (3) to Improve Quality
120 points
(40 points each for three interventions)
Intervention #1: Targeted Infection Prevention is utilizing a combination of socio-adaptive and technical interventions.
Technical interventions emphasize the professional development of urinary catheter utilization, antimicrobial stewardship, catheter care, and maintenance (Mody et al., 2017). Socioadaptive factors focus on empowering healthcare facility teams, dealing with implementation challenges, and providing a solution to overcome some of the barriers. The socio-adaptive elements also promote a resident safety culture, encourage leadership and team building, as well as engage resident and families in the caregiving process. Socioadaptive interventions also improve the understanding of various technical components associated with catheter use to the end-users, including allowing application of these parts into actual practice. The invasion also permits and promotes modifications to fit the local population, workflow, and culture.
The approach utilizes multicomponent interventions, customized to address particular shortcomings in CAUTI prevention in healthcare settings. Technical factors considered under the intervention include a reduction in the duration of an indwelling catheter use, antimicrobial stewardship, and improving catheter maintenance and care. The comprehensive bundle intervention highlights critical solutions to preventing CAUTIs including aseptic insertion, catheter removal, training for incontinence care planning, hydration practices, and catheter care (Mody et al., 2017).
The intervention bundle incorporates fundamental infection prevention strategies such as hand hygiene, educating stakeholders such as families, residents and frontline staff on CAUTI prevention, and application of barrier precautions.
Catheter-associated UTI barring-specific strategies are also included, for instance, promptly removing unnecessary catheters, utilization of evidence-based methods for catheter insertion and maintenance, exploring alternatives to urinary catheters that are indwelling.
The intervention also facilitates antimicrobial stewardship, coupled with proper utilization of diagnostic tests, such as urine culture and urinalysis (Mody et al., 2017). The technical and socio-adaptive dimensions of the bundled intervention complement each other. The technical aspect forms a framework for educational content, toolkits, and synergistic activities. The socio-adaptive element facilitates the enhancement of behaviors and attitudes relating to infection prevention exercises and comprehensive resident safety in the care setting.
Intervention #2: Nurse-Driven Process For Catheter-Associated Urinary Tract Infection Reduction and Prevention.
A nurse-driven evidence-based approach for decreasing the number of CAUTIs in healthcare settings is useful and productive preventing the problem. The attainment of the intervention depends heavily on the easiness of utilizing eight-point criteria called Question Foley, the accessibility of electronic clinical records, support from the physician and nursing administration, and interdisciplinary collaboration (Quinn, 2015).
Question the Foley provides nurses with decision points that they utilize daily in assessing whether the continued use of the Foley catheter is necessary or appropriate (Quinn, 2015). Nurses pursue a particular order established by the framework to ascertain the relevance or discontinue utilization of Foley catheter in case the patient no longer meets the necessary criteria. The eight-point criteria used encompasses physician support, daily monitoring, targeted education, informatics collaboration, and dissemination of results across the organization (Quinn, 2015).
Nurses combine the eight tactics to prevent and reduce CAUTI in healthcare settings. Physician support involves the backing of the chief medical officer, assisted with the review of relevant medical records, and enforcement of the process in conjunction with colleague physicians. The aspect of informatics collaboration encompasses designed physician and nursing documentation in electronic form, including medical records and ordering systems to reflect the criteria. The component also includes a customized reports monitoring and tracking system to keep up to date with patient needs (Quinn, 2015).
Physician support aspect of the intervention criteria highlights the support offered by the chief medical officer and inclusion of the intervention in the healthcare setting policies. Targeted education involves creating and executing diverse education sessions for physicians and nurses on measures to prevent CAUTIs. One registered nurse is eventually tasked with tracking a physician's orders, insertions, and application of the criteria. Also, the nurse reports on intervention progress identify CAUTIs from other microbiology reports and recognize the staff members involved in the process (Quinn, 2015).
Implementation of the tactics and adherence to the eight-point Question the Foley has been shown to be an effective intervention in addressing CAUTIs. The approach is nurse-centered and oriented since one nurse is accountable for overseeing the evidence-based protocol in a healthcare setting.
Intervention #3: Avoiding unnecessary use of indwelling catheters and exploring alternative methods.
The intervention is by far the most effective in preventing CAUTIs in healthcare settings. The first step involves conducting a thorough assessment of the patient to determine whether utilization of a catheter is necessary. If placement of a catheter is not imperative, then the healthcare providers need to result in other treatment alternatives. McNeill (2017) posits that catheters are often used for non-critical reasons, such as nursing staff convenience and incontinence. Also, catheters are usually left in place due to provider's inadvertent forgetfulness in ordering for the removal.
Instead of directing a catheter placement when a patient is only incontinent, other measures can be considered, such as frequent rounds to the bathroom, use of external catheters, and intermittent catheterization (McNeill, 2017). Protocols reflecting proper criteria for catheter placement should be established in all acute care settings. Such a protocol would ensure that unnecessary use of catheters is avoided, subsequently preventing CAUTIs in the process.
Instances indicating the necessary application of a catheter include preoperatively for certain select surgeries, facilitate pressure ulcer healing, relieve acute urinary healing, enhance patient comfort nearing end-of-life, and obtaining accurate measurements of output in critically ill patients (McNeill, 2017).
Once the necessity of a catheter is determined, the next important measure ensures appropriate placement utilizing the aseptic technique. Usually, nurses are responsible for inserting catheters. Therefore, application of a guideline or nursing policy for catheter insertion, nursing competencies, education, and random audits of the insertion processes promote proper placement and adherence to necessity only. The ultimate step ensures patients are not exposed to CAUTIs unnecessarily, and if that is the case, chances of contracting the health-acquired infections are minimized or eliminated.
Improve: Professional Article to Support Interventions
75 points
(25 points reference and citation; 50 points summary)
Citation must be included with appropriate intervention above. Do NOT type in this box.
Reference
Mody, L., Greene, M. T., Meddings, J., Krein, S. L., McNamara, S. E., Trautner, B. W., & ... Saint, S. (2017). A National Implementation Project to Prevent Catheter-Associated Urinary Tract Infection in Nursing Home Residents. JAMA Internal Medicine, 177(8), 1154-1162. doi:10.1001/jamainternmed.2017.1689
Summary:
The study reviews the implementation of a National project aimed at preventing catheter-associated urinary tract infections in nursing home residents. The intervention used in the project encompassed both a special bundle, consisting of factors such as aseptic insertion, catheter removal, and training caregivers, as well as a socio-adaptive bundle encompassing leadership, useful communication, and family engagement.
The findings of the research show that a combination of socio-adaptive and technical CAUTI prevention interventions effectively and successfully reduces the prevalence of the CAUTIs.
The article forms the basis for this study.
Reference:
Saint, S., Greene, M. T., Kowalski, C. P., Watson, S. R., Hofer, T. P., & Krein, S. L. (2013). Preventing catheter-associated urinary tract infection in the United States: A national comparative study. JAMA internal medicine, 173(10), 874-879.
Summary:
The article conducts a comparative study of various interventions used to prevent catheter-associated urinary tract infections in United States hospitals. State-level standardized infection ratio (SIR) estimates for CAUTIs in Michigan are compared with those of other states.
Results indicate that the collaborative effort of Michigan in preventing CAUTIs through the “Keystone Bladder Bundle Initiative” has resulted in the hospital within the State doing much better than their counterparts.
The study recognizes the shortcomings of many US hospitals failure to implement CAUTI prevention intervention and proposed more collaborations between hospitals across states to address the problem.
Reference:
Quinn, P. (2015). Chasing zero: A nurse-driven process for catheter-associated urinary tract infection reduction in a community hospital. Nursing Economic, 33(6), 320-325.
Summary:
The article explores a nurse-driven system of intervention for decreasing incidences of hospital-acquired CAUTIs. The response is based on an eight-point criterion called Question Foley, about Foley’s catheter. The requirements establish whether it is necessary to use a catheter in particular circumstances.
Other essential elements of this approach include support from the hospital administration, accessibility of electronic medical records, and interdisciplinary collaboration.
The effectiveness of the intervention is proven using case analysis of New York hospital which uses the approach to prevent and reduce cases of CAUTIS. The healthcare center is called White Plains Hospital.
Reference:
McNeill, L. (2017). Back to basics: How evidence-based nursing practice can prevent catheter-associated urinary tract infections. Urologic Nursing, 37
(4), 204-206. doi:10.7257/1053-816X.2017.37.4.204.
Summary:
The article recognizes the central role of nurses in preventing CAUTIs. The study further reviews how nursing care can be successfully used in the implementation of various evidence-based guidelines to prevent CAUTIs during acute. In addition to the factual guidelines for managing catheters, the study explores why it is essential to avoid using catheters unnecessarily. The use of disease-free technique during the insertion of catheters, and removal of catheters soonest possible are also measures emphasized to prevent CAUTIs.
The study reiterates the role of nurses in preventing hospital-acquired infections such as CAUTIs, and why catheters should be used as a last resort if they must be used at all.
Control:
Control/
Evaluation
90 points
(30 points each for 3 evaluations)
Evaluation for Intervention #1: Due to the extensive range nature of the intervention, multiple approaches would be used for evaluating and controlling the outcomes of CAUTIs in the healthcare setting. The response would correct information in urinary catheter usage in the particular setting, and information on catheter-associated UTI rates across the nation using the National Healthcare Safety Network. Random-effects binomial models of regression would be used to examine the changes in CAUTIs. Other measures taken through the models would include catheter utilization rates, coupled with urine cultures. The latter measurements would, however, be adjusted for covariates such as 5-star rating, supply of sub-acute care, bed size, ownership, and presence of an infection preventionist, and infection control committee (Mody et al., 2017).
The Centers for Medicare and Medicaid Services (CMS) offer a 5-star quality rating systems, which assigns nursing homes rating ranging between 1 and 5. A 5-star rating indicates a nursing home is exhibiting above average quality, while a 1-star rating is below average (Mody et al., 2017). Once a case nursing home quality level has been rated, application of the combined socio-adaptive and technical interventions should result in a better rating when reviewed after some time. Also, the random-effects binomial models of regression should reflect a decrease in both usages of catheters and prevalence of CAUTIs in the selected healthcare setting.
Negative rating and an increase in the prevalence of CAUTIs should be addressed by evaluating the entire intervention process step-by-step to ascertain the failing parts.
Evaluation for Intervention #2: The primary approach used in evaluating the success or failure of the nurse-driven procedure for catheter-associated urinary tract infection reduction would be the standard infection ratio (SIR) estimates. SIR estimates for CAUTI are “calculated by dividing the total number of observed infection events for a given population by an expected number of infection events for that population” (Saint et al., 2013). Company with the Centers for Disease Control and Prevention (CDC) and the local Department of Health should enable acquisition of comparative results over time and with similar healthcare centers.
After implementation of the nurse-driven process for preventing and reducing CAUTIs, the rate of the health associated infection associated with catheters should be lower. The prevalence of CAUTIs in the healthcare setting should also be smaller than that of other healthcare center used in the comparison, and that is even not using a particular intervention to solve the problem, whether locally or across states.
Constant review of the electronic records used by the lead registered nurse should facilitate and ensure that nurses are adhering to protocols and guidelines aimed at preventing CAUTIs in the healthcare center. Failure in particular areas of the process and by individual nurses should be addressed immediately and appropriately. The ultimate measure of this intervention is the determination that all stakeholders in the CAUTIs prevention and reduction process adhere to the stipulated guidelines. Also, cases of CAUTIs should decline in proportion to the duration the intervention is in place.
In the event the event that a patient contracts a CAUTI in a healthcare center setting, an invitation is extended to the nurse charged with caring for the patient. The nurse is involved in the process of analyzing the cause, and events leading to the hospital-acquired CAUTI. Involved nurses should be encouraged to point out any barriers or challenges that might have contributed to the breaks in the prevention initiative and appropriate measures taken to address the same.
Evaluation for Intervention #3: Avoiding unnecessary use of indwelling catheters and exploring alternative methods seems like the simplest method of preventing CAUTIs in hospitals. However, lack of proper monitoring and control mechanisms can render the intervention inefficient and ineffective. Since the primary objective of the response is a reduction in the usage of catheters, and subsequent lowering in CAUTIs prevalence, three categories of data should be collected.
The first category is the pre and post intervention is implementation point prevalence and the patients’ demographics. The clinicians’ knowledge and competence before and after implementation of the intervention should be assed. The final category of data collected should entail the perceived enablers and barriers to the implementation process. The latter type of data covers the period after the implementation only.
Desired outcomes from the intervention include a decline in the prevalence of hospital-acquired CAUTIs, and improvement in clinician’s knowledge and competence. The alleged barriers to the enactment of the CAUTIs prevention evidence-based intervention should be eliminated. However, healthcare centers should adopt the enablers to the application of the CAUTIs prevention process.
An electronic health record (EHR) system can also be used to monitor a decrease or increase in the usage of urinary catheters. The EHR can be used to facilitate and determine the use of proposed guidelines for CAUTI prevention. The system can generate expected documentation of the daily assessment aimed at identifying the necessity of continued use of catheters in particular patients. The results would illuminate whether there has been a decline or increase in the use of urinary catheters among patients.
