Write a 3–4-page paper that addresses the following:

Introduction. Briefly review your practice problem and include a purpose statement.

• Evidence-Based Practice Plan Explanation  (Completed in Week 4)

  Provide a detailed explanation of the evidence-based practice  performance improvement plan that you will be use to address the  practice problem.
  Support your plan with scholarly references (the sources you found in the analysis of the evidence).

• Resources (completed in Week 5)

  Describe the resources needed to support the change in practice such  as personnel time, supplies for staff education, cost of new equipment,  or cost of software.
  Explain why each resource is necessary.

• Conclusion

  Discuss all key points addressed in this assignment.

Practice Experience Discussion Week 4

Catheter-Associated Urinary Tract Infections (CAUTI) Management Plan

           Since CAUTI is a hospital-acquired infection, knowledge concerning the risk factors for CAUTI contributes to the maximum prevention of the problem. It paves the way for the implementation of a quality improvement plan in healthcare facilities. The entering of germs into the body through a patient’s urinary catheter leads to a severe complication, including death for critically ill patients. So, appropriate measures need to be put in place to curb the health issue through a well-structured CAUTI management plan that provides a roadmap.

The objective of the Plan

The objective of the CAUTI management plan is to decrease CAUTI rates sustainable through fostering a safety culture in participating units.

Identification of the Causes of CAUTI

            The rates of CAUTI cases are increasing, especially among patients with extended stays at hospitals due to some issues (Tenke, Mezei, Bőde, & Köves, 2017). These issues include;

a. the contamination of catheter upon insertion

b. failure of nurses to the regularly clean catheter

c. the backward flow of urine in the catheter bag into the bladder

d. poor removal of catheter

e. bacteria from a bowel movement getting on the catheter

f. failure to empty drainage bag often

g. poor hygiene in healthcare facilities

Steps for Implementing CAUTI Improved Practice

1. Assessing Catheters: Catheters in newly hospitalized and re-hospitalized patients, nurses and clinicians should assess the to know if they are still required and should be removed at the right time as the doctor approves.

2. Aseptic Insertion: It is good for healthcare providers to practice aseptic insertion of indwelling catheters and hand hygiene before and after catheter contact.

3. Regular Assessment: The nurses will need to use consistent assessments to insert new catheters only at only specific conditions. For instance, clinicians should insert new catheters in the appropriate conditions when required and carry reassessment at a certain interval.

4. Training: Care practitioners, residents, and families need training concerning catheter care and its appropriateness.

Challenges and Impediments to Implementing a Quality Improvement Plan

            The implementation of this improved practice plan may face a blow from circumstances such as skipping the basics. Skipping the basics means nurses focus on high-levels outcomes without first getting a solid foundation for the plan basics (Russell, 2019). For instance, a nurse may skip aseptic insertion that has the critical fundamentals of having a practical quality plan. Another evident challenge is neglection of the power of cheerleaders. Nurses may tend to avoid stakeholders such as a patient’s family, with informal information on preventing CAUTI. Family members may help nurses in improving hygiene among hospitalized patients.

Required Resources for the Plan

            The plan requires tools and equipment for hygiene maintenance at a healthcare facility where the insertion of catheters and its removal takes place. For hand hygiene, nurses should put on gloves when inserting catheters. Also, sanitizers or water and soap should be in place to ensure nurses wash their hands after the removal of gloves and catheters are cleaned. Sterilizers are needed to sterilize catheters to ensure patient safety (Gould, Umscheid, Agarwal, Kuntz, Pegues, & Healthcare Infection Control Practices Advisory Committee, 2010). The hospital should ensure enough stock of drainage bag to ensure the emptied ones are immediately replaced with new ones. Further, trainers are critical to teaching nurses on the best process of inserting and removing catheters. These resources are cost-effective because sanitizers, gloves, and hiring trainers can be done at low cost compared to outcomes such as severe CAUTI cases leading to deaths due to failure to take preventive measures in advance. Medical practitioners, the facility management, and medical suppliers are direct stakeholders to feel the impact of the change because they take part in either through decision-making, discharge treatment duties, or supply medications to take care of CAUTI patients.

References

Gould, C. V., Umscheid, C. A., Agarwal, R. K., Kuntz, G., Pegues, D. A., & Healthcare Infection Control Practices Advisory Committee. (2010). Guideline for prevention of catheter-associated urinary tract infections in 2009. Infection Control & Hospital Epidemiology, 31(4), 319-326.

Russell, J. A., & Watters, R. (2019). Implementation of a nurse-driven CAUTI prevention algorithm. Nursing Clinics, 54(1), 81-96.

Tenke, P., Mezei, T., Bőde, I., & Köves, B. (2017). Catheter-associated urinary tract infections. European urology supplements, 16(4), 138-143.

Practice Experience Discussion Week 5

Catheter Associated Urinary Tract Infection (CAUTI)

           CAUTI is a risk hospital-associated infection resulting from the extended use of the urinary catheter? The problem affects parts of the urinary system, which include kidney, ureters, urethra, and bladder. Among hospital-acquired urinary tract infections, almost 75% are linked to a urinary catheter. In the hospital where I work, between 15 to 25% of admitted patients receive urinary catheters during their stay in our healthcare facility. Since the problem has turned out to undermine the outcome of care services given to our patients, the hospital has implemented several interventions to combat CAUTI. These current interventions are, educating medical practitioners on reinforcing the CAUTI bundle, nurse-driven timely removal of urinary catheters, and urinary catheter care during placement.

Educating Staff on Reinforcing the CAUTI Bundle

            This intervention is regarded as clinical practice and practice change that can improve the safety of patients, especially in our healthcare setting, where the use of indwelling catheters is common. As a result, the facility has implemented an education program for all medical practitioners on CAUTI to improve their knowledge in managing patients with indwelling catheters. The knowledge they receive includes the management of extended use of the catheter and proper insertion and maintenance (Fritsch, Sutton, Roche, Berberi, Whidden, & Holder, 2019). Nurses are being engaged regularly because they significantly impact the care quality of the entire hospital. The education program covers the best guidelines that are supported by evidence-based knowledge to advocate for patients with CAUTI. So, the education strengthens nurses’ ability to work within the best guidelines and attaining better catheter monitoring.

            One of the facility, goals are to reduce the CAUTI rate in long-term stay in the hospital. Through the implementation of the education program in reinforcing the CAUTI bundle, the healthcare facility achieves this goal, where it ensures the safety of patients and satisfaction while minimizing financial burden related to CAUTI. For instance, financial penalties from Centers for Medicare & Medicaid Services. Improving the knowledge of nurses by educating them on evidence-based guidelines means that the nurses will develop confidence in providing quality care to patients with indwelling catheters (Fritsch et al., 2019). This new knowledge currently assists in bridging the gap that exists between evidence-based practice and application of concepts of EBP to nursing, increasing nurses’ awareness, and enhancing the descending trends in the CAUTIs’ occurrences. In general, the hospital education program on CAUTI bundles consists of washing hands and wearing gloves, red sealing intact, having free-kinks tubing, drainage bag, and tubing not touching the floor, and conducting a daily evaluation of catheter’s need.

Nurse-Driven Timely Removal of Urinary Catheters

            This intervention in the hospital helps nurses in answering some critical questions regarding the safety of patients using indwelling catheters. For instance, if the urinary catheter is in place, healthcare facility nurses look at whether the patient meets the criteria to leave a catheter in (Yatim, Wong, Ling, Tan, Tan, & Hockenberry, 2016). The responsibility of a nurse becomes continuing to assess a patient daily. If there is no urinary catheter, nurses are required not to take action necessary; instead, they should focus on continuous assessment of urinary output while avoiding the placement of the catheter.

            Also, nurses in our hospital under nurse-driven timely removal of urinary catheters the intervention has followed protocol unless the patient falls into at least one of the following categories:

· Haematuria, gross

· Obstruction catheterization by Urologist

· Urologist surgery

· Decubitus ulcer

· Nursing end-of-life care

· Immobility due to unstable fracture or bedbound

When a patient has none of the listed above categories, nurses are taking the removal of catheter and assessment of voiding within six hours as an action.

Urinary Catheter Care During Placement

            The nurses in the healthcare clean a patient’s genital area with a sterile solution as a strategy of implementing urinary catheter care during placement. Lubricant jelly is one of the current equipment for ensuring care during catheter placement, where nurses use it to ensure that the catheter goes smoothly (Luo, Lee, Ng, & Koh, 2017). Other care measures that nurses are taking during catheter placement include asking a patient to take slow, deep breaths, or to push as if he is trying to urinate as the catheter is inserted. Also, the intervention requires nurses to insert the catheter in a slow and gentle move into a patient’s bladder. In case nurses see urine flowing from the catheter, they take action to fill the balloon at the catheter’s end. This balloon ensures that the catheter does not come out. This action has strengthened the efforts of providing urinary catheter care during placement.

            Overall, the three interventions discussed above have promoted patient safety in healthcare facilities through solving CAUTI issue in measurable approaches. Education program for nurses on the reinforcement of CAUTI bundle brings practice change in which nurses gain in-depth knowledge of managing patients with CAUTI and putting prevention measures to protect hospitalized patients. On the other hand, nurse-driven timely removal of the urinary catheter has helped care providers in defining the best ways to use catheters to enhance patients’ safety. Urinary catheter care during placement focuses on appropriate insertion procedure to ensure the problem is contained at all levels. The hospital has continued to benefit from the implementation of these three interventions in terms of ensuring patient safety, improving care services, and reducing medical expenditures.

References

Fritsch, P. F., Sutton, J., Roche, E., Berberi, V., Whidden, E., & Holder, C. (2019). Reinforcing a Catheter-Associated Urinary Tract Infection (CAUTI) Bundle Compliance Decreases Overall Catheter Days and CAUTIs. American Journal of Infection Control, 47(6), S22.

Luo, R., Lee, S. L., Ng, F. C., & Koh, L. T. (2017). Inadvertent placement of a urinary catheter into the ureter: A report of 3 cases and review of the literature. Asian journal of urology, 4(4), 256-261.

Yatim, J., Wong, K. S., Ling, M. L., Tan, S. B., Tan, K. Y., & Hockenberry, M. (2016). A nurse‐driven process for timely removal of urinary catheters. International Journal of Urological Nursing, 10(3), 167-172.