NURSE 590 TOPIC 1 DISCUSSION 1 ESSAY

NURSE 590 TOPIC 1 DISCUSSION 1 ESSAY

NURSE 590 TOPIC 1 DISCUSSION 1 ESSAY

 Topic 1 DQ 1

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Catheter-associated urinary tract infections (CAUTIs) are a leading cause of increased costs and poor patient outcomes for millions of patients in healthcare facilities. The Centers for Disease Control and Prevention (CDC) (2019) is categorical that urinary tract infections among hospitalized patients account for over 75% of infections associated with the use of catheters. Nurses as healthcare providers require sufficient knowledge and understanding of the different aspects on CAUTIs to reduce their prevalence by using evidence-based practice interventions through a care bundle approach, use of aseptic techniques, and engaging in continuous professional development through education (Abdelmoaty et al., 2020). As such, the proposed intervention in this quality improvement project to tackle CAUTIs in the facility is training of nurses on best practices on catheter insertion and care to reduce the prevalence by 50%. Training nurses to understand different aspects of catheterization like use and removal of Foley catheters, replacing the Foley catheters and daily CHG bathing as well as keeping tubing free of kinks and loops will offer sufficient knowledge for the providers to improve overall management of CAUTIs and reduce their prevalence.

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The intervention supports the population of focus, the setting, and nurse’s role in many ways. Firstly, it improves patient safety and reduce the increased cost burden associated with longer stays in the facility. Secondly, the intervention ensures that the facility provides quality and patient-centric care for the targeted patients (Kaur, 2021). Again, the intervention is essential for nurses as it demonstrates their heightened and critical role in improving quality of care, patient safety and overall satisfaction with their duties and responsibilities.

The selected issue of investigation, CAUTIs and the need to offer training to nurses, is amenable to a research-based intervention as it can be altered to align with the PICOT approach. For instance, the use of nurse training can be replaced with other interventions like implementing care bundles to improve patient safety that include CAUTIs and other aspects of quality improvement (Lem et al., 2022). The increased prevalence of CAUTIs in the facility reduces the quality of care and having this intervention is critical to addressing quality improvement aspects.

PICOT Statement

Among hospitalized patients with indwelling Foley catheters (P), does training nurses on the best practices on catheter insertion and care (I) compared to standards Foley care (C) reduce the rates of CAUTIs by 50% and length of hospital stay (O) within four months (T)?

References

Abdelmoaty, A., A. Sabry, H., M. Kenawy, A., & H. ElSebaie, E. (2020). Indwelling Urinary

Catheter: Effect of Training on Nurses Knowledge and Skills. The Egyptian Family Medicine Journal, 4(1), 144–157. https://doi.org/10.21608/efmj.2020.90206

CDC. (2019, October 1). Catheter-associated Urinary Tract Infections (CAUTI) | HAI | CDC.

            https://www.cdc.gov/hai/ca_uti/uti.html

Kaur, D. (2021). The Impact of Nurse-Led Initiative Interventions on CAUTI. Master’s Projects

            and Capstones. https://repository.usfca.edu/capstone/1235

Lem, M., Jasperse, N., Grigorian, A., Kuza, C. M., Deyell, J. S., Prasad, J. P., … & Nahmias, J.

(2022). Effect of external urinary collection device implementation on female surgical patients. Infection, Disease & Health, 27(4), 227-234. https://doi.org/10.1016/j.idh.2022.05.005

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Based on the PICOT you developed for NUR-550, summarize the intervention you are proposing. How does this support the population of focus, your setting, and role? Justify how the problem you selected to investigate is amenable to a research-based intervention using the PICOT format. Include your PICOT statement with your response.

THE POPULATION IS 60 BEDS IN THE MEDICAL UNIT

7O RNS TO EDUCATE

ITS MOSES WHO DID MY PICOT

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Education Tip Sheet: CAUTI Prevention Standards of Care

Professional Development Council and HAI Prevention Education Workgroup

Responsibilities RN RNs and Clinical Partners
 

Assessment

Ø Assess for alternatives to indwelling urinary catheter use to

avoid unnecessary catheter use

Ø Assess that an indwelling urinary catheter is indicated

Ø Review any contraindications to the procedure and notify MD

 

Implementation of indwelling urinary catheter

Ø Verify the MD’s order

Ø Choose appropriate catheter

Ø If there are any problems encountered with catheter insertion, notify MD immediately

Ø Observe sterile technique when inserting, manipulating, and maintaining an indwelling urinary catheter

Ø Document date and time of insertion

 

 

 

 

 

 

Maintenance and management of

indwelling urinary

catheter

Ø Document assessment findings and indications for catheter use q shift

Ø Inspect periurethral area for signs of inflammation and infection

Ø Provide pt and family education on proper handling of catheter

Ø Provide other health care workers education on proper handling of catheter

Ø CHG baths are required daily

Ø Document and provide peri care and foley care q shift and PRN after each loose bowel movement

Ø Clean foley during CHG baths, and can also clean foley

with peri wash, peri wipes, soap and water

Ø Keep catheter and tubing free of kinks and avoid dependent loops

Ø Keep the drainage bag below the pt’s bladder

Ø Empty drainage bag regularly when it becomes ½ to 2/3 full

Ø Inspect catheter for any leakages or break in system

Ø Secure catheter properly and assess securement device every shift

Ø Keep drainage bag off the floor

Ø Maintain safety of catheter when turning, repositioning or transporting pt

Ø Monitor and document urine output q shift

 

Clinical Partners:

Ø Notify RN if there are any leaks in the system

Ø Notify RN if pt is refusing CHG bath or foley care

 

Indications for replacement

Ø Replace catheter when leakages occur or break in sterile

system

Ø Consider alternative devices prior to replacement

Ø Notify MD if there are any problems with the catheter (e.g. obstruction, pain, discomfot)

Ø Notify MD before replacing catheter

Indications for removal of catheter Ø Assess daily for indication for removal

Ø No appropriate indication

Ø No order for catheter

Ø Meets critereia for Indwelling Urinary Catheter Removal Standardized Protocol

Ø Meets criteria for Active Voiding Trial

Urine specimen collection from

inwelling urinary catheter

Ø It is highly recommended to collect urine culture

specimen from a newly inserted catheter (if the catheter has been in placed >14 days)

Ø Use the complete vacutainer foley collection kit to obtain urine from the disinfected sampling port

Ø Send urine specimen w/in 1 hour of collection

 

Reference: Lippincott Procedures Manual

For more information, contact the SME, Eunice Santos, MSN, RN, NPD Practitioner, at: Phone: (310) 967-8350 Email: Eunice.Santos@cshs.org

For any feedback, please contact the PDC chair at Charisse.Murakami@cshs.org

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