EBP Change Process form: Catheter Associated Urinary Tract Infections (CAUTI)

Week 6 Assignment:  EBP Change Process form
ACE Star Model of Knowledge Transformation
Follow Nurse Daniel as your process mentor in the weekly Illustration section of the lesson. Please do not use any of the Nurse Daniel information for your own topic, nursing intervention, or change project.  Nurse Daniel serves as an example only to illustrate the change process.
 Name: _____________________
Star Point 1:  Discovery (Identify topic and practice issue)
Identify the topic and the nursing practice issue related to this topic. (This MUST involve a nursing practice issue.)
Topic: Catheter Associated Urinary Tract Infections (CAUTI)

Nursing Practice Issue: Urinary catheters are primarily used to manage urinary problems such as urinary incontinence and urinary retention. These catheters are considered the gold standard for the management of bladder emptying dysfunctions and during surgical interventions. Upon insertion of the catheter, nurses play a crucial role in ensuring care for the patient, maintenance of catheter position, prevention of infection, and documentation. The nursing practice issue involves the routine care for inserted catheters which includes hand hygiene when handling the catheters, emptying of the urine drainage, and routine assessment for the need of the catheters. Failure to adhere to the above guidelines has led to an increase in CAUTI cases in the facility.

Briefly describe your rationale for your topic selection. Include the scope of the issue/problem. 

The selected topic on CAUTIs addresses the burden of healthcare-associated infections in the world which is a common problem across all healthcare institutions. Healthcare-associated infections represent infections occurring in a patient during the process of care which was not present during admission. Urinary tract infections account for about 34% of all nosocomial infections and CAUTIs are the most common of these infections. The CDC report indicates that about 15% of hospitalized individuals become catheterized at some point and 75% of these patients acquire CAUTIs. Because CAUTIs are the most common healthcare-associated infections, healthcare organizations should prepare staff through education and implementation of evidence-based practices to reduce the problem.

Star Point 2:  Summary (Evidence to support need for a change)

Describe the practice problem in your own words and formulate your PICOT question.

There exists a problem with the prevention of CAUTIs in the organization which is caused by failure to adhere to the set guidelines. The healthcare teams especially the nursing team are reluctant in performing routine care and assessment of patients who have indwelling catheters leading to increased CAUTI cases. First, there is the poor practice of hand hygiene during routine maintenance of the catheters and many patients are observed to lack knowledge on how to maintain their catheters. Secondly, most patients report that their catheters are emptied when full instead of the recommended three-quarter mark for emptying. Additionally, there is a lack of communication between healthcare teams regarding assessment for removal of the catheters which has seen patients remain with the catheters for a long. These indicators show the need for implementation of a strategy to streamline catheter management and collaboration between healthcare teams.

PICOT Question: In adult patients hospitalized in acute care facilities (P), how does educating nurses on catheter care (I), compared with no education (C), affect the number of CAUTIs (O) over a six months intervention period (T)?

List the systematic review chosen from the CCN Library databases. Type the complete APA reference for the systematic review selected.

Meddings, J., Saint, S., Krein, S. L., Gaies, E., Reichert, H., Hickner, A., McNamara, S., Mann, J. D., & Mody, L. (2017). Systematic Review of Interventions to Reduce Urinary Tract Infection in Nursing Home Residents. Journal of hospital medicine12(5), 356–368. https://doi.org/10.12788/jhm.2724

List and briefly describe other sources used for data and information. List any other optional scholarly source used as a supplement to the systematic review in APA format.

Davies, P. E., Daley, M. J., Hecht, J., Hobbs, A., Burger, C., Watkins, L., … & Coopwood, T. B. (2018). Effectiveness of a bundled approach to reduce urinary catheters and infection rates in trauma patients. American journal of infection control46(7), 758-763. https://doi.org/10.1016/j.ajic.2017.11.032

In acute healthcare facilities, catheterization is a common procedure for patients with injuries, especially in trauma wards. Despite the practice being common in hospitals, catheters can be life-threatening because they can cause serious infections in the urinary tract. In 2015, the Centers for Medicare and Medicaid Services began imposing financial penalties for institutions where CAUTI rates are higher than predicted (Davies et al., 2018). This study analyzed the relevance of using the bundled intervention to optimize the urinary catheterization process together with culturing practices to reduce false positives. The bundle approach used included catheter avoidance strategies, hand hygiene, perineal care, and daily necessity review to limit catheter days. After the interventions were made, the CAUTI rate was reduced by over one-third within two years. The conclusion from the study indicates that the implementation of a CAUTI prevention bundle works synergistically to improve patient safety and hospital performance.

Briefly summarize the main findings (in your own words) from the systematic review and the strength of the evidence.

The systematic review aimed at reviewing strategies to reduce urinary tract infections especially CAUTIs among geriatric patients in nursing homes. The studies included employed different approaches including reducing catheter use (13 studies), general infection prevention strategies 99 studies while others focused on the use of standard management guidelines for CAUTI prevention (Meddings et al., 2017). The findings from the studies indicate that interventions to improve hand hygiene and the use of bundled approaches yielded more results in CAUTI prevention. There was also evidence that improving patient hygiene through nursing intervention and patient education reduced CAUTI infection rates. It was observed that all studies agreed on the implementation of effective infection control program that included multiple interventions to reduce CAUTI rates.

Outline one or two evidence-based solutions you will consider for the trial project.

I will recommend the use of bundled approach in the prevention of CAUTIs in the facility. Evidence-based practice demonstrates that practicing hand hygiene, catheter necessity review, perineal care, and the use of catheter avoidance strategies can greatly reduce CAUTIs in acute care facilities (Meddings et al., 2017). This calls for education of nurses on various approaches to the prevention of CAUTIs including collaborative care.

  Star Point 3:  Translation (Action Plan)

Identify care standards, practice guidelines, or protocols that may be in place to support your intervention planning (These may come from your organization or from the other sources listed in your Summary section in Star Point 2).

The centers for Disease Control and Prevention (CDC) provides guidelines for the insertion, maintenance, and removal of catheters. Healthcare providers should demonstrate appropriate urinary catheter use by inserting catheters only when indicated. The CDC also warns against using catheters for patients and nursing home residents for the management of urinary incontinence. Regarding the proper insertion techniques, hand hygiene and insertion by trained personnel is highly stressed. Other precautions include routine perineal care, securing the catheter well, and emptying the urinary drainage when three-quarter full.

List your stakeholders (by title and not names; include yourself) and describe their roles and responsibilities in the change process (no more than 5).

Nurse Educator: Will coordinate necessary education for nurses during the implementation of the CAUTI prevention bundle.

Administration: Will ensure the availability of necessary resources such as capital for the implementation of the new change. The administration will also work to coordinate care delivery withing different healthcare teams.

Registered Nurses: Will participate in educational programs to improve on CAUTI prevention in the facility. The nurses will also be part of the evaluation team for the effectiveness of the new strategies.

Me: I will work together with the administration and unit managers to ensure regular monitoring of the new approaches to CAUTI prevention.

What specifically is your nursing role in the change process? Other nursing roles?

My primary role is to function as a nurse researcher responsible for gathering evidence and implementing evidence-based practices for process change in the organization. Other roles will include coordinating care delivery and evaluation of practices to promote quality care within the organization.

List your stakeholders by position titles (charge nurse, pharmacist, etc.).Why are the members chosen (stakeholders) important to your project?

Charge Nurse: Will be responsible for monitoring the implementation of the new change in their respective units. Will also be part of the evaluation team analyzing the effectiveness of the new strategy.

Administrator: Will coordinate the implementation process and engage in policy formulation concerning the new change.

Nurse Educator: Will ensure nurses are equipped with knowledge on CAUTI prevention and also coordinate routine progress assessment of the new strategy.

What type of cost analysis will be needed prior to a trial?  Who needs to be involved with this?

Minimal cost will be required to implement the new change. The administrator will be involved in allocating funds to guide the education programs and ensuring availability of catheters for insertion.

Star Point 4: (Implementation)

Describe the process for gaining permission to plan and begin a trial.  Is there a specific group, committee, or nurse leader involved?

To gain permission for the trial, I will approach the hospital administration through the hospital project manager. The project manager is in a position to convince the administration of the need for the new change based on the evidence provided. I will ensure the availability of a written report on the new project, the necessary resources required and the support needed to complete the project. Additionally, I will describe the potential benefits of the project to the organization including financial benefits and the effect on patient care.

Describe the plan for educating the staff about the change process trial and how they will be impacted or asked to participate.

The nurse educator is identified as a key stakeholder in the implementation of the project. The plan is to engage the nurse educator who will seek guidance from experts to educate nurses on CAUTI prevention strategies. An initial meeting will be organized to inform the nurses on the new change, its relevance to the organization, and its benefits to the patient. I will present evidence-based research to support the new change and through the hospital administration, I believe employees will be persuaded to participate in the trial.

Outline the implementation timeline for the change process (start time/end time, what steps are to occur along the timeline).

The implementation will take six months and this will include project planning, nurses’ education, and actual implementation of the change. The first month will involve seeking permission, creating awareness, and educating staff on CAUTI prevention. The second month through the fifth will involve using the bundled approach to prevent CAUTIs and intermittent evaluation of progress. The sixth month will involve evaluation of the strategy and communication of results.

List the measurable outcomes based on the PICOT.  How will these be measured?

Reduced CAUTI cases measured by comparing current findings with previous cases.

Improved HCAHPS scores measured by comparing with previous findings.

What forms, if any, might be used for recording purposes during the pilot change process. Describe.

No forms will be used for recording purposes.

What resources are available to staff (include yourself) during the change pilot?

The first available resource is support from the administration which will ensure the engagement of employees towards implementing the new change. Secondly, the involvement of nurse leaders and experts will ensure the success of the project because they will guide the implementation process and use their expertise to solve issues that may arise.

Will there be meetings of certain stakeholders throughout the trial?  If so, who and when will they meet?

The implementation team will meet on a weekly basis to analyze the progress of the project and discuss any problems that might arise. The team will also meet the administrators to provide progress reports.

Star Point 5: (Evaluation)

How will you report the outcomes of the trial?

I will report the outcome using internal memos sent to the unit managers. Secondly, I will ensure the outcome reports are available on the hospital notice boards. Permission to make the results available on the organization website will be requested from the administration.

What would be the next steps for the use of the change process information?

The change process information will be used to improve organizational performance regarding CAUTI prevention. I believe the administration will consider designing policies regarding the use of a bundled approach in the prevention of CAUTI in the facility. If the project does not yield results, further research will be required to refine the steps of the change process.

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