Answer C361-MLM1-Performance Assessment 1 Essay

Answer C361-MLM1-Performance Assessment 1 Essay

Answer C361-MLM1-Performance Assessment 1 Essay

ANSWER

C361 – MLM1 – Performance Assessment 1

Introduction

Urinary tract infections (UTIs) are infections that occur in any part of the urinary systems such as the urethra, kidney, or bladder. Most UTIs involve the lower urinary tract, and due to the morphology of their body, women are at greater risk than men of getting the UTIs. Over 75% of the UTIs that are hospital-acquired are directly linked with the use of urinary catheters, tubes that assist in draining the urine from the bladder, and are inserted via the urethra (Centers for Disease Control and Prevention, CDC, 2020). Patients who use urinary catheters for prolonged periods of time are at greater risks of developing the UTIs compared to those who use it fewer times (CDC, 2020). This essay examines different research that is present regarding Catheter-Associated UTIs (CAUTIs).

Impact of the Problem on the Patient

The problem of CAUTIs has many potential and actual negative impacts on patients. One of these is the increased rate of readmissions among the patients. Patients who acquire UTIs after the use of urinary catheters risk being readmitted after discharge, since the infections mostly manifest themselves only after the patients are declared free of illness (Meddings et al., 2019). Another implication that this problem may have on patients is that there is increased costs of care, as patients have to spend more than they anticipated for them to achieve their recovery. Also, much of the costs associated include the time lost not working as the patients stay in the hospitals, hence an indirect loss of income.

Impact of the Problem on the Organization

Facilities which have increased problems of hospital-acquired CAUTIs spend more on average compared to those with lesser cases. Specifically, more readmissions mean that more of the hospital resources are used, and this leads to straining the current expenditure. Also, in some of the cases, the facilities linked with the CAUTIs may face legal punishment that would mean a direct loss of income to the victims (Meddings et al., 2019). Lastly, the problem is likely to have detrimental effects on the reputation of the organization, where potential clients may have fear receiving services as a result of the past incompetence.

Identify the PICO components

P – Patient/ Problem/ Population

The Problem being put in central focus is CAUTIs in patients admitted to the facility, with a large focus on patients who are in the acute care settings. The patients are already admitted to the facility but due to problems associated with indwelling catheters, they develop UTIs. Patients who had catheters within two days are also examined for the problem of the CAUTIs.

I – Intervention

The intervention entails education of healthcare givers on some of the safety precautions when inserting catheters in patients. Also, there should be a standard application of the usage of different indwelling catheters, including but not limited to guidelines on the timely removal and other elements in usage (Saint et al., 2016). The education has to be timed, where it is completed on a quarterly basis using teaching tools that are standardized. Also, the use of detailed procedures and policies regarding catheter insertion and removal should be mentioned in the education.

C – Comparison

The comparison of the intervention is done with current practices that have minimal education regarding catheter use and insertion. Also, in the current practices, there are many policies regarding catheter use that are difficult to understand as well as implement. Some of them are also vague as they do not provide the nurses with the right information regarding catheter application.

O – Outcome

The outcome of care that should follow the interventions would be decreased CAUTIs in hospital units. A secondary outcome would be the decrease of the costs of care on the patient as the patient would no longer have to leave work and spend much of their time doing follow-up visits in the hospital. Also, there is likely to be reduced expenditure in the healthcare organization following the reduced rate of readmissions (Parker et al., 2017). The overall results would be the presence of a more knowledgeable staff and also increased patient satisfaction.

Evidence Based Practice Question

Does provider-training reinforcements that include standardized policies, education on catheter insertion standards, catheter care, and catheter removal on patients who develop CAUTIs lead to a decreased prevalence of CAUTIs when compared with implementation of the catheter administration using the present resources and knowledge of the healthcare givers?

B: Research Article

Background/Introduction

The article by Ferguson (2018) seeks to improve the nurse education regarding CAUTI prevention in two healthcare facility units within acute settings that have higher CAUTIs prevalence, with an aim of improving the knowledge base of nurses regarding catheter usage, and hence promoting patient care outcomes.

Methodology

The author starts by identifying the knowledge base of the providers that is the present knowledge of the nurses and physicians involved. The author uses a questionnaire to access this information on catheter care and insertion (Ferguson, 2018). He then conducts an interactive and multifaceted training on CAUTI prevention among the nurses and physicians affected. The different approaches used to train the nurses are aimed at boosting the present knowledge base of the nurses. It is also timed (one hour) to ensure that the interviewer sticks to only the relevant areas.

Level of Evidence

The article falls in the category of level II evidence.

Data Analysis

Data analysis in the study is based on statistical analysis, where the nurse’s prior knowledge is obtained through standard tests, and the results taken and compared with the results of the same test after the training. Also, the study assesses the different policies that are present regarding the use of catheters, and checks for the suitability of implementation of similar policies in care (Ferguson, 2018). The ratings in the tests are scored on a rate of 1 to 5, where one means least effective and 5 means the most effective. An average of the scores in different categories gives the overall scores, which are used in making the decisions. The CAUTI rates are compared in two inpatient units for a three-month period, and it is evident that there are better results in both units of reduced CAUTIs infections following the implementation of the training.

Ethical Considerations

All the participants in the project were selected on a voluntary basis. That is, there was no coercion in reaching the participants. Also, there was a high level of confidentiality and anonymity that was maintained among the participants. Nurses, as well as patients, also had the chance not to take part in the study, and no names of the study participants were included in the findings (Ferguson, 2018).

Quality Rating

According to the JHNEBP model, the article’s quality rating is ‘high.’

Analysis of the Results / Conclusions

The article collected data from two hospital inpatient units to assess for the care of patients who have CAUTIs. Before the training regarding the proper usage of catheters and policies surrounding catheter usage among clinicians, the two units had CAUTI rates of 7.49 and 4.12 per 1000 catheter days, and this reduced to 0 and 1.56 per 1000 catheter days respectively (Ferguson, 2018). The hands-on demonstration and the teaching were therefore relevant in the reduction of the number of CAUTIs in the two units.

C: Non-Research Article

Background Introduction

The article by Abubakar et al. (2020) compiles the resources that are used in education of staff in hospitals and assesses for their effectiveness in care. The aim of the article is to reduce the number of healthcare associated infections by creating a conceptual framework through the implementation of a catheter lifecycle model.

Type of Evidence

Among the evidence types used in the article is the systematic review of articles regarding CAUTI education. The authors also utilize multiple databases to identify articles, and they do this using specific search terms such as UTI and Catheters.

Level of Evidence

Level V Evidence.

Quality Rating

According to the JHNEBP model, the article’s quality rating for the article is ‘high.’

Author’s Recommendations

The recommendations of the author are based on the findings that the number of instruments that are applied in the assessment of the knowledge of CAUTI prevention by health workers are limited. Hence, from the findings, it is right to conclude that there are presently no standard tools that are available for utilization in hospital settings for CAUTI prevention (Abubakar et al., 2020). The authors recommend that nurses should receive regular education that would help in decreasing the prevalence of CAUTIs.

Recommended Practice Change Based on Evidence Based Practice Question

To enhance improved knowledge on CAUTI prevention among healthcare givers, there is need for regular training regarding the standard practices when inserting, using, and removing urinary catheters. In most of the cases, nurses only receive such specific training during their school education, and for those who are lucky, during their induction into the hospitals they work for (Abubakar et al., 2020). Given the increased number of cases in the number of recorded CAUTIs, it is evident that this education is not enough. There is need for more regular training, such as on a monthly basis.

Key Stakeholders

Nurse educators are top in the list of key stakeholders that would help in supporting my recommendation of practice change. These nurse educators would help in relaying to the nurses about accurate and up-to-date information regarding catheter infection (Meddings et al., 2019). Other key stakeholders include the nurse supervisors and nurse managers, who would take part in regulating the practice changes.

Barrier to Implementation

Lack of dedication towards the training could be a major challenge in the implementation of the recommended change (Saint et al., 2016). In most of the units, there is short-staffing of nurses, and it becomes hard to engage them in training as they have heavy workloads they have to cover during the intended training time.

Strategy to Overcome the Implementation Barrier

A possible way of overcoming this implementation barrier is scheduling the training plans to be friendly in terms of the nurse availability. This could include engaging additional members of staff on locum basis so as to improve the involvement of the nurses in the training.

Indicator to Measure the Outcome

The indicator that would be used is to assess the outcome would be the reduction in the CAUTI rates. This is best assessed after applying the education for a period of 12 months.

References

Abubakar, S., Boehnke, J. R., Burnett, E., & Smith, K. (2020). Examining Instruments Used To Measure Knowledge Of Catheter-Associated Urinary Tract Infection Prevention In Healthcare Workers: A Systematic Review. American Journal of Infection Control. https://doi.org/10.1016/j.ajic.2020.07.025

Centers for Disease Control and Prevention, CDC, (2020). Healthcare-associated Infections (HAI): Catheter-associated Urinary Tract Infections (CAUTI). https://www.cdc.gov/hai/ca_uti/uti.html

Ferguson, A. (2018). Implementing a CAUTI Prevention Program in an Acute Care Hospital Setting. Urologic Nursing, 38(6). DOI:10.7257/1053-816X.2018.38.6.273

Meddings, J., Manojlovich, M., Fowler, K. E., Ameling, J. M., Greene, L., Collier, S., & Saint, S. (2019). A Tiered Approach for Preventing Catheter-Associated Urinary Tract Infection. Annals of Internal Medicine, 171(7_Supplement), S30-S37. https://doi.org/10.7326/M18-3471

Parker, V., Giles, M., Graham, L., Suthers, B., Watts, W., O’Brien, T., & Searles, A. (2017). Avoiding Inappropriate Urinary Catheter Use and Catheter-Associated Urinary Tract Infection (CAUTI): A Pre-Post Control Intervention Study. BMC health services research, 17(1), 314. https://doi.org/10.1186/s12913-017-2268-2

Saint, S., Greene, M. T., Krein, S. L., Rogers, M. A., Ratz, D., Fowler, K. E., & Faulkner, K. (2016). A Program to Prevent Catheter-Associated Urinary Tract Infection in Acute Care. New England Journal of Medicine, 374(22), 2111-2119. DOI: 10.1056/NEJMoa1504906