Overview of Evidenced-based Practice

The Joint Commission deciding on reimbursement with the factors on the number of CAUTI and satisfaction in healthcare among other major factors in patient care. We as a healthcare provider we must focus on limiting the CAUTI rates in our patients. Healthcare providers are having to look outside the box to lower the rate and keep our patients safe. In this research paper, we will see what the national average of CAUTI’s are, how we can monitor our hospital's rate and what steps we can do to improve our hospitals CAUTI rate.

We will discuss the difference between Evidence-Based Practice and research. Lastly, we will discuss the PICOT and PICo approach in research.

“The purpose of conducting research is to generate new knowledge or to confirm existing knowledge based on a concept” (Brown (2013). Research is used to gain knowledge for a subject and inquire a broad knowledge for a certain subject. “For research results to be considered reliable and valid, researchers must use the scientific method in orderly, sequential steps” (Brown (2013). Unlike research, Evidence-based Practice (EBP) concentrates on clinical decision-making studies (Brown (2013). The purpose of EBP is to use the best evidence available to make patient-care decisions (Brown (2013).

EBP is used in a clinical setting and the study is used in a clinical setting. “Most of the best evidence stems from research, EBP goes beyond research use and includes clinical expertise as well as patient preferences and values” (Brown (2013). Research is about developing new knowledge, EBP involves innovation in terms of finding and translating the best evidence into clinical practice (Brown (2013). The MSN specially track that is being pursued is Family Nurse Practitioner and my focus of practice is helping patients for the good of mankind. The goal is to practice medicine to help patients not prolong life. In a medicinal practice, all our research is EBP. We center healing and wellness on patient-based research. In the clinical setting we concentrate on improving the patient setting and gaining knowledge on patient outcomes.

Nursing Concern

The HAC Reduction Program “encourages hospitals to make patient safety better and reduce the number of hospital-acquired conditions” (Peasah, McKay, Harman, Al-Amin, etc. (2013). The HAC measures categories like pressure sores and hip fractures after surgery (Peasah, McKay, Harman, Al-Amin, etc. (2013). “The HAC Reduction Program saves Medicare approximately $350 million every year” (Peasah, McKay, Harman, Al-Amin, etc. (2013). HAC will take back Medicare reimbursements for high number of hospital acquired infections and low satisfactions scores (Peasah, McKay, Harman, Al-Amin, etc. (2013). As a Family Nurse Practitioner, the goal is to stay in acute care and with the acute care setting we focus on reducing the number of CAUTI’s to improve our HAC scores and received maximum reimbursement.

The impact of the stakeholders is less reimbursement for our organization. Less reimbursement equals more financial strain on the organization. The stated consequences of this are less viable income that can lead to the liquidation of medical treatment services. The proposed solution is to not catheterize patients unless for retention or surgery on the prostate. In this purposed solution, we would eliminate the use of indwelling catheters. Using EBP we can document the starting rate for facilities CAUTI rate and after ninety days we can document the change in practices and rate of CAUTI’s.

PICOT/ PCo Question

The nursing concern that has been chosen is how to reduce the CAUTI infection rate in a hospital acute care setting. In 2018 Joint Commission continues to require hospitals to implement evidence-based practices to prevent catheter-associated urinary tract infection (CAUTI) related to the use of an indwelling urinary catheter (IUC), including measuring, monitoring, and evaluating the effectiveness of CAUTI prevention efforts and outcomes in patient care areas with a high volume of patients with an IUC (Woten, Mennella, (2018).

For this research, we will use the population as adults age 18-60. Our intervention will be less indwelling catheter’s in the ICU unless determined by retention and prostate surgeries. Comparisons control will be national average and state average in comparison to hospital average in the same time frame. The outcome will be to reduce the number of CAUTI in our hospital comparison to the national average. The time frame will be ninety calendar days. CAUTIs are the most occurring healthcare-associated infections (HAIs) in U.S. hospitals according to the CDC (Woten, Mennella, (2018) .

The U.S. Centers for Disease Control and Prevention (CDC) reports 75% of patients that develop urinary tract infections in the hospital are associated with a urinary catheter (Woten, Mennella, (2018). A risk assessment that is either qualitative, quantitative, or a combination of both; the risk assessment should determine CAUTI prevention efforts and assist in establishing goals to reduce the number of CAUTI’s per month (Woten, Mennella, (2018). The CDC and the National Healthcare Safety Network define CAUTI as a positive culture with no more than 2 species of organisms, at least one of which is a bacterium of ? 105colony forming units (CFU)/ml (Woten, Mennella, (2018).

The steps we will use for conducting an literature review for CAUTI will be Chamberlain database and google scholar. The use of two different data basis will be helpful in obtaining a wide source of knowledge. The main terms that will be used are CAUTI and EBP to obtain the research topics. The one especially organization that will be used it Certified Board of Urology Nurses Association CBUNA (American Nurses Association. (2015). This is a resource that is urology based and can help with reducing the CAUTI in sterile technique and non-indwelling catheters (American Nurses Association. (2015).

Framework

The theoretical framework is that non-indwelling catheters will reduce the CAUTI rate for the age group of 18-60 when compared to the dwelling CAUTI rate (Gould, Umscheid, Agarwal, etc (2016). In a New York hospital, the CDC conducted a study on the ICU and dwelling vs indwelling risks of CAUTI’s (Gould, Unscheid, Agarwal, etc (2016). The study was conducted with 1,453 patients with 1,088 having symptoms of a UTI (Gould, Unscheid, Agarwal, etc (2016). Overall 45.5% of CAUTI were in the ICU patient and 22.3 % were seen in a non-indwelling catheter (Gould, Unscheid, Agarwal, etc (2016). The rate was higher in surgery and peds patients. With this study, they looked at sterile tech and days that the catheter was in place (Gould, Unscheid, Agarwal, etc (2016).

In conclusion in the acute care setting not using an indwelling catheter is beneficial to the healthcare organization in reimbursement and keeping our patient safe. When using EBP we can monitor our hospital average and compare it to the national average. With EBP we can monitor how we use sterile tech, what we have changed in our practices and how we can implement new tech to keep our CAUTI’s at a minimum.

Learn about the importance of designing and implementing policies and procedures to measure, monitor, and evaluate the effectiveness of CAUTI prevention efforts and outcomes in patient care areas with a high volume of patients with IUCs. The ANA developed a nurse-driven CAUTI prevention tool based on the 2013 CDC Criteria for Indwelling Urinary Catheter Insertion guidelines that promote the use of fewer catheters, timely removal and insertion of catheters, and the provision of maintenance and post-removal care (American Nurses Association (2015). With EBP we can improve our hospital safety and reimbursements to maintain a good working institution.

References

1. American Nurses Association. (2015). ANA CAUTI Prevention Tool. Retrieved February 26, 2018, from http://nursingworld.org.chamberlainuniversity.idm.oclc.org/CAUTI-Tool
2. Brown SJ (2013) Evidence-Based Nursing: The Research-Practice Connection. 3rd ed. Burlington, MA: Jones & Bartlett Learning
3. Centers for Disease Control and Prevention. Estimates of healthcare-associated infections.http://www.cdc.gov/ncidod/dhqp/hai.html. Accessed July 10, 2014.Google Scholar
4. Gould, CV, Unscheid, CA, Agarwal, RK, Kuntz, G, Peques, DA. Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for prevention of catheter-associated urinary tract infections 2009.
5. Peasah, S. K., McKay, N. L., Harman, J. S., Al-Amin, M., & Cook, R. L. (2013). Medicare Non-Payment of Hospital-Acquired Infections: Infection Rates Three Years Post Implementation. Medicare & Medicaid Research Review, 3(3), E1–E13. https://doi-org.chamberlainuniversity.idm.oclc.org/10.5600/mmrr.003.03.a08
6. Keib, C. N., Cailor, S. M., Kiersma, M. E., & Chen, A. M. H. (2017). Changes in nursing students’ perceptions of research and evidence-based practice after completing a research course. Nurse Education Today, 54, 37–43. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1016/j.nedt.2017.04.007
7. Woten, M. R. B., & Mennella, H. D. A.-B. (2018). National Patient Safety Goals (The Joint Commission, 2018): Evaluating Efforts to Prevent Catheter-Associated Urinary Tract Infection (CAUTI). CINAHL Nursing Guide. Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=nup&AN=T903607&site=eds-live&scope=site

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