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.

Name: Lishan Brown

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.) The topic is hospital acquired infections. The nursing practice issue is catheter associated urinary tract infections and the high incidence on an acute rehabilitation unit.

Briefly describe your rationale for your topic selection. Include the scope of the issue/problem.The nursing practice issue I would like to investigate is healthcare associated infections (HAI), particularly catheter associated urinary tract infection (CAUTI). CAUTI is very important to investigate because I believe HAI’s can be decreased, if not prevented. Being that nurses are educated on the possible causes or symptoms of HAI’s, we can be more proactive in our treatment plans. If a patient falls, that can be an unpredictable event but HAI’s are more so predictable. With CAUTI, making sure that the perineal area is cleaned on a regular, consistent basis is important. Providing proper interventions to not keep an indwelling catheter in longer than necessary is also important.

Urinary tract infections are one of the most common hospital acquired infections. At least 80% of urinary tract infections can be attributed to an indwelling urinary catheter. There are approximately 13,000 annual deaths associated with catheter associated urinary tract infections (CAUTI). CAUTIs can lengthen hospital stays, increase morbidity and mortality, and raise healthcare costs.

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

Describe the practice problem in your own words and formulate your PICOT question.The practice problem is members of the healthcare team are not properly cleaning the perineal area of patients who have indwelling catheters and indwelling catheters are placed for unnecessary longer periods of time.

PICOT question:In (P) patients with an indwelling catheter on an acute rehabilitation unit, does (I) cleansing the perineal area every eight-hour period compared to (C) routine daily cleansing of the perineal area (O) decrease the catheter associated urinary tract infection with patients over a (T) six month period?

List the systematic review chosen from the Cochrane Database of Systematic Reviews from the Chamberlain library. Type the complete APA reference for the systematic review selected.

Reference:Flodgren G, Conterno LO, Mayhew A, Omar O, Pereira CR, Shepperd S. Interventions to improve professional adherence to guidelines for prevention of device‐related infections. Cochrane Database of Systematic Reviews. 2013, Issue 3. Art. No.: CD006559. DOI: 10.1002/14651858.CD006559.pub2.

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.In my search for evidence, I found an article about nurse-driven CAUTI prevention. This evidence is relevant to my PICOT because I would like to find a way to decrease or eliminate the instances of CAUTI in a hospital setting. The article gives a history of prevalence of CAUTI then goes into costs related to CAUTI. The article also mentions ways of preventing CAUTI. The article also discusses an algorithm used to decrease the prevalence of CAUTI.

I also found an article about the causes of CAUTI and how to properly clean the perineal area as an educational tool.

Reference:Russell, J. A., Leming-Lee, T. ‘Susie,’ & Watters, R. (2019). Implementation of a Nurse-Driven CAUTI Prevention Algorithm. Nursing Clinics of North America, 54(1), 81–96. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1016/j.cnur.2018.11.001

Memorial Sloan Kettering Cancer Center (2018). Caring for Your Urinary (Foley®) Catheter. Retrieved from https://www.mskcc.org/cancer-care/patient-education/caring-your-urinary-foley-catheter

Briefly summarize the main findings (in your own words) from the systematic review and the strength of the evidence.The main findings from the systemic review were that there wasn’t sufficient evidence to properly corroborate the research. The trials were too small and there was inadequate reporting of information. Because the findings were too small, it was difficult to determine which intervention would be optimal in CAUTI care. The strength of the evidence was weak for the change process.

Outline one or two evidence-based solutions you will consider for the trial project.An evidence-based solution would be the CAUTI Prevention Tool by the American Nurses Association. This streamlined evidence-based tool is used to reduce CAUTI by fewer catheters being used, timely removal, and insertion, maintenance, and post-removal care.

Reference:American Nurses Association (2009). Streamlined Evidence-Based RN Tool: Catheter Associated Urinary Tract Infection (CAUTI) Prevention. Retrieved from https://www.nursingworld.org/~4aede8/globalassets/practiceandpolicy/innovation–evidence/clinical-practice-material/cauti-prevention-tool/anacautipreventiontool-final-19dec2014.pdf

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). Care standards for urinary catheter care would be proper education to staff and those in use of the indwelling catheter (importance of infection prevention, symptoms of urinary tract infection, proper care of an indwelling catheter).

Provide written criteria for the necessity of an indwelling catheter by using the CAUTI Prevention tool.

Following procedures for the insertion and maintenance of an indwelling catheter (proper handwashing, use of aseptic techniques for insertion and removal of the catheter, securing the tubing and drainage bag, maintaining sterility, replacement of supplies).

Having proper documentation of insertion, maintenance, and removal.

Reference:The Joint Commission (2017). Requirements for the Catheter-Associated Urinary Tract Infections (CAUTI) National Patient Safety Goal for Hospitals. Retrieved from https://www.jointcommission.org/assets/1/6/R3_Cauti_HAP.pdf

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 Leader: The person leading the trial, responsible for ensuring the success of the project and day-to-day intricacies of the project.
• Nurse Manager: Person overseeing the trial to ensure the nurse leader and provide assistance as necessary.
• Unit Nurses: Team members who are assisting in carrying out the change process and day-to-day bedside care with patients with indwelling catheters.
• Patient: Consents to a clinical trial and helps to identify symptoms of CAUTI.

What specifically is your nursing role in the change process? Other nursing roles?My nursing role in the change process is to be at the forefront of the change process. As the nurse leader, I would want to ensure that all supplies, education, proper documentation is in place throughout the trial to ensure effectiveness. Unit nurses are responsible for the placement of an indwelling catheter, the daily care management, and the removal of the indwelling catheter. Nurses are also responsible for specimen collection. Nurses are also the main person to diagnose a patient who is suspected of CAUTI.

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

• MD (Doctor of Medicine)
• DO (Doctor of Osteopathic Medicine)
• Nurse Educator
• RN (Registered Nurse)
• CNA (Certified Nursing Assistant)
• Nurse Manager

These members are important to the project because they are all part of the team who is essentially caring for a patient with an indwelling urinary catheter. They are important in making necessary changes to decrease the incidents of catheter associated urinary tract infection. It all begins with proper education right down to actually caring for the patient who has an indwelling catheter. The MD/DO are responsible for ordering the indwelling catheter for the patient. Unit nurses and CNAs are important in the day-to-day care of the indwelling catheter. The nurse manager is important in making sure policies are followed for the change process and provide additional assistance if necessary.

What type of cost analysis will be needed prior to a trial? Who needs to be involved with this?The type of cost analysis which would be needed prior to a trial would be a cost-effectiveness analysis. A cost-effectiveness analysis is a method of analyzing the cost and health outcome of an intervention. The finance department would need to be involved in this portion of the change process. This is necessary to see how much funds can be allocated to the project for additional resources. It is also important to know the initial cost to the hospital for CAUTIs compared to after the completion of the trial to see if there was an improvement. Having the quality control department involved ensures policy and procedures are being followed as well.

Reference:Jamison DT, Breman JG, Measham AR, et al., editors. Priorities in Health.