NRS 433V Introduction To Nursing Research

Statement of problem/issue:

In current clinical practices, there have been many instances where patients are prescribed with urinary catheters without any proper indication (Averch, 2014). Although there is always an order for all clinical practice from a medical doctor or a qualified senior staff, sometimes the decisions are decided without any rigid necessity (Averch, 2014). This problem aims to examine the aspects of urinary catheter administration in a hospital setting and its possible contraindications and necessities.

The scope of the problem/issue

The problem with urinary catheter affects nurses, patients; health care providers and the hospital institution meaning the extent of the problem include the whole health sector and related fields (Ching, 2015). Various concerns such as urinary catheter infections, services funding, multiple modes of practices and patients satisfaction have made health care workers and researchers to understand the scope of the problem (Ching, 2015). Such concerns have led to many hospitals and healthcare providers to minimize urinary catheter insertions and only use them when the patients are in practical and actual needs.

What are the PICO Components?

P-(Patient, Population or Problem) –An increase in urinary tract infections associated with Foley catheters.  

I- (Intervention) – Use sterile techniques when inserting urinary catheters and only use them when required. Ensuring the urinary catheters are only produced by supervisors for usage (Saint et al., 2013).

C-(Comparison with other treatments)-Use other methods of relieving urine like the use of male condoms catheters and helping the patients to empty urine in and urinary dish (Saint et al., 2013). 

O-(Outcome(s-Decrease urinary catheter infections, understanding of proper indications for Foley catheter insertion (Saint et al., 2013).

T- (Timeframe)- Three to six months to determine and evaluate whether the action plan has worked. 

Does the problem/issue require?

X Change in Practice?

In most cases, the urinary catheters are always placed in areas where all healthcare providers can easily access (Kennedy, Greene & Saint, 2013). This has led to the insertion of Foley catheters to patients who do not necessarily need them (Kennedy, Greene & Saint, 2013). In addition, many nurses and healthcare workers often use urinary catheters in patients who have not been prescribed to mostly in the emergency units. Therefore, Foley catheters should be kept in areas where only supervisors access them. Also, sterile techniques should be observed all the time during the procedure of insertion.

X Education?

A continue medical education and follow up concerning the change should be introduced to all healthcare workers leaders. In addition, a review of the sterile procedure of insertion should be conducted to ensure all healthcare workers are qualified (Ching, 2015). Other than that, all hospitals should be given flow charts that easily elaborate the standards to be used when dealing with Foley catheters.

X Referral to Quality Team?

The problem should be referred to infections and control unit in order to receive advises on standard infection control when it comes to the use of urinary catheters (Ching, 2015).

X Addition/Change to Procedure Manual?
The procedure manuals should be updated and reevaluated to make sure all updates concerning the standards of use are incorporated (Kennedy, Greene & Saint, 2013).

X Addition/Change to Documentation

All documentation of Foley catheters should be well recorded. This includes a proper electronic database that shows the time the urinary catheter was used, the reason for ordering and the supervisor who released it.

What is the evidence/research that supports problem identification?

In the US, hospitalized associated infections are generally costly, deadly and common. According to the Center for Deceases Control in 2017 catheter-associated urinary tract infections (CAUTI) accounts for 75% of all urinary tract infections (UTI) acquired in the hospital. Around 15-25% of the patients receive the urinary catheters during their stay in hospital of which 10% of these patients do not require them. The most risk factor of developing CAUTI is prolonged use of urinary catheters (CDC, 2017). In addition, poorly indicated catheters inserted using wrong procedures are the aggravating factors. Another report by the CDC showed that there is an estimate of over 2 million hospital-acquired infection every year due to poor handling of patients equipment (CDC, 2017). Out of those, about 99,000 patients die every year due to CAUTI. According to the American Urological Association in 2014, there were 3.8 million cases of CAUTI between 2001 and 2010 in 70.4 million catheterized adults (Averch, 2014). The association showed that prevention of CAUTI primary depends on the selection of appropriate patients and mode of insertion (Averch, 2014). Therefore, Urinary catheters should only be used for proper indications and should be removed as soon as when the patient no longer need them.

Action Plan 

Follow-Up and Evaluation Plan 

Medical leaders and manager should perform a routine follow up checking whether the healthcare workers comply with the new changes (Chesla, 2008). This should include checking whether the patients catheterized were appropriately indicated, reviewing documentation of all procedure and continuous monitoring of all catheters released from the store. The new changes should be evaluated after six months to change whether the CAUTI infections have reduced and if the health care providers have implemented the new proposed guidelines (Mulnard, 2011). Also, the new proposed guidelines should be evaluated whether they are effective or not.

References

Averch, T. (2014). Cather-Associated Urinary Tract Infections: Definitions and Significance in the Urologic Patient. Retrieved from https://www.auanet.org/guidelines/catheter-associated-urinary-tract-infections

CDC,(2017)  Catheter-associated Urinary Tract Infections (CAUTI).. Retrieved from https://www.cdc.gov/hai/ca_uti/uti.html

Chesla, C. A. (2008). Translational research: Essential contributions from interpretive nursing

 science. Research in Nursing & Health, 31(4), 381–390. doi:10.1002/nur.20267 

Ching, P. (2015). Prevention of Catheter-Associated Urinary Tract Infection (CAUTI) through a bundle of care approach. Journal Of Microbiology, Immunology, And Infection, 48(2), S26. doi: 10.1016/j.jmii.2015.02.200

Kennedy, E., Greene, M., & Saint, S. (2013). Estimating hospital costs of catheter-associated urinary tract infection. Journal Of Hospital Medicine, 8(9), 519-522. doi: 10.1002/jhm.2079

Mulnard, R. A. (2011). Translational research: Connecting evidence to clinical practice. Japan

Journal of NursingScience, 8(1), 1-6. doi:10.1111/j.1742-7924.2011.00184.x 

Saint, S., Greene, M., Kowalski, C., Watson, S., Hofer, T., & Krein, S. (2013). Preventing Catheter-Associated Urinary Tract Infection in the United States. JAMA Internal Medicine, 173(10), 874. doi: 10.1001/jamainternmed.2013.101