HLTH325 Quality Improvement Process

HLTH325 Quality Improvement Process

Introduction and Problem

Catheter-associated urinary tract infection (CAUTI) is common among inpatients particularly those undergoing surgical operations (Metersky et al., 2017). These infections are caused by indwelling catheters. They cause long hospital stays, increase morbidity and mortality rates, cause discomfort and increase the hospital cost. Due to the increased need for surgical treatment in the contemporary society, without appropriate and effective measures, CAUTIs are almost inevitable. ABT Hospital is not an exception. The rehab facility provides treatment services for brain surgery, stroke, patients with amputations and spinal cord injuries. The organization is not so much burdened by CAUTI even though they continue to challenge the quality of care delivered as well as patient safety. HLTH325 Quality Improvement Process

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   ABT is however determined to provide high quality and holistic care to inpatients by initiating changes that reduce CAUTIs and minimize the risks of infection. Recently, they proposed a CAUTI prevention project to reduce the infection rates in the hospital. The project is associated with creation of awareness to both the nurses and the patients on the application, use and cleaning of catheters through collaborative efforts by the task force leaders, interdisciplinary teams and nurse educators.

Literature review

According to Agency for Healthcare Research and Quality (AHRQ) (2016), CAUTI were among 722,000 hospital-acquired infections recorded in 2011. Every year, about $40 billion of the US budget goes to CAUTI infections (Haque et al., 2018). This indicates the criticality of these illnesses and its increased healthcare costs and why healthcare facilities need to device measures to curb the infections. According to a study by Umer et al. (2016), increased costs of hospitalization, high morbidity and mortality of CAUTI is influenced by the use, maintenance and removal of catheters. This followed a study based on CMS guidelines concerning indwelling urinary catheters (IUC) that concluded that multifaceted approach characterized by changes in staff education, healthcare processes and general organizational culture. This is supported by a study by Wooller et al. (2018) which indicates that the patient’s safety can be improved trough similar approaches via a SafetyLEAP program.
Sarah and Oktamianti (2018) associate CAUTIs with large hospitalization numbers. According to the study, the duration of catheterization is linked to increased risks of infection with at least a 5% rate daily. Following their study, Sarah and Oktamianti (2018) note that the implementation of effective interventions in the reduction of CAUTI such as supervision, reduction of unnecessary use of catheters, bladder bundles intervention and shortened duration of catheterization, provides positive outcomes with regard to hospitalization costs, length of stay, urinary catheterization duration and cost of medications.           Consequently, the Center for Disease Control and Prevention (2016) indicate that 75% of UTIs are related to the use of catheters. Like the other studies, prolonged use of these urinary tubes is the main cause of infection (Castillo-Tokumori, Irey-Salgado & Málaga, 2017). The CDC recommends the removal of catheters as soon as they are no longer required by the patient. Appropriate indications should also be followed during the insertion and removal. In addition, prevention is supported by monitoring the CAUTI rates and assessment of the effectiveness of efforts put in place to reduce infections.

The three themes identified are prevention, infection and safe use of catheters. The prevention theme entails stopping CAUTI infections from happening within the hospital setting. This is possible through various preventive strategies outlined in the paper. Infection theme is characterized by the acquisition and spread of CAUTIs while the safety theme is associated with provision of measures on the use, maintenance and removal of catheter in a manner that prevents spread of infections.

Analysis of the root cause from quality standards

CAUTI cases in the organization are majorly caused lack of compliance of insertion, maintenance and removal standards (McMullen, Smith & Rebmann, 2020). This results in prolonged use of catheters or unsafe handling which supports buildup and transmission of infections. The microbes therefore get the opportunity to multiply and thrive in the system causing urinary tract infections. The professional expectations and care standards during catheterization of patients are outlined in the catheter maintenance bundle and protocols. These provide a detailed guide on safe insertion, handling and removal as well as informs evaluation of the objectives. Moreover, these guidelines ensure consistency in care for patients with indwelling catheters.

Catheter care bundles optimizes the procedures and helps reduce the risk of infections (Sun et al., 2020). It gives evidence-based prevention strategies and practices that reduce CAUTI in long-term care. In this case, the lack of compliance with these standards by the hospital staff influences the contraction of the diseases. Nurses are thus not able to keep the drainage bag below the bladder level and also away from the floor. They might not keep the catheter secured in the right position and as well as not be able to advice patients on related hygiene. Furthermore, nurses that do not comply with the standards are not likely to advice the patient on how to position themselves to prevent blockage of the urine flow in the tube. As such, this is the major cause of CAUTI in the ABT Hospital. HLTH325 Quality Improvement Process

Interventions addressing the quality improvement initiative

The interventions to address the proposed improvement project was the application of nurse-driven ICU procedures. The adoption of these interventions revealed a significant reduction of the application of catheters as well as promoting nurses’ adherence to the current protocol for preventive measures of CAUTI. Even though, there are various interventions applicable primarily to reduce the number of patients contracting CAUTI. For instance, taking proper measures in the use of gloves and maintaining proper hand hygiene. In this case, the use of gloves is a frequent norm in the hospital setting, therefore, medics in this field are required to be keen pre and post wearing. This will help nursing patients while handling catheters, collecting urine samples, and emptying drainage bags. More so, proper maintenance of bath basin intervention is workable in the reduction of CAUTI cases by maintaining cleanliness and disinfecting after every bath. Also, in case of the basin are not in use to be maintained dry and stored upside down to avoid contamination. Lastly, ensuring the use of standard leg bags will be used in hospitals since some clients prefer maintaining dignity. In this case, the bag and leg straps should be maintained dry, wiped while taking bath while preventing direct contact with the skin.

Change model application in implementing this project

in the recent past, the healthcare sector has revealed the need to reduce the number of CAUTI cases occurring in the ICU. This can be practically achieved by adopting the best intervention measures as well as equipping medics with the right CAUTI prevention protocol. In this project, implementation can be easily achieved with the adoption of Lewin’s theory of change. Additionally, the Lewin’s theory expounds on the need to have change for an identified problem (Baines et al., 2017). According to the author, there is important to instill probable changes that easily accommodate changes that assist in the decline of CAUTI cases. While accommodating these changes, there will be a decrease in the number of patient cases concerning catheter-related. The moving stage in this project will involve the implementation of the new change while the refreezing stage will implement the new organizational norm.

Benchmarks That Will You Use to Measure the Expected Outcomes

This project will use internal benchmarks in measuring the outcome. Basically, the outcome measurement parameters will show the best practices in an organization while comparing the present outcomes with the past in a given time. However, the outcome will be measured in terms of catheter days in use, compliance of IUC cleansing procedures, and CAUI incidences. For instance, a decrease of cases will be as a result of an increase in compliances of CAUTI protocol thus indicating a positive outcome in cutting down the cases. Also, paying attention to internal benchmarks around ICU maintenance will automatically lower the number of CAUTI issues. HLTH325 Quality Improvement Process

Timeline for implementation and expected outcomes

The planned implementation will be conducted in a schedule ranging from 1-8 weeks as follows.

Week 1

This week will be scheduled for the organization and formation of the planned team and prior interactions with the team engagement according to the implementing unit-based mode of performance.

Week 2

In this phase there will be sharing of the pre implemented information to all the participating members. Still, there will be a verification process for approval from the top nursing leadership management.

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Week 3

Participating nurses will be educated on the required standards to meet the new project implementation.

Week 4

Implementation of IUC rounding to provide coaching.

Week 5 and 6

This will involve putting in place the actual formulated guidelines and protocol

Week   7

Evaluating to gauge whether the implemented project meets the intended objectives as well as ensuring the feedback achieved is satisfactory.

Week 8

This will involve the implementation and development of relevant policy that aligns with the stipulated protocol.

References

Agency for Healthcare Research and Quality (2016). Toolkit for Reducing Catheter-Associated Urinary Tract Infections in Hospital Units: Implementation Guide. Overview. Retrieved from https://www.ahrq.gov/hai/cauti-tools/guides/implguide-pt1.html#:~:text=Complications%20associated%20with%20CAUTI%20result,CAUTI%20is%20%24340%E2%80%93450%20million.

Baines, T., Bigdeli, A. Z., Bustinza, O. F., Shi, V. G., Baldwin, J., & Ridgway, K. (2017). Servitization: revisiting the state-of-the-art and research priorities. International Journal of Operations & Production Management.

Castillo-Tokumori, F., Irey-Salgado, C., & Málaga, G. (2017). Worrisome high frequency of extended-spectrum beta-lactamase-producing Escherichia coli in community-acquired urinary tract infections: a case–control study. International Journal of Infectious Diseases, 55, 16-19. HLTH325 Quality Improvement Process

CDC. (2016). catheter-associated UTI (CAUTI). Retrieved from https://www.cdc.gov/hai/ca_uti/uti.html

Haque, M., Sartelli, M., McKimm, J., & Bakar, M. A. (2018). Health care-associated infections–an overview. Infection and drug resistance, 11, 2321.

McMullen, K. M., Smith, B. A., & Rebmann, T. (2020). Impact of SARS-CoV-2 on hospital acquired infection rates in the United States: Predictions and early results. American Journal of Infection Control, 48(11), 1409-1411.

Metersky, M. L., Eldridge, N., Wang, Y., Mortensen, E. M., & Meddings, J. (2017). National trends in the frequency of bladder catheterization and physician-diagnosed catheter-associated urinary tract infections: Results from the Medicare Patient Safety Monitoring System. American Journal of Infection Control, 45(8), 901-904.

Sun, Y., Bao, Z., Guo, Y., & Yuan, X. (2020). Positive effect of care bundles on patients with central venous catheter insertions at a tertiary hospital in Beijing, China. Journal of International Medical Research, 48(7), 0300060520942113.

Umer, A., Shapiro, D. S., Hughes, C., Ross-Richardson, C., & Ellner, S. (2016). The use of an indwelling catheter protocol to reduce rates of postoperative urinary tract infections. Conn Med, 80(4), 197-203.

Wooller, K. R., Backman, C., Gupta, S., Jennings, A., Hasimja-Saraqini, D., & Forster, A. J. (2018). A pre and post-intervention study to reduce unnecessary urinary catheter use on general internal medicine wards of a large academic health science center. BMC health services research, 18(1), 1-9. HLTH325 Quality Improvement Process