Year of Publication

2016

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Debra Gay Anderson

Clinical Mentor

Dr. Katie Ballert

Committee Member

Dr. Chizimuzo T.C. Okoli

Abstract

When patients are admitted to a hospital patient safety should be a priority in all aspects of the care they receive. Preventing patients from acquiring hospital infections (HAIs) is one example of patient safety. All hospital employees have the responsibility to ensure that standard workflow and processes are in place to ensure this safety. The purposes of this Practice Inquiry Project (PIP) were to examine and develop interventions to decrease the risk of catheter associated urinary tract infections (CAUTIs), incorporate an effective process and standard workflow to implement evidence practice practices (EBP), and to evaluate the effectiveness of implementing the Post Foley Removal Guideline (PFRG) to prevent reinsertion of the indwelling catheter for urinary retention, and thereby decreasing the risk of developing a CAUTI.

The clinical and fiscal impact of CAUTIs are quite significant as well as are the challenges to ensure best practices are implemented enterprise-wide to reduce these risks. The first manuscript is a literature review of the impact of CAUTIs and prevention strategies to decrease the risk. The purpose of this literature review is to examine the most effective strategies/interventions to prevent hospital acquired CAUTIs. Studies have noted that a majority of these infections are preventable, with insertion and duration of use being the two principle preventable risk factors (Alexis’s 2014; APIC 2009; Umscheid, 2011; US-HHS, 2014).

The second manuscript in this series details the development of an organization structure and workflow that would provide a vehicle to identify risk factors and implement best practices hospital-wide. Through evaluation by senior nursing leadership, the Quality Improvement Project (QIP) was developed to create an organization structure that would be effective in implementing enterprise-wide evidence based practice (EBP) and ensure standard of care was being given in all areas to make an effective impact on lowering CAUTI rates.

The final manuscript is a pre and post-retrospective analysis of the impact the Post Foley Removal Guideline (PFRG) had on the CAUTI rates, device days, hospital length of stay, re-insertion rates and compliance. The study noted a significant decrease in CAUTIs, with only partial compliance to the PFRG and no significant difference in device days. This indicates multiple factors are present when implementing a new protocol.

This PI was instrumental in helping me develop knowledge and skills to evaluate the extent of a patient safety issue, develop leadership skills to facilitate changes within a large hospital system, translate EBP to the clinical units, and evaluate outcomes.

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