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A4c.
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This is the list of requirements to answer for my paper and the rubric that I need to follow for it. I have submitted the paper twice and had it returned for revision to section 4d, which I have highlighted. I am not sure what they are looking for that I am not including. I am including my paper so you can see what I have written. Any help is appreciated.

 

A.  Discuss a healthcare safety concern using the SBAR (situation, background, assessment, recommendation) format by doing the following:

1.  Describe a healthcare-related situation prompting a patient safety concern (S).

2.  Analyze background information about the concern by doing the following (B):

a.  Describe the data that support or would support the need for change.

b.  Explain how one or more national patient safety standards apply to this situation.

3.   Discuss the impact of the safety concern on the patient(s), staff, and organization (A).

a.   Explain how the safety concern affects value for the patient(s) and the organization.

4.   Recommend an evidence-based practice change that addresses the safety concern (R).

a.   Discuss how this recommendation aligns with the principles of a high reliability organization. 

b.   Describe two potential barriers to the recommended practice change.

c.   Identify two potential interventions to minimize the barriers from part A4b to the recommended practice change.

d.   Discuss the significance of shared decision-making in implementing this recommendation.

e.   Describe an outcome measure that could be used to evaluate the results of the recommendation.

f.    Discuss how the care delivery model in this organization would be impacted by this change.

 

A. 

1. 

CAUTIs or Catheter-Acquired Urinary Tract Infections, specifically, those patients who develop CAUTIs from using indwelling catheters in the acute care setting.

2. 

a. 

Long-term catheterization is a major risk factor for CAUTI development and has been shown to occur at a rate of up to 5% a day (Gupta, 2017). Healthcare-associated infections complicate the admissions of one-third to one-fourth of patients admitted in adult intensive care units (ICUs). ICU-acquired infections increase patient risk of morbidity and mortality, delay hospital discharge, and increase interventions, all the while resulting in increased hospital costs and patient suffering (Gupta, 2017).

b. 

The National Patient Safety Standards (NPSS) apply to CAUTI prevention by setting goals for improving patient safety. Goal 2 – Improve the effectiveness of communication among caregivers, and Goal 7 – Reduce the risk of healthcare-associated infections.

3. 

The length of IUC use has a direct correlation to the probability of developing a UTI. Studies show that strict and restrictive IUC policy use combined with intensive education of health care providers can significantly reduce the CAUTI rates in a non-ICU setting. Furthermore, prolonged catheterization is the major risk factor for developing CAUTI at a rate of 5% a day (Gupta, 2017). The use of indwelling catheters unnecessarily exposes patients to CAUTIs, which can cause other problems associated with the UTI such as longer hospital stays and frequent use of antibiotics which can, in turn, lead to antibiotic resistance. Hospitals now are required to pay for all costs associated with CAUTIs that were acquired during the hospitalization costing the organization money for staffing and health care costs. Staff can be overwhelmed by CAUTI patients being required to stay longer and being added to their patient assignments.

a. 

CAUTIs cost hospitals revenue due to increased staffing costs and longer lengths of time the patient must stay. Patients could have decreased satisfaction with the care received, longer periods of being in pain as well as the costs of being in the hospital for an extended period. If the CAUTI causes complications such as sepsis, then the stay becomes even longer and costs the patient as well as the facility even more.

 

 

 

4. 

I believe the best intervention to decrease the rates of CAUTIs is the reinforcement of education or better training on the appropriate usage, cleaning techniques, and removal guidelines for indwelling catheters.

a. 

Recommendation to reinforce instruction or provide greater training on catheter care aligns with high-reliability organization concepts. By training workers on correct catheter use, cleaning, and removal, CAUTIs can be prevented. This recommendation respects the expertise of experts for indwelling catheters.

b. 

I think there are several barriers that could be encountered such as the new practice not being followed by staff who are resistant to change or feel that it is easier to deal with multiple patients if they have an IUC. There is also the issue of incontinent patients that can develop skin integrity issues which is why many patients have an IUC.

c. 

For incontinent patients more frequent trips to the bathroom or use of a bedpan, diaper or chucks could be helpful in not using an IUC. For staff that is resistant to change, ask them why they feel the new guidelines are not achievable and if they have any ideas that they feel could be implemented that would be helpful to the issue.

d.

Team nursing would be the ideal nursing care delivery model for CAUTI prevention in this unit since it would be a small group of a team leader (RN) and a few personnel to complete patient care for a small group of patients. This model would ensure IUC care training is the same for everyone and patient care is completed by trained personnel. There are three groups that would be important to involve in the decision-making of this practice change. The first group would be the nurses that work at the bedside because they are the ones that understand how important it is to implement the new changes and their input on whether the changes are positive or negative will be important. The second group would be the unit leaders or managers because they will be enforcing the new changes and providing training on how to insert, use and care for IUCs if new guidelines are implemented as well as providing valuable opinions on how to reduce CAUTIs. The third group I would include would be the physicians that work in the unit because they are the ones who prescribe the IUCs and will be making the decision as to whether an IUC is necessary for that specific situation.

e. 

The outcome that would measure my recommended change would be a decreased number of cases of hospital-acquired CAUTIs in an acute care unit over 3 months compared to the 3 months before the changes were implemented.

f. 

The current care delivery model in use for the unit is a functional nursing care model where the nurses are responsible for medications, assessments, and plan of care; and the patient care assistants perform hygiene tasks and take vital signs (Cherry & Jacob, 2019). The intervention strategy, CAUTI bundle, in-and-out catheterization, and bladder scanning would impact the care delivery model by decreasing the IUC use rate leading to lower CAUTI rates, as well as improving quality and safety regimens in a large ICU while being able to create a durable cultural change regarding the use of IUC in hospital staff (Gupta, 2017).  

SCIENCE
HEALTH SCIENCE
NURSING
BS NURSING D221

 

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