Research Paper on "Analyzing Needs Assessment and Quality Improvement Plan"

Research Paper 15 pages (4816 words) Sources: 10

[EXCERPT] . . . .

Project Charter

Objectives and scope

The objective of this plan is to implement and assess the success of an intervention aimed at reducing CAUTIs in acute care settings through the reducing of the use of IUCs. The hypothesis was that catheter-days and infection rates of CAUTIs would reduce during the period of intervention (six months) compared to the eleven months prior to the intervention. The total number of catheter-days and monthly rates of catheter-associated UTIs were calculated utilizing unpaired t tests prior to and during the intervention. P was set at p< .05 (Elpern, et.al, 2009).

Structure

Unit clinicians were assigned the duty of developing signs for continuing the use of indwelling urinary catheters. For the intervention period, patients in medical ICUs who had IUCs were assessed on a day-to-day basis using the criteria developed by unit clinicians (Elpern, et.al, 2009). Recommendations were then made on whether or not to continue with catheterization based on the results of the evaluation. Then the catheter-days and infection rates of CAUTIs during the period of intervention were compared to with the rates in the preceding eleven months before the start of the intervention.

Implementation:

The sample population was made up of all patients admitted to the medical intensive care unit over a twelve-month period and at some point had an IUC inserted in them. During the sampling period all the individuals admitted into the ICU who had IUC were identified on a daily basis by the clinical co-investigators on their nursing shift reports. The patients were then evaluated by the clinical researchers from the day of admission into the medical intensive care unit and on a day-to-day basis from then on utilizing the criteria for evaluating catheterization continuance (Elpern, et.al, 2009). The nurse co-investigators were recruited principally for consultation on catheter continuation/discontinuation. day-to-day assessments were made by nurses until either the IUC was removed or the patient was discharged from ICU. Results of the day-to-day evaluations were presented by the nurses during multidisciplinary roundtables every morning. Recommendations were then made to discontinue IUCs in individuals who were found not to have met the set criteria.

Issues/Premises/Constraints:

Total elimination of catheter-associated UTIs is not considered by many as a viable goal. IUCs still have an important role in certain situations, and even with the strict adherence to the best practices the CAUTIs will still occur. A more viable goal would be to reduce the extensive use of IUC and the decrease CAUTI infection rates (Elpern, et.al, 2009). The integration of an approach like ours might be a huge shift for most acute care nurses. This is because incontinence is a huge problem for nurses especially in obese, female, or immobile patients. During the research period many patients were hesitant to discontinue catheterization since they feared incontinence-related risks. However, it is thought that reductions in number of infections would help nurses to be less hesitant in removing catheters without worries about risks and the additional works related to the discontinuance such as linen changes and hygiene interventions.

The need for resources is expected to increase with the coming of new practices such as the early removal of catheters. The need for resources such as linens, washroom products and external catheters is expected to increase during the intervention period. There will also be a need to frequently assess patients using the bladder scanner to check for urinary retention during the study. Lastly, there is a need for further studies to be conducted on this subject. We were specifically limited by the small body of research on incontinence-related risks and complications (Elpern, et.al, 2009). Very few studies have also focused on patient catheter comfort/discomfort. We also found very little data that compared the advantages and disadvantages of indwelling urinary catheters and condom catheters. There is a need for investigations on the two common types of catheters so that the relative benefits and risks of both can be assessed. Generalization of outcomes is restricted by the utilization of a single medical unit in a single health facility and by fact that the study was limited to IUCs only. The catheter-days and CAUTI rates were also compared prior to and during the intervention period rather than the utilization of a control group, introducing the likelihood that other factors might have come into play within the study period (Elpern, et.al, 2009). Another limitation would be that the appropriateness of catheter use was not evidence-based. Instead consensus opinions among stakeholders were used to determine whether it was proper to remove a catheter. Where there were differences in opinion, the researchers gave most weight to the opinions given by the nurses who were the ones directly interacting with the patients.

Needs Assessment and Quality Improvement Plan

Six Sigma is the model to be utilized for the deployment of this plan. At SFMC, Six Sigma deployment is based on three major principles: a) a strong belief in the combined wisdom our people and the ongoing development of problem solving proficiencies at the micro-system level; b) the constant need for an immediate line of sight from plan to action; and c) application of steady, process centered and data motivated decision making to enhance the most significant procedures (Nimtz-Rusch and Thompson, 2008). Methodology entails equipment and techniques from different disciplines with the inclusion of Six Sigma (error minimization), lean (waste eradication), process management (gauging and management of process performance over time), project management, as well as change management (identification and reduction of resistance to change).

The NHSN developed standards for CAUTIs based on comparable hospitals. In the intensive care unit, the standard for CAUTI was a rate of 4 for every 1000 catheter days assembled from 300 hospitals in 2004 (Edwards, Peterson, et al., 2007). In 2007, in getting ready for the new CMS principles for healthcare obtained infections, PENN Presbyterian Medical Center in Philadelphia, Pennsylvania, initiated a campaign to minimize the frequency of CAUTIs through implementing a set of evidence-based principles and scrutinized the impacts of these principles on the rate of CAUTIs in a pilot research conducted in one of the ICUs. Prior to implementing these set of principles PENN Presbyterian Cardiac Care Unit had a CAUTI rate of 13.1 in 2006 after one year. Sticking to these principles, by the conclusion of 2007 the rate had fallen to 6.80. All of the University of Pennsylvania Hospitals adapted segments of these principles and made variations in accordance to their specific patient numbers (Gorman, n.d.). This work shall summarize what was done by PENN Presbyterian, however, shall focus only on some of the interventions used by all three hospitals. Interventions were evaluated by committees from all three hospitals that met on a quarterly basis. Practice guidelines/principles are basically systematically created statements to help both patients and practitioners in making decisions regarding suitable healthcare for particular situations. Some of the aspects of high quality guidelines are validity, reproducibility, dependability, multidisciplinary process and documentation, evaluation of proof, clinical flexibility, clinical appropriateness, and transparency among others.

Strengths and Weaknesses of Current Practice:

The duty of infection preventionist in attempts to minimize CAUTI's frequency entails policy and best practice subject-matter skill, supply of surveillance data and risk evaluation, seeking advice on infection prevention interventions, and facilitation of CAUTI-linked development projects. It is essential that the infection preventionist stays in touch with and interacts with every member of the patient care team about CAUTI-linked infection prevention (Guide to the Elimination of Catheter-Associated Urinary Tract Infections (CAUTIs)). Offering subject-matter skill to those included in clinical management of the patients, including nurse practitioners, physicians, and physician assistants is quite important. An awareness of the constituents of surveillance definitions, in comparison to secondary or primary diagnoses and complications, is important for proper coding and documentation. Various weaknesses have been realized. According to non-randomized clinical assessments, multilumen catheters are linked with a greater infection risk when compared to single-lumen catheters, most likely since more ports raise the incidence of catheter manipulation. The location of insertion is another discretionary aspect in catheter placement which influences the infection risk (Trautner and Darouiche, 2004). A new randomized assessment comparing subclavian and femoral locations for venous catheterization discovered a greater rate of thrombotic and infectious complications at the femoral site. Catheters placed under developing circumstances or outside the hospital might easily have been infected during the insertion procedure and ought to be replaced as fast as possible. After placement, catheters should be controlled as less as possible; for instance, hemodialysis catheters need to be used just for hemodialysis. Lastly, hand washing is the basis of infection control and needs to be done prior to and after the insertion, replacement, accessing, or dressing of an intravascular catheter. Even though most of these recommendations are not convenient, even frustrating, for clinicians to abide by daily, in the long-term these easy preventive measures could distinctly minimize the rate of intravascular catheter -- associated infections (Trautner and Darouiche, 2004).

Gaps and Need for Change:

A CAUTI is frequently thought of as a kind or acceptable side effect… READ MORE

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