Nursing Research Utilization Project: Section C Essay

Custom Student Mr. Teacher ENG 1001-04 2 April 2016

Nursing Research Utilization Project: Section C

Several articles have been reviewed as a research base for this project. Identification of appropriate research is critical to the successful implementation of nurse-led evidence-based practice protocols. Each article was carefully selected for what it could contribute to the quality of the project. Using the evidence in this research will help with the development of an implementation plan. Article #1

Adams, D., Bucior, H., & Day, G. (2012, January). HOUDINI: make that urinary catheter disappear-nurse-led protocol. Journal of Infection Prevention, 13, 44-48. This article discusses the use of 7 criteria that must exist in order to keep an indwelling urinary catheter in place. According to Adams (2012), the average daily risk of developing a bacteremia with an indwelling urinary catheter increases by 3%-7% for every additional day the catheter remains indwelling. The study uses the acronym HOUDINI to demonstrate the criteria. The acronym stands for Hematuria, Obstruction, Urologic surgery, Decubitus ulcer, Input and output measurement, Nursing end of life care, and Immobility. In the absence of these aforementioned indications, according to the study, the catheter should be removed to decrease the risk of catheter-associated bacteremia. Article #2

Bernard, M. S., Hunter, K. F., & Moore, K. N. (2012). A Review of Strategies to Decrease the Duration of Indwelling Urethral Catheters and Potentially Reduce the Incidence of Catheter- Associated Urinary Tract Infections. Urologic Nursing, 32(1), 29-37. This article discussed different strategies to decrease the incidence of indwelling urinary catheter times. It was a retrospective study that analyzed data obtained from hospital databases. The study supports nurse-led or electronic chart reminders every 24 hours to assess the need for indwelling urinary catheters on a daily basis. The conclusion lists timely removal as one of the main factors affecting the incidence of CAUTI. Article #3

Clarke, K., Tong, D., Pan, Y., Easley, K., Norrick, B., Ko, C., & … Stein, J. (2013). Reduction in catheter-associated urinary tract infections by bundling interventions. International Journal For Quality In Health Care: Journal Of The International Society For Quality In Health Care / Isqua,25(1), 43-49. doi:10.1093/intqhc/mzs077 This article reviews the affect on incidence of CAUTI by bundling interventions. Also a retrospective study, this research reviewed the effectiveness of bundling four interventions for patients with indwelling urinary catheters. The bundle consisted of 1) Using a silver alloy impregnated catheter 2) Using a securement device to limit the catheter movement 3) Repositioning of the catheter tubing if it was found to be kinked or on the floor 4) Prompt removal of the catheter on post operative day one or two. Implementing this bundle of care for patients resulted in a significant decrease in CAUTI for these study participants. Pre implementation of the bundle the CAUTI incidence rate was 5.2/1000. Seven months post implementation the CAUTI incidence rate was 1.5/1000. The authors have proven with statistical significance that the four-intervention bundle will be successful in reducing the incidence rate of CAUTI in indwelling urinary catheter patients. Article #4

Levers, H. (2014). Switching to an antimicrobial solution for skin cleansing before urinary catheterisation. British Journal Of Community Nursing, 19(2), 66-71. This study suggests that switching to an antimicrobial cleaning solution for the area prior to insertion of a urinary catheter will reduce the incidence of CAUTI. The research recommended using Octenilin solution for cleansing the meatus prior to catheterization. The case studies are ongoing and no results were mentioned in the study except for to say the change was cost neutral and the practice change is promising. This study failed to show a statistically significant decrease in CAUTI post implementation. Article #5

Meddings, J. A., Reichert, H., Rogers, M. M., Saint, S., Stephansky, J., & McMahon Jr., L. F. (2012). Effect of Nonpayment for Hospital-Acquired, Catheter-Associated Urinary Tract Infection. Annals Of Internal Medicine, 157(5), 305-312. This study reviewed the Centers for Medicare Services (CMS) recent (2008) initiative to hold or eliminate reimbursement for costs associated with hospital acquired CAUTI. This study alluded to the misuse of coding in failing to identify CAUTI when it actually did exist, therefore claiming the financial impact on health care organizations is low for non-payment of hospital acquired CAUTI. Even when the researchers included all urinary tract infections catheter associated and otherwise, the loss of reimbursement to healthcare organizations would have been less than 1% due to improper coding. Conclusion

In conclusion, the prevalence and incidence of CAUTI is affected by many factors. First health care workers need to be aware of the significance of CAUTI and be compliant with new practice guidelines to decrease risk. Second, adherence to inclusion criteria for indwelling urinary catheters and their placement using the HOUDINI protocol (Adams, Bucior, & Rimmell, 2012). Lastly, implementation of a bladder bundle to decrease the incidence of hospital acquired CAUTI. Each factor focuses on a unique evidence-based prevention, reduction, or eradication strategy to address the problem of CAUTI. Health care workers, who possess an awareness of the need to decrease this preventable infection, will add to the forward trajectory of solving this problem, and implementing this project.

References
Adams, D., Bucior, H., & Day, G. (2012, January). HOUDINI: make that urinary catheter disappear-nurse-led protocol. Journal of Infection Prevention, 13, 44-48. Bernard, M. S., Hunter, K. F., & Moore, K. N. (2012). A Review of Strategies to Decrease the Duration of Indwelling Urethral Catheters and Potentially Reduce the Incidence of Catheter- Associated Urinary Tract Infections. Urologic Nursing, 32(1), 29-37. Clarke, K., Tong, D., Pan, Y., Easley, K., Norrick, B., Ko, C., & … Stein, J. (2013). Reduction in
catheter-associated urinary tract infections by bundling interventions. International Journal For Quality In Health Care: Journal Of The International Society For Quality In Health Care / Isqua,25(1), 43-49. doi:10.1093/intqhc/mzs077 Levers, H. (2014). Switching to an antimicrobial solution for skin cleansing before urinary catheterisation. British Journal Of Community Nursing, 19(2), 66-71. Meddings, J. A., Reichert, H., Rogers, M. M., Saint, S., Stephansky, J., & McMahon Jr., L. F. (2012). Effect of Nonpayment for Hospital-Acquired, Catheter-Associated Urinary Tract Infection. Annals Of Internal Medicine, 157(5), 305-312.

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