Informatics – Much of what nurses do involves technology
Informatics – Much of what nurses do involves technology. Documentation is computer-based, and medication
barcode scanning is the standard of care. The definition of informatics is, “The use of information and
technology to communicate, manage knowledge, mitigate error, and support decision making” (QSEN, 2003).
Evidence-Based Practice – Evidence-Based Practice (EBP) is defined as “Integrating best current evidence with
clinical expertise and patient/family preferences and values for delivery of optimal health care” (QSEN, 2003).
An example of EBP is the nurse-driven foley catheter removal protocol. Through clear, approved protocols
(without an individual physician order), the number of healthcare associated urinary tract infections drops
significantly. This is now the standard of care in many hospitals.
Read the article:
Chasing Zero: A
Nurse-Driven
Process For
Catheter-Associated Urinary Tract
Infection
Reduction in a Community Hospital.
Instructions
After reading the article, recall the assigned readings and activities from the lesson plans. What are your
thoughts on the article about nurse-driven foley catheter removal protocol? Respond to one (1) of these
prompts/questions. Include references:
•
How did this article describe the integration of Evidence–Based Practice and Informatics?
•
Discuss another area of healthcare that you have identified as needing research leading to the
implementation of Evidence-Based Practice?
•
How did informatics support, or create barriers to, communicate, manage knowledge, mitigate error, or
support decision making in this article?
•
What potential barriers exist to implementation of a nurse driven process described in the article?
•
What was most eye opening or inspiring about the article?
NURSING ECONOMIC$/November-December 2015/Vol. 33/No. 6320
CATHETER-ASSOCIATED urinarytract infections (CAUTI)continue to challenge com-munity hospitals. Hospital- acquired urinary tract infections account for 40% of hospital-ac quir – ed infections, with 80% of those in – fections related to use of a urinary, or Foley, catheter (Gokula, Smolen, Gaspar, Hensley, Benninghoff, & Smith, 2012; Hanchett, 2012). Given the rising cost of treating CAUTI, the Centers for Medicare & Medicaid Services (CMS) identi- fied hospital-acquired CAUTI as one of eight conditions for which hospitals would no longer receive reimbursement as of October 1, 2008 (Milstein, 2009). Community hospitals, therefore, are charged with implementing innovative strategies that will reduce the inci- dence of hospital-acquired CAUTI.
A variety of strategies have been explored in nursing and other scientific literature for decreasing the incidence of CAUTI. Practical suggestions, such as stickers on pa – tients’ medical records or comput- er-generated reminders, along with implementation of evidence-bas – ed guidelines for Foley cathe ter maintenance, have been offer ed as potential solutions (Bruminhent, Keegan, Lakhani, Roberts & Passalacqua, 2010; Gokula et al., 2012; Wilson et al., 2009). The majority of literature, however,
has been focused on tertiary or academic medical centers and long-term care facilities
White Plains Hospital is a 301-bed non-academic communi- ty hospital in the suburbs of New York City that has implemented a nurse-driven process that reduced the incidence of CAUTI 50% within 1 year of implementation. The incidence of CAUTI contin- ues to decline to date with the goal of eventually having zero hospital- acquired CAUTI events. Further, with the decline in the incidence of CAUTI, costs decreased sub- stantially. White Plains Hospital’s nurse-driven, cost-effective pro – cess for reducing CAUTI is des – cribed. The ideas and steps taken to implement and sustain the process are outlined, along with suggestions for how nurse leaders in similar clinical settings can replicate the process.
Background In 2007, White Plains Hospital
experienced a transition in its sen- ior nursing leadership that reor- ganized the roles and responsibil- ities of the directors of nursing. The incoming chief nursing offi- cer launched the nursing division on its Magnet® journey and creat- ed an innovative role for the organization: the director of nurs- ing quality. This senior nursing
EXECUTIVE SUMMARY Due to treatment costs and lack of reimbursement, community hospitals are charged with imple- menting innovative strategies that will reduce the incidence of hos- pital-acquired catheter-associated urinary tract infections (CAUTI).
A nurse-driven system for decreasing the number of hospi- tal-acquired CAUTI is effective and useful for a community hos- pital.
One nurse with accountability for implementing a simple evidence- based protocol can dramatically decrease the total incidence of hospital-acquired CAUTI.
The basis for the success of this initiative relied heavily on the ease of using the eight-point Question the Foley criteria, the availability of the electronic med- ical record, interdisciplinary col- laboration, and support from nursing and physician administra- tion.
With collaboration and support from nursing leadership, the goals for patient safety by reduc- ing hospital-acquired CAUTI can become a reality in a short period of time.
Paul Quinn
Chasing Zero: A Nurse-Driven Process For Catheter-Associated Urinary Tract
Infection Reduction in a Community Hospital
PAUL QUINN, PhD, CNM, RN-BC, NEA- BC, CEN, CCRN, is Director of Nursing, White Plains Hospital, White Plains, NY.
321NURSING ECONOMIC$/November-December 2015/Vol. 33/No. 6
leadership role had direct respon- sibility for all nursing-sensitive indicators, performance improve- ment, nursing research, evidence- based practice, and dissemination of quality data within the nursing division. Specifically, the director of nursing quality was charged with identifying trends in health care that could affect the nursing division, performing gap analyses, and reporting the findings to the chief nursing officer so that action plans could be created and imple- mented.
The author, in the role of direc- tor of nursing quality, utilizing cod- ing data and a retrospective chart audit, found White Plains Hospital had an astonishing 110 incidences of CAUTI for the period of 2007 and the first two quarters of 2008. Current estimates for an organiza- tion to treat each incidence of hos- pital-ac quired CAUTI range from $1,200 to $2,400 (Palmer, Lee, Dutta-Linn, Wroe, & Hartmann, 2013; Rebmann & Greene, 2010). Since treating a hospital-acquired CAUTI was costly, with the poten- tial for those costs to increase over time, the chief nursing officer made reducing the incidence of CAUTI a key initiative in her strate- gic plan.
The Question the Foley pro – cess (see Figure 1), an evidence- based criteria that utilized existing resources within the organization, was implemented. Adopted from a best practice described in a long- term care setting in Illinois, the criteria provided a framework for nurses to use daily to assess the need for continuing a Foley cath – eter (Robinson et al., 2007). This successful initiative, however, relied on the usefulness of eight- point criteria, physician support, informatics collaboration, targeted education, daily monitoring, and dissemination of results through- out the organization (see Table 1).
Question the Foley To minimize the incidence of
hospital-acquired CAUTI, nurses needed a way to evaluate which
Figure 1. Question the Foley Criteria
Ask Daily if the Foley Catheter Is Being Used to:
1. Provide bladder irrigation and/or instill medication? 2. Provide relief from urinary tract obstruction not manageable by other means? 3. Permit urine drainage in a patient with neurogenic bladder dysfunction,
hydronephrosis, or urinary retention not manageable by other means? 4. Obtain accurate intake and output in critically ill patients? 5. Aid in urologic surgery or other surgery in the contiguous area (GYN or lower
GI surgery)? 6. Manage urinary issues or special purposes/circumstances such as a difficult
insertion per the urologist? 7. Manage urinary incontinence in patients with Stage III or Stage IV pressure
ulcers? 8. Provide comfort care in terminally ill or hospice patients?
If the patient meets NONE of the above criteria, the RN will contact the physician and discuss the possibility of catheter removal.
Table 1. Tactics for CAUTI Reduction
Tactic Comments
Question the Foley criteria
• Evidence based • Daily assessment for Foley catheter need; done on the day
shift only • Nurse pursues an order to discontinue Foley catheter if the
patient no longer meets the criteria
Physician support
• Support from the chief medical officer crucial • Physician champion helpful (e.g., chief of infectious diseases) • Physician assisted with review of medical records • Enforced process with fellow physicians
Informatics collaboration
• Designed nursing documentation in electronic medical record to include 8-point criteria
• Designed physician documentation and ordering to reflect the criteria
• Created customized reports for tracking and monitoring
Targeted education
• Created diverse education sessions for nurses and physicians • Varied hours and shifts • Case presentation, explanation of process and eight-point
criteria
Daily monitoring
• One RN responsible only • Track physician orders, insertions, use of criteria • Report outliers and statistics • Identify CAUTI from microbiology report • Identify all staff involved in the care of a patient with CAUTI;
letters sent to all involved
urinary catheters should be con- tinued and which ones were no longer being used for a specific purpose and should thus be dis- continued. A long-term care cen- ter in Illinois had tackled this issue and, through its work with
implementing an evidence-based practice, created criteria based on the literature that would provide nurses with situations to assess whether a Foley catheter should be continued (Robinson et al.,…
