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Week 6 Assignment: EBP Change Process form
ACE Star Model of Knowledge Transformation
Follow Nurse Daniel as your process mentor in the weekly Illustration section of the lesson.
Name: __________Lishan Brown___________
Star Point 1: Discovery (Identify topic and practice issue)
Identify the topic and the nursing practice issue related to this topic. (This MUST involve a nursing practice issue.)
The topic is hospital acquired infections. The nursing practice issue is catheter associated urinary tract infections and the high incidence on an acute rehabilitation unit.
Briefly describe your rationale for your topic selection. Include the scope of the issue/problem.
The nursing practice issue I would like to investigate is healthcare associated infections (HAI),
particularly catheter associated urinary tract infection (CAUTI). CAUTI is very important to
investigate because I believe HAI’s can be decreased, if not prevented. Being that nurses are
educated on the possible causes or symptoms of HAI’s, we can be more proactive in our
treatment plans. If a patient falls, that can be an unpredictable event but HAI’s are more so
predictable. With CAUTI, making sure that the perineal area is cleaned on a regular, consistent
basis is important. Providing proper interventions to not keep an indwelling catheter in longer
than necessary is also important.
Urinary tract infections are one of the most common hospital acquired infections. At least 80%
of urinary tract infections an be attributed to an indwelling urinary catheter. There are
approximately 13,000 annual deaths associated with catheter associated urinary tract infections
(CAUTI). CAUTIs can lengthen hospital stays, increase morbidity and mortality, and raise
healthcare costs.
Star Point 2: Summary (Evidence to support need for a change)
Describe the practice problem in your own words and formulate your PICOT question.
The practice problem is members of the healthcare team are not properly cleaning the perineal area of patients who have indwelling catheters and indwelling catheters are placed for unnecessary longer periods of time. PICOT question- In (P) patients with an indwelling catheter on an acute rehabilitation unit, does (I) cleansing the perineal area every eight-hour period compared to (C) routine daily cleansing of the perineal area (O) decrease the catheter associated urinary tract infection with patients over a (T) six month period?
List the systematic review chosen from the Cochrane Database of Systematic Reviews from the Chamberlain library. Type the complete APA reference for the systematic review selected.
Interventions to improve professional adherence to guidelines for prevention of device‐related infections.
Reference
Flodgren G, Conterno LO, Mayhew A, Omar O, Pereira CR, Shepperd S. Interventions to improve professional adherence to guidelines for prevention of device‐related infections. Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD006559. DOI: 10.1002/14651858.CD006559.pub2.
List and briefly describe other sources used for data and information. List any other optional scholarly source used as a supplement to the systematic review in APA format.
In my search for evidence, I found an article about nurse-driven CAUTI prevention. This evidence is relevant to my PICOT because I would like to find a way to decrease or eliminate the instances of CAUTI in a hospital setting. The article gives a history of prevalence of CAUTI then goes into costs related to CAUTI. The article also mentions ways of preventing CAUTI. The article also discusses an algorithm used to decrease the prevalence of CAUTI.
I also found an article about the causes of CAUTI and how to properly clean the perineal area as an educational tool.
Reference
Russell, J. A., Leming-Lee, T. ‘Susie,’ & Watters, R. (2019). Implementation of a Nurse-Driven CAUTI Prevention Algorithm. Nursing Clinics of North America , 54 (1), 81–96. https://doiorg.chamberlainuniversity.idm.oclc.org/10.1016/j.cnur.2018.11.
Memorial Sloan Kettering Cancer Center (2018). Caring for Your Urinary (Foley®) Catheter. Retrieved from https://www.mskcc.org/cancer-care/patient-education/caring-your-urinary-foley-catheter
(CAUTI) National Patient Safety Goal for Hospitals. Retrieved from https://www.jointcommission.org/assets/1/6/R3_Cauti_HAP.pdf
List your stakeholders (by title and not names; include yourself) and describe their roles and responsibilities in the change process (no more than 5).
Nurse Leader- the person leading the trial, responsible for ensuring the success of the project and day to day intricacies of the project.
Nurse Manager- Person overseeing the trial to ensure the nurse leader and provide assistance as necessary.
Unit Nurses- team members who are assisting in carrying out the change process and day to day bedside care with patients with indwelling catheters. Patient- consents to a clinical trial and helping to identify symptoms of CAUTI.
What specifically is your nursing role in the change process? Other nursing roles?
My nursing role in the change process is to be at the forefront of change process. As the nurse leader, I would want to ensure that all supplies, education, proper documentation is in place throughout the trial to ensure effectiveness. Unit nurses are responsible the placement of an indwelling catheter, the daily care management, and the removal of the indwelling catheter. Nurses are also responsible for specimen collection. Nurses are also the main person to diagnose a patient who is suspected of CAUTI.
List your stakeholders by position titles (charge nurse, pharmacist, etc.).-Why are the members chosen (stakeholders) important to your project?
MD- Doctor of Medicine
DO- Doctor of Osteopathic Medicine
Nurse Educator
RN- Registered Nurse/ Unit Nurse
CNA- Certified Nursing Assistant
Nurse Manager
These members are important to the project because they are all a part of the team who is essentially caring for a patient with an indwelling urinary catheter. They are important in making necessary changes to decrease the incidents of catheter associated urinary tract infection. It all begins with proper education right down to actually caring for the patient who has an indwelling catheter. The MD/DO are responsible for ordering the indwelling catheter for the patient. Unit nurses and CNA’s are important in
the day to day care of the indwelling catheter. The nurse manager is important in making sure policies are followed for the change process and provide additional assistance if necessary.
What type of cost analysis will be needed prior to a trial? Who needs to be involved with this?
The type of cost analysis which would be needed prior to a trial would be a cost effectiveness analysis. A cost effectiveness analysis is a method of analyzing the cost and health outcome of an intervention. The finance department would need to be involved in this portion of the change process. This is necessary to see how much funds can be allocated to the project for additional resources. It is also important to know the initial cost to the hospital for CAUTI’s compared to after the completion of the trial to see if there was an improvement. Having the quality control department involved ensures policy and procedures are being followed as well.
Reference
Jamison DT, Breman JG, Measham AR, et al., editors. Priorities in Health. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2006. Chapter 3, Cost- Effectiveness Analysis. Available from: https://www.ncbi.nlm.nih.gov/books/NBK10253/
List the measurable outcomes based on the PICOT. How will these be measured?
The measurable outcomes based on the PICOT would be the number of CAUTI incidents over a sixmonth
period. This can be measured by the incident reports for CAUTI, the necessary medications needed to
treat CAUTI and also the number of indwelling catheterizations utilized on the unit.
What forms, if any, might be used for recording purposes during the pilot change process. Describe.
Forms that may be used for recording purposes would be documentation of education and refresher for
staff members. Consent forms from patients detailing the intention of the trial would be important.
Staff would be required to document each time perineal care was given or any catheter care to the
patient. Staff would also be given a self-assessment on their readiness and understanding of catheter
care in order to effectively care for the population of patients with indwelling catheters.
What resources are available to staff (include yourself) during the change pilot?
Resources that would be available to staff during the pilot would be extra catheter care supplies, such as
Foley catheter bags, tubing, stat locks, perineal soap, etc. Educational resources for staff and patients on
recognizing CAUTI, ways of preventing CAUTI and general care for an indwelling catheter.
Will there be meetings of certain stakeholders throughout the trial? If so, who and when will they
meet?
Meetings throughout the trial will be held with stakeholders on the progress of the trial and if any
necessary changes need to be made. Meetings will be held weekly during the first month and twice per
month for the remainder of the trial. All stakeholders would be invited to the meetings to get a progress
of is happening during the trial. Opinions can be shared on what could be effective or changes that can
be made to make the trial a success.
Star Point 5: (Evaluation)
How will you report the outcomes of the trial?
Reporting of the outcomes will be posted throughout the staff rooms on the unit in the form of a data
report. A meeting at the end of the trial will also be held to discuss how effective the trial was or wasn’t.
The data from the report can then be given to management to consider further implementation or
recommendations.
What would be the next steps for the use of the change process information?
Using the information from the trial, ongoing changes can continue to be made regarding CAUTI using
the takeaway from the trial. After seeing what worked and what didn’t, staff can adapt what was
successful and build on that information and make progress in decreasing the incidents of CAUTI on the
unit.
