NRS 493 Topic 6 DQ 2
DQ Briefly describe your proposed solution to address the problem, issue, suggestion, initiative, or educational need and how it has changed since you first envisioned it
My initial capstone topic started out as CAUTI (Catheter Associated Urinary Tract Infection) associated with foley utilization rates. Although there are several evidence-based practices that have been shown to reduce CAUTI including reducing the use of urinary catheters, incorporating interventions to help avoid the use of urinary catheters when they are not indicated including nurse-driven protocols for the removal of urinary catheters as soon as no longer required (Centers for Disease Control and Prevention, 2019).
The issue I am focusing on for the Capstone Project is an unmet educational need specific to prenatal/postpartum women and newborns. The educational need is in regard to a specific audit tool used when hospitals and/or clinics are working toward the Baby Friendly Hospital Initiative (BFHI). The Ten Steps to Successful Breastfeeding are the broad framework that guide the Baby-Friendly Hospital Initiative. In a recent audit, the scores identified that there were not enough mothers who could list 4-5 benefits of breastfeeding for both mothers and babies. The topic and intervention will target mothers during the prenatal and postpartum period and education will be done at the OB/GYN clinic with their provider. The overall goal is to council and educate mothers of all ages and gravidas on the benefits of breastfeeding to both mom and baby and have them verbalize 4 benefits during an audit.
This is quite different than the current focus of my change proposal. I decided to shift to a more narrowed focus that is a direct reflection of a current need at the rehabilitation hospital. One influential moment for the change came when I was asked by a staff nurse, “Do I really have to change the foley out before I get a specimen?” I thought that she was just joking, considering her experience and longevity with the company. Either way I assumed that she would know the proper procedure to collect from a catheterized patient. After going over the policy of urine specimen collection in catheterized patients, it dawned on me that perhaps she actually didn’t know, which may result in improper collection and false positive readings. After discussing this situation with my preceptor, she shared with me that that hospital just got their second CAUTI of the year, due to urine cultures being ordered without proper clinical indication. After considering these factors, my focus shifted to urine culture collection and how they can increase CAUTI rates.
My capstone change proposal project involves the initiation of a Urine culture stewardship initiative focused on addressing the issue of
increased rates in CUATI associated with improper testing of urine cultures for reason that do not indicate the need for culture testing, as well as addresses the significance of proper specimen collection practices and in reducing the overtreatment with antibiotics and other associated treatment costs. Specific studies have shown that urine culture stewardship initiatives aimed at reducing UC overutilization and were correlated with a decrease in CAUTIs, and the addition of urine-culture stewardship to standard best practices could reduce CAUTI in various care settings (Al-Bizri, Vahia, Rizvi, Bardossy, Robinson, et al., 2021).
Reference
Al-Bizri, L., Vahia, A., Rizvi, K., Bardossy, A., Robinson, P., Shelters, R., Alangaden, G. (2021). Effect of a urine culture stewardship initiative on urine culture utilization and catheter-associated urinary tract infections in intensive care units. Infection Control & Hospital Epidemiology, 1-4. doi:10.1017/ice.2021.273
CDC (Centers for Disease Control and Prevention). (2019). Survey Practices and Outcomes. Urine Culture Stewardship. HAI. https://www.cdc.gov/hai/prevent/cauti/indwelling/survey.html
Thank you for sharing your project with the class. In addition to what you elaborated on the interventions that are mostly carried out by health professionals to prevent CAUTI are external catheters such as condom catheters for male patients and pure wick for females. These external catheters are used in my unit a lot on patients on incontinent patients with impaired movement and also on patients who are on diuretics and on strict intake and output.
Thank you for responding to my post. The alternatives to foley catheters are many, but I agree are greatly under utilized. Evidence-based alternatives to indwelling catheterization include intermittent catheterization, bedside bladder ultrasound, external condom catheters, and suprapubic catheters. In addition, adherence to general infection control principles is important (eg, hand hygiene, surveillance and feedback, aseptic insertion, proper maintenance, education). Other CAUTI prevention strategies include aseptic insertion, catheter maintenance, antimicrobial UCs, and bladder bundle implementation (Meddings, Rogers, Krein, Fakih, Olmsted, & Saint, 2014).
Reference
Meddings, J., Rogers, M. A. M., Krein, S. L., Fakih, M. G., Olmsted, R. N., & Saint, S. (2014). Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review. BMJ Qual. Saf., 23(4), 277–289. doi: 10.1136/bmjqs-2012-001774
I am interested in the topic you are working on because we had the same issues about collecting urine specimens from indwelling catheters in the hospital where I work. Before, we were doing urine cultures on all patients admitted with an indwelling catheter even when they did not have any symptoms. But by doing that, all CAUTIs were recorded against the hospital. So, we do not do that anymore. We only collect urine cultures when patients present with symptoms of UTI. According to CHI Health, collecting urine specimens from an indwelling catheter follows the following steps; Using a 70% alcohol swab, clean the catheter collecting port. Puncture the collecting port with a needle linked to a syringe using sterile procedures. Take a syringe and a sterile container and aspirate the urine. Using urine from a collection bag is not recommended.
CHI Health. (2020). https://www.chihealth.com/content/dam/chi-health/website/documents/lab/collection-and-transport/collection/urine-collection-instructions.pdf
When considering the intervention I had selected, feedback from my preceptor and fellow classmates, the major gap that I identified was that in order to gain the best results for my population, simply educating them on the perils of smoking and coping strategies may not be sufficient in empowering them to change. This is because for smokers, the addiction to nicotine makes them dependent on smoking and thus, it becomes vital to sever this dependence as this will most likely lead to more lasting outcomes (Zwar, 2020). Based on my research, it has also been established that education sessions should only last between two to three sessions in order to get positive outcomes and unfortunately, that may not be enough of an intervention to inhibit smoking in the patient population. It is important to look for sufficient supplemental interventions that will ultimately augment the impact of education. Based on these findings, my proposed solution is to integrate Nicotine replacement therapy alongside an educational intervention program in order to improve the efficiency of the intervention.
Nicotine replacement therapy is a medically improved intervention addressing people with tobacco use disorder. This intervention seeks to treat people with nicotine dependence to take nicotine through other means other than tobacco. Nicotine replacement therapy has been used to inhibit smoking through several means other than smoking or chewing tobacco. According to Devi et al. (2020). Nicotine replacement therapy increases the chances of quitting tobacco by 55%.
My initial intention entailed trying to reduce the prevalence of smoking through an educational intervention that will empower the patients to understand the perils of smoking and thus, willingly deviate from their smoking habits. However, I would be remiss not to appreciate that the population has most likely been exposed or even experienced the perils of smoking and the fact that they have still carried on with smoking (Hartmann-Boyce et al., 2018). My current perspective was brought about by the realization that in this project, merely deploying and educational intervention would not be enough and thus, it would suffice to add an additional and more effective intervention, one that is evidence based.
Therefore in a bid to improve the efficacy of this solution, my project will involve the adoption of nicotine replacement therapy, alongside educational interventions that will enable the smokers to set off on their smoking withdrawal journey.
There are some challenges that I expect with deploying this solution and this is that some patients may not be appreciative of a nicotine replacement therapy and this is mainly because this therapy has not been widely accepted and it is likely to lead to opposition. In order to address this, one strategy that I intend to use is to design an educational session that will empower the patient in order to ensure that they are well apprised of the invention and its ramifications on their smoking.
References
Devi, R. E., Barman, D., Sinha, S., Hazarika, S. J., & Das, S. (2020). Nicotine replacement therapy: A friend or foe. Journal of family medicine and primary care, 9(6), 2615–2620. https://doi.org/10.4103/jfmpc.jfmpc_313_20
Hartmann-Boyce, J., Chepkin, S. C., Ye, W., Bullen, C., & Lancaster, T. (2018). Nicotine replacement therapy versus control for smoking cessation. The Cochrane database of systematic reviews, 5(5), CD000146. https://doi.org/10.1002/14651858.CD000146.pub5
Zwar N. A. (2020). Smoking cessation. Australian journal of general practice, 49(8), 474–481. https://doi.org/10.31128/AJGP-03-20-5287