Effectiveness Of A Bundled Approach To Reduce Urinary Catheters And Infection Rates In Trauma Patients

Research Critiques and PICOT Question Guidelines – Final Draft

The use of catheters on critically ill patients is common practice today as it reduces the need for frequent movements to and from the lavatory. While the catheter has a multitude of advantages especially in helping alleviate the health of patients, their use sometimes leads to urinary tract infections commonly referred to as catheter associated urinary tract infection (CAUTI). This health acquired infection is a nursing practice problem that has triggered a handful of researches aimed at finding a solution. The purpose of this paper is to form a PICOT question aimed at addressed the identified nursing practice problem. In critically ill patients at risk of catheter-associated urinary tract infections (CAUTI) in an acute care setting (P), does applying a nurse-driven bladder bundle (I) reduce the occurrence of CAUTI (O) compared to patients given the usual care (C) within a timeframe of 3 months (T) Effectiveness Of A Bundled Approach To Reduce Urinary Catheters And Infection Rates In Trauma Patients.

ORDER A PLAGIARISM FREE PAPER NOW

Background of Studies

Ravi and Joshi (2018) conducted a qualitative study seeking to determine the effectiveness of CAUTI care bundles on at-risk patients. The two researchers determined that success of care bundle would be if its individual elements had positive outcomes on patients. A second qualitative study by Mody et al. (2017) examined the extensive application of the care bundle intervention. The focus of the study was on 48 different states across the United States. A quantitative study conducted by Davies et al. (2018) aimed at determining the effectiveness of the bundled approach to reducing catheter-associated UTIs. Their research was motivated by the need to find a solution to the problem and also by the fact that since 2015, fines are imposed on providers when their patients acquire health-related illnesses such as CAUTI. Research by Witwer et al. (2019) focused on CAUTI best practices for neurovascular/cardiovascular/intensive care unit patients. The researchers proposed that healthcare providers need to conduct frequent audits on the use of catheters and the application of bundle methods. Based on audits conducted between 1st March and October 3oth 2018, Witwer et al. (2019) made the preliminary conclusion that when the bundle methods are appropriately done, the incidences of CAUTI reduce marginally.

How These Articles Support the Nursing Practice Problem

Broadly, the studies conducted offer support for nursing practice based on the fact that they have suggested approaches that can be used to help alleviate the identified problem CAUTI. The researchers acknowledge that CAUTI is a prevalent health care acquired illness and interventions are required (Witwer et al., 2019). The focus of the fours studies is the bundle intervention which addresses key issues of timely extraction of the catheter, standardization of use, cleanliness and maintenance of the devices placement minimizations (Ravi & Joshi, 2018). Research studies analyzed point out the importance of effectively applying the suggested bundle intervention otherwise they will fail to address the identified nursing problem of CAUTI. Since the use of catheters is mostly on critically ill patients, the suggested methods go a long way in improving their plight in terms of health outcomes. Davies et al. (2018) have emphasized that the incorporation of the bundle approach helps both the patients and health care institution – reputation in the latter’s case. The suggestions offered in these four articles compare closely with the picot question on two bases. One, the picot intervention suggested is the use of nurse-driven bundle of care similar to the studies and the fact that the use of this method could help improve the health prospects of the at-risk critically ill patients Effectiveness Of A Bundled Approach To Reduce Urinary Catheters And Infection Rates In Trauma Patients.

Method of Studies

The method of study used by Davies et al. (2018) is retrospective review to evaluate trauma patents. With the bundle intervention appropriately used the urinary catheterization process and culturing practices leading to reduction in type one errors. The benefit of a retrospective study is watching and interviewing patients and burses was not necessary. This made it less time consuming. The limitation of this method is that it is hard to quantify the statistical figures and results. Witwer et al. (2019) on the other hand engaged with a Joint Commission to trace the incidence of CAUTI for each of weekly patients’ audits done three times per week. The selected patients were the ones that had catheters left in their bladder. The joint commission also involved the patients being observed by listening to their views in terms of the impacts that the catheters were having on the, and also the ways that nurses were handling them and these were compared with the standards set. The Poisson regression model used in this study has the benefit of being reliable in finding solutions of the standard issues identified. The drawback of this method is that the data fails to match the Poisson distribution in settings where a significant number of patients are not hospitalized. The Ravi and Joshi (2018) study method was observational. In their study, they focused on the outcomes of interventions met after eight months and then engaged in a 21-month intervention. The two separate outcomes were then compared. The researchers focused on a single health facility that had 410 beds and served an average of 5,000 patients annually. The benefit of using observational study is that the researcher is able to see firsthand how the catheters are handled by the nursing team. The drawback of this method is that it is difficulot to control the variables being studied because the researcher takes a hands-off approach to see how things work. Lastly, an inductive method was used for the Mody et al. (2017) study. Ideally, patients were organized in different focus groups and studied separately and results later used for comparisons.

Results of Studies

In the Ravi and Joshi (2018) study, it was determined that the prevalence of CAUTIs dropped significantly when the preventative procedures were combined into a single plan. Mody et al. (2017) found a decline in CAUTI by 54% within a year of intervention. In addition, 75% of the facilities that adopted the bundle approach had over 40% decline in CAUTI. Davies et al. (2018) found that the urine culturing technique led to a reduction in the need for catheter insertion and, on overall, a decline of CAUTI by 37%. The Witwer et al. (2019) study found that there is a strong association between adhering to the entire bundle care as recommended and CAUTI rates. Adherence led to a decline in CAUTI rate. In the overall, the application of the suggested measures by the four studies would help hospitals manage CAUTI rate.

Ethical Considerations

The researchers of the four different studies were guided by ethical standards and codes of practice. Key among these are impartiality, transparency and accountability, beneficence and honesty. Participants were issued with written informed consent to make them aware of the scope of the research and what its intended use of the findings were. Beneficence concept were applied by ensuring the participants directly benefited in one way or the other and were also protected from hazards in the course of the research Effectiveness Of A Bundled Approach To Reduce Urinary Catheters And Infection Rates In Trauma Patients.

Outcomes Comparison

Guided by the analyzed research studies addressing the issue of CAUTI, the expected outcomes of the current study are that the proposed intervention using the bundles method will yield positive outcomes. This is in the sense that CAUTI rates will decline when nurses in healthcare facilities apply the proposed measures. What’s more, adoption by hospitals across the country will lead to improved health outcomes especially in regard to healthcare acquired illnesses. The current research question and the four from the qualitative and quantitative research studies will likely have similar outcomes because they are generally related questions researched using different methods of study.

Proposed Evidence-Based Practice Change

Nursing practice is evidence based and when faced with challenges such as a problem that needs being resolved, organizing it using the PICOT mnemonic helps address individual components relevant to ensuring all key issues are addressed. The picot question developed at the start of this essay outlined the individual problem, CAUTI, the proposed intervention which is the use of bundled care, expected outcomes which in this case was improved health outcomes for critically ill patients using catheters and timeline within which the results were expected is three months. Drawing from the findings of this research, an evidence based practice that could help address the identified nursing practice problem is adoption of the bundled care by nurses.

Conclusion

In a few words, the catheter associated urinary tract infection (CAUTI) can be reduced if the evidence based practice of bundled care is applied. Four research articles analyzed highlight the importance of applying the individual components of bundled intervention to help reduce the healthcare acquired infection of CAUTI. The challenge for healthcare providers and in particular nurses is to develop standards of practice while using catheters on patents. Based on the findings of the analyzed articles, if catheters are handled more professionally in terms of timely extraction, maintenance of consistent standards and maintaining cleanliness while using them, the incidences of CAUTI would reduce materially.

References

Davies, P. E., Daley, M. J., Hecht, J., Hobbs, A., Burger, C., Watkins, L., Murray, T., Shea, K., Ali, S., Brown, L. H., Coopwood, T. B., & Brown, C. V. (2018). Effectiveness of a bundled approach to reduce urinary catheters and infection rates in trauma patients. American Journal of Infection Control, 46(7), 758-763. https://doi.org/10.1016/j.ajic.2017.11.032

Mody, L., Greene, M. T., Meddings, J., Krein, S. L., McNamara, S. E., Trautner, B. W., Ratz, D., Stone, N. D., Min, L., Schweon, S. J., Rolle, A. J., Olmsted, R. N., Burwen, D. R., Battles, J., Edson, B., & Saint, S. (2017). A national implementation project to prevent catheter-associated urinary tract infection in nursing home residents. JAMA Internal Medicine, 177(8), 1154. https://doi.org/10.1001/jamainternmed.2017.1689

Ravi, P., & Joshi, M. (2018). Role of “Bladder care bundle” and “Infection control nurse” in reducing catheter-associated urinary tract infection in a peripheral hospital. Journal of Marine Medical Society, 20(2), 116. https://doi.org/10.4103/jmms.jmms_8_18

Witwer, M., Dobbins, G., Uher, C., & McFarren, M.D. (2019). Auditing CAUTI best practices bundle adherence in a 24-bed neurovascular/cardiovascular/intensive care unit. American Journal of Infection Control, 47(6), S30. Doi:https://doi.org/10.1016/j.ajic.2019.04.062.

Research Critiques and PICOT Question Guidelines –

Final Draft

Qualitative and Quantitative Studies

Introduction

Introduce your nursing practice problem and discuss the purpose of your paper.
State your updated PICOT question incorporating any feedback that you received from your instructor.

Background of Studies

Summary of studies including problem, significance to nursing, purpose, objective, and research questions.

How Do These Four Articles Support the Nursing Practice Problem You Chose?

Discuss how the four articles will be used to answer your PICOT question.
Describe how the interventions and comparison groups in the articles compare to those identified in your PICOT question.

Method of Studies:

State the methods of the four articles you are comparing and describe how they are different.
State one benefit and one limitation of each method you have identified.

Results of Studies:

Summarize the key findings of each of the studies into a comprehensive summary.
What are the implications of the four studies you chose in nursing practice?

Ethical Considerations

Discuss two ethical considerations in conducting research.
Describe how the researchers in the four articles you choose took these ethical considerations into account while performing their research Effectiveness Of A Bundled Approach To Reduce Urinary Catheters And Infection Rates In Trauma Patients.

Outcomes Comparison

What are the anticipated outcomes for your PICOT question?
How do the outcomes of the four articles you chose compare to your anticipated outcomes?

Proposed Evidence-Based Practice Change

What is the link between the PICOT question, the research articles, and the nursing practice problem you identified?
Based on this information, propose an evidence-based practice change for your identified setting.

Conclusion

Your conclusion should summarize the main points in the essay, including a varied restatement of the thesis.

PLACE YOUR ORDER HERE

Quantitative Research Critique and Ethical Considerations

People who are hospitalized often suffer from urinary tract infections (UTIs), and one of the most prevalent causes of these infections is the use of catheters. If the catheter is allowed to remain in place for an extended period, the risk of infections is significantly increased. CAUTIs are linked to undesirable outcomes such as damage to the kidneys, which may occur because of persistent or recurrent infections (Fauziah et al., 2018). The goal of this paper is to provide an analysis and critique of two quantitative publications that relate to my PICOT question: In critically ill patients at risk of catheter-associated urinary tract infections (CAUTI) in an acute care setting (P), does applying a nurse-driven bladder bundle (I) reduce the occurrence of CAUTI (O) compared to patients given the usual care (C) within a timeframe of 3 months (T)?

Background of the Studies

In the article “Effectiveness of a bundled approach to reduce urinary catheters and infection rates in trauma patients,” by Davies et al. (2018), their research is based on the fact that CAUTIs (catheter-associated urinary tract infections) are a prevalent hospital-acquired infection in healthcare institutions. When it comes to CAUTI rates, the Centers for Medicare and Medicaid Services (CMS) started levying monetary sanctions in 2015. These fines are imposed on institutions whose CAUTI rates are greater than projected. The surveillance criteria for CAUTI, on the other hand, is not a medical diagnosis and might instead indicate bacteriuria without symptoms (Davies et al., 2018). The research question used in this study is: Is there a correlation between the use of bundled interventions and a decrease in the incidence of urinary catheterization and CAUTI?

In the other article “Auditing CAUTI best practices bundle adherence in a 24-bed neurovascular/cardiovascular/intensive care unit,” the authors Witwer et al. (2019) base their research on the increasing reports of CAUTIs in the United States. According to the authors, prior research has demonstrated the importance of tracking and documenting auditing catheter care strategies. The researchers performed audits of CAUTI bundle adherence between March 1st and October 30th, 2018 and examined the link between bundle adherence and the prevalence of CAUTI to minimize CAUTI prevalence in the Cardiovascular, Neurovascular, and Intensive Care Unit (ICU). The goal of the study was to answer the question, “Does auditing of CAUTI bundle compliance lower CAUTI rates?”

Support for the Nursing Practice Problem

These publications examine the effectiveness of the bundle approach in preventing and controlling CAUTIs in acute care facilities. In this sense, they provide reinforcement to the nursing practice problem of CAUTI in patients who are critically ill. The study by Davies et al. (2018) addresses how the incorporation of a CAUTI prevention bundle may enhance both safety of patients and the overall efficiency of healthcare organizations. On the other hand, Witwer et al. (2019) study presents evidence on why complying with a CAUTI bundle is the ideal approach to CAUTI prevention and treatment.

Method of Studies

Davies et al. (2018) used a retrospective review to evaluate trauma patients. The bundled intervention enhanced the urinary catheterization process and culturing practices to decrease type one errors. The CAUTI rate was described as number of CAUTI’s divided by number of catheter days multiplied by 1,000 days. The notable benefit of a retrospective review, which was used in this investigation, is that it does not need watching and interviewing the subjects of the research. As a result, the gathering of data requires less effort, both in terms of time and money. However, the use of this research method presents a major limitation, in that it is not possible to quantify some essential statistics, and the choice of controls might be subject to considerable biases Effectiveness Of A Bundled Approach To Reduce Urinary Catheters And Infection Rates In Trauma Patients.

In Witwer et al. (2019), the CAUTI tracing instrument by the Joint Commission was used for each of the weekly three patient audits that were performed on patients who had catheters left in the bladders. On-the-spot verbal feedback was provided to personnel on the unit floor. Weekly reports on compliance were sent to the administration of the institution. To assess whether or not there was a link between the different components of the CAUTI tracing tool and the CAUTI rates, a Poisson regression analysis was carried out using SAS version 9.4 as the software platform. The main benefit of using the Poisson regression model is that it is able to solve a few of the issues that are present in the standard model. Because of this, it is an excellent choice for a distribution in which the value that is most usual or the mean is somewhat near 0. The most significant drawback associated with it is the fact that data do not match a Poisson distribution very well in settings in which a significant number of patients are never hospitalized.

Results

The findings that were presented by Davies et al. (2018) included the fact that the adoption of a bundled intervention emphasized the most appropriate method for catheter insertion as well as the most suitable patients to undergo the procedure. The standardization of urine culturing techniques contributed to a combinatorial reduction in catheter insertion that resulted in a 37% decrease in the CAUTI rate. There was no statistically significant difference in the CAUTI rate, but the findings still have clinical value. For instance, the post-CAUTI rate among trauma ICU patients in 2013 was 1.08, which was lower than the NHSN target of 2.7 for a large medical and surgical teaching ICU. This contributed to an improvement in the general performance of the institution.

According to the findings of the research carried out by Witwer et al. (2019), the link between adhering to the whole bundle of care and CAUTI rates was shown to be very close to being significant. During this time frame, there was a rise in the number of CAUTI cases in the ICU, but the audit compliance did not change. The researchers concluded that the prevention of CAUTI in facilities should place a greater emphasis on initial education on appropriate procedures than it does on regular maintenance audits.

Ethical Considerations

Several ethical considerations were taken into consideration by the researchers when conducting the investigations. The researchers demonstrated a commitment to a number of guiding concepts, including beneficence, respect, impartiality, honesty, and transparency. In both of these investigations, the researchers first obtained the participants’ informed consent before beginning their work. They operated in a manner that was congruent with the principle of beneficence by ensuring that the participants in the research gained something from it and were shielded from any hazards that could have been involved.

Conclusion

The prevention of CAUTI is a continuous problem that calls for measures to be taken from a wide variety of viewpoints. They consist of the proper criteria for use, the accurate maintenance practices, the timely termination of usage, and the adoption of a new concept of urine culturing. The process of establishing consistent criteria for the elimination of urine culture works in tandem with the optimization of the practical components of catheter insertion. It’s possible that a multi-pronged solution will be effective in lowering CAUTI rates in critically ill patients.

References

Fauziah, W., Rochana, N., & Juniarto, A. Z. (2018). The effect of catheter associated urinary tract infection (CAUTI) bundle of care: A systematic review. Proceedings of the 1st International Conference of Indonesian National Nurses Association. https://doi.org/10.5220/0008205901230131

PICOT Question

Revise the PICOT question you wrote in the Topic 1 assignment using the feedback you received from your instructor.
The final PICOT question will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).

Research Critiques

In the Topic 2 and Topic 3 assignments, you completed qualitative, quantitative, and mixed methods research critiques on two articles for each type of study (four articles total). Use the feedback you received from your instructor on these assignments to finalize the critical analysis of each study by making appropriate revisions.

The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT question.

Use the “Research Critiques and PICOT Question Guidelines – Final Draft” document to organize your essay. Questions under each heading should be addressed as a narrative in the structure of a formal paper. Please note that there are two new additional sections: Outcomes Comparison and Proposed Evidence-Based Practice Change.

General Requirements

You are required to cite a minimum of three peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance Effectiveness Of A Bundled Approach To Reduce Urinary Catheters And Infection Rates In Trauma Patients.