Nursing 240 Paper Title

LEADERSHIP STRATEGY ANALYSIS

Nursing 440 Leadership Strategy Analysis

Samantha Fries, Heather Hulien, Kathryn Kaufman, Corrin Simon, Sara Staffen

FerrisStateUniversity

Leadership Strategy Analysis

This strategy analysis provides an opportunity to create an interdisciplinary team that is responsible for data collection and analysis of catheter associated urinary tract infections (CAUTI), developing a goal, and implementing a plan for quality improvement. According to the Centers for Disease Control (CDC) hospitals should implement effective quality improvement programs that promote proper use, insertion, and maintenance of urinary catheters and assess appropriateness and need for catheters often (2009).

Clinical Need for CAUTI Guidelines

Urinary tract infections (UTI) are caused by bacteria entering the urethra and traveling to the bladder. Urinary tract infections are the single most commonly acquired infection during a hospital stay, and account for more than 40 percent of infections reported by acute care facilities (American Association of Critical-Care Nurses [AACCN], 2011). Indwelling catheter associated urinary tract infections (CAUTI), account for the majority of nosocomial UTIs according to a review by Trautner (2011). Prevention is the top priority because an untreated CAUTI can lead to complications such as sepsis, cystitis, prostatitis, epididymitis, endocarditis, vertebral osteomyelitis, septic arthritis, andendophthalmitis. Complications associated with a CAUTI can also cause discomfort to the patient, prolonged hospital stays, increased healthcare costs, and higher rates of mortality (AACCN, 2011).

Interdisciplinary Team

The care and prevention of CAUTI can involve more than just the nurse. It may take a team of healthcare providers, also known as an interdisciplinary team. An interdisciplinary team will need to be knowledgeable on catheter bagging, tubing placement, securement, and proper hygiene. For patients who need indwelling catheters, the team may evaluate catheter insertion and educate patients and family members on proper care to prevent infection, risks associated with catheter use, and to be as independent as possible in managing bladder functioning. A team for CAUTI may involve: patient care technician, nurse, charge nurse or nurse manager, physician, social worker, infection control preventionist, the CEO of the hospital, and stockholders (Oman et al., 201, p. 549).

A patient care technician will need education on how to care for catheters. This will involve proper perineal care, sanitary emptying of the bag, and correct discontinuation of the catheter if permitted. He or she may also take vitals, such as temperature, to watch for any change due to the infection. A nurse will be required for insertion, care of, and the removal of the catheter in either clean or sterile techniques. He or she may also be involved in medication administration if a CAUTI does develop. An RN writes the plan of care for a patient, and this may need to involve interventions based upon treatment of a CAUTI. The nurse manager or charge nurse will need to organize educational meetings or seminars for the staff to attend pertaining to CAUTIs and care. He or she may also need to develop a new policy regarding the insertion of catheters and the care. A physician will be involved if a CAUTI develops by writing orders for medications, normally a type of antibiotic, which will treat the infection. He or she is will be the one to diagnose the patient with a CAUTI. Social workers may need to educate the patient on healthcare workers’ roles in their plan of care, help with facilitating decisions on behalf of the patient, promoting communication among healthcare workers, and arranging for resource or funds for the patient. An infection control preventionist islicensed in theprevention and careof infections. He or she is an expert in the prevention of infection, methods to stop the spread of infection, education, andresearch. The CEO and stockholder for the facility will deal with money and legal issues. If a patient receives an infection while in the hospital, the hospital may be responsible for the cost of treatment. This will lose money for the facility which affects stakeholders because the stock they hold for the company begins to lose its worth.

Establishing CAUTI Outcomes

Catheter use in hospitals is leading to urinary tract infections which cause longer hospital stays for patients and potential long term health complications. Catheter acquired urinary tract infections are the most common type of healthcare associated infections (Gould, C., 2009). In every hospital, outcomes must be established in order to prevent these costly infections.

The first outcome to decrease CAUTI’s includes limiting the amount of catheters being inserted in the hospital and decreasing duration of use. Indwelling catheters should only be inserted by nurses for appropriate purposes, and catheters should only be left in as long as needed (Healthcare Infection Control Practices Advisory Committee [HICPAC], 2009). Indwelling catheters for incontinence purposes should be avoided especially for high risk populations that include women and elderly. Use of catheters in operative patients should be used only as needed, instead of routine practices. If a catheter must be placed during surgery, removal within 24 hours will cut down on the risk of infection (HICPAC, 2009, p.10).

Nurses must be properly trained in inserting catheters using aseptic technique with sterile equipment (HICPAC, 2009, p.12). Hand hygiene should always be performed before and after catheterization. If sterile technique is broke, a new catheter kit will be obtained and the process restarted.After insertion, the catheter should be properly secured to prevent movement of tubing and reinsertion of bacteria (HICPAC, 2009, p.11). Technique should be evaluated once a year to determine if nurses are maintaining sterile catheter guidelines.

Aseptic technique must be used throughout urinary catheter maintenance. Following a closed drainage system during emptying will decrease chances of introducing bacteria into the catheter (HICPAC, 2009, p.13). The drainage bag must remain attached to the bed frame and be placed below the patient at all times. When emptying the bag, gloves will be used, and urine will be placed into a clean container.

Catheter associated urinary tract infections can be significantly reduced by decreasing the amount of catheters being placed and teaching nurses and doctors the appropriate situations when a catheter is indicated. If a catheter must be placed, it is crucial to use aseptic technique with sterile equipment and maintain this technique when maintaining catheter care. With these techniques, hospitals can decrease the number of CAUTI’s leading to costly infections, decreased long-term complications, and hospital stays.

Implementation

In order to effectively create a change, a process for implementing a change must be identified and utilized. The rate of catheter associated urinary tract infections is high, and making changes in nursing care is necessary for decreasing the problem. The most effective method for implementing the changes that will reduce CAUTI is the process of engaging staff members, educating the staff, executing the change, and evaluating intended and unintended consequences of the change (Saint, 2011). This process is likely to be successful because staff members will understand the reasons for making changes. According to Roger’s innovation-decision process theory, encouraging the use of an idea and providing information about its benefits and disadvantages promotes change (Yoder-Wise, 2014). Furthermore, a study reported by Scott et al. suggests that incorporating staff into the implementation of a change will lead to long-term acquisition of knowledge and longer-term results (2014).

The step of engaging others includes discussing the importance of the intervention. This will be done by giving hand-outs that address the issue of CAUTI to all the nurses. Education is completed when specific expectations of the intervention are discussed. Education will be provided for the staff nurses through mandatory training classes. Once the team is engaged and educated, the change must be executed by providing the necessary tools to carry out the intervention. After the change has been employed, evaluation of the new intervention is essential to determining if the change has been successful in decreasing the occurrence of CAUTI.

Evaluation

The purpose of evaluating change is to ensure that the problem is improving. One method used for measuring improvement in staff performances in preventing CAUTI is to calculate the percent of personnel who insert urinary catheters and who have proper training before, during, and after the changes are implemented (Centers for Disease Control and Prevention [CDC], 2009). One-hundred percent of personnel need to be trained after the change is implemented. If a staff member is not trained, he or she will be required to immediately complete the training courses. Staff performance can also be evaluated by conducting random audits. The audits can be used to calculate compliance rate of documentation of catheter insertion and removal dates, and documentation of indication for catheter placement. By the end of the implementation process, documentation is expected to be completed accurately in all of the charts that are reviewed.

The outcome of the interventions can be evaluated by calculating rates of CAUTI before, during, and after the implementation of the nursing interventions (CDC, 2009). According to the Centers for Disease Control and Prevention (2009), measurement of rates allows facilities to determine the longitudinal impact of implementation of prevention strategies. Assessing the improvements in staff members’ performances and changes in rates of CAUTI throughout the change process allows the leader to determine if corrections need to be made in the process of implementing change. According to Yoder-Wise (2014), the cybernetic theory proposes that, “negative feedback, or information indicating a correction must occur within the system, informs the change agent where problems exist” (p. 332). After being informed of the problems that continue to exist, additional changes can be made in order to continue decreasing the rate of CAUTI.

Conclusion

The occurrence ofurinary tract infections due to the use of indwelling catheters has become a problem in acute care facilities. In order to provide quality care and protect patients from CAUTI, changes in nursing care need to take place. This quality improvement initiative will help the nursing profession identify the issue, develop a team that will be involved in solving the problem, establish goals for improvement, implement change, and evaluate movement toward reducing CAUTI in hospitals.

References

American Association for Critical-Care Nurses. (2011). Catheter-Associated Urinary Tract Infections. Retrieved from

Centers for Disease Control and Prevention. (2009). Guideline for Prevention of Catheter-associated Urinary Tract Infections. Retrieved from

Gould, C. (2009). Catheter-associated urinary tract infection (CAUTI) toolkit. Center for Disease Control. Retrieved from

Healthcare Infection Control Practices Advisory Committee. (2009). Guidelines for prevention of catheter-associated urinary tract infections. Center for Disease Control. Retrieved from

Oman, S., Makic, M., Fink, R., Schraeder, N., Hulett, T., Keech, T. & Wald, H. (2011). Nurse-directed interventions to reduce catheter-associated urinary tract infections. American Journal of Infection Control, 40(6), 548-53. doi: 10.1016/j.ajic.2011.07.018

Saint, S. (2011). Implementing change: The technical & socio-adaptive aspects of preventing cauti. Informally published manuscript, VA Medical Center, university of Michigan, Ann Arbor, MI. Retrieved from

Scott, R. A., Oman, K. S., Flynn-Makin, M. B., Fink, R. M., Hulett, T. M., Braaten, J. S., Severyn, F., & Wald, H. L. (2014). Reducing indwelling urinary catheter use in the emergency department: A successful quality-improvement initiative. Journal of Emergeny Nursing, 40(3), 237-244. Retrieved from

Yoder-Wise, P. S. (2014). Leading and managing in nursing. (5th ed., pp. 330-332). St. Louis, MO: Elsevier Mosby

Trautner, B.W., (2001). Management of Catheter-Associated Urinary Tract Infection (CAUTI). National Institutes of Health, 23(1): 76–82.

Appendix A

Appendix B