Quality Improvement Process - Megan Moore



Quality Improvement ProcessJack Arnold, Megan Moore Haley VanWormer and Shannon VandenbergFerris State UniversityAbstractWhen patients are hospitalized, there are many protocols followed to decrease risk of further complications. Protocols are initiated to encourage high quality of care, related to best evidence-based practice. Anytime a catheter is place, the patient becomes a higher risk for a Catheter Acquired Urinary Tract Infection (CAUTI). The quality improvement process requires: identifying the clinical need, a professional team, data collection, establishing outcomes, implementation of strategies and an evaluation of the process.Quality Improvement ProcessIn health care, quality improvement is an ongoing process which every discipline undertakes. Patient satisfaction and safety are two major areas which drive the need for these improvements. This paper is going to follow the steps undertaken during a quality improvement process and what is involved in these steps. The steps which will be covered are as follows: identify a clinical need, assembly of an interdisciplinary team, design a data collection method, established outcomes, implementation and lastly evaluation. Catheter acquired urinary tract infections are the process which will be evaluated to determine if current standards of practice are still applicable to current evidence based research. Through this process, it can be assured the best possible outcomes for the patient are considered.Clinical NeedCatheter acquired urinary tract infections (CAUTI) account for approximately 75% of urinary tract infections acquired in the hospital (Centers for Disease Control and Prevention, 2015). Medicare and Medicaid have created a list instituting a non-payment policy for hospital acquired infections. CAUTIs are one of 8 such infections on the list (Peasah, McKay, Harman, Al-Amin, & Cook, 2013). According to Peasah et al., (2013), a study was conducted three years post implementation of the non-payment policy only to find the number of CAUTI’s had actually risen by 0.04% among admitted patients. While this may seem insignificant, it represents an increase of over fourteen-thousand additional cases per year (Centers for Disease Control and Prevention, 2015). Since reduction in this number has not occurred overall, it is more crucial now than ever for hospitals to ensure their policies regarding urinary catheter use are up to date. Depending on the size of the hospital, this could have a significant financial impact. The other consideration is the impact to the patient. An infection means a longer hospital stay, antibiotics, and other possible repercussions due to the infection. All of the above examples demonstrate a clinical need for urinary catheter use to be examined.Interdisciplinary TeamTo ensure comprehensive care, for patients with CAUTIs, there are many professionals involved in treatment; the team would include a physician, quality management professional, a nurse, pharmacist and a nurse technician. The physician, or team leader, diagnoses and observes the patient during treatment; in addition, he/she ensures orders for a urinalysis and medications. The quality management professional focuses on research related to decreasing CAUTIs; he/she would help educate professionals on new initiatives and hospital protocols. The quality management team member is then in charge of collecting data and changing practices based on the outcomes. The pharmacist will be involved to supply the proper antibiotics, if a CAUTI were to occur while following protocol, and clarify there are no allergies or medication interactions with current medications. The nurse provides proper hygiene, education on urinary tract infections, medication administration and monitoring for further infections or symptoms. The nurse is responsible for use of the tool created on newly admitted patients. The nurse technician will assist with personal care and bathing. Working as a team is vital for proper patient care; in this situation, the team addresses a hospital acquired infection. This team collectively creates new protocols to decrease risk for CAUTIs in hospitalized patients.Data Collection MethodFor data collection purposes the CDC’s official definition of CAUTI will be used, which states: A urinary tract infection (UTI) where an indwelling urinary catheter was in place for greater than two calendar days on the date of event, with day of device placement being day one, and an indwelling urinary catheter was in place on the date of event or the day before. If an indwelling urinary catheter was in place for greater than two calendar days and then removed, the date of event for the UTI must be the day of discontinuation or the next day for the UTI to be catheter-associated. ("CDC device-associated module," 2015, p. 7-2)A chart was developed (see appendix A) to count the number of urinary tract infections reported within the hospital which meet the defined criteria stated by the CDC. Any patient with a urinary catheter will be included to monitor how the new protocol is affecting patient outcomes. The chart will also include if catheter placement met the criteria stated in the policy, how many days the catheter was in place and the patient’s medical record number for further chart auditing. When a CAUTI is confirmed, the nurse assigned to the patient is to report the lab results along with previously stated patient information to the nurse manager of the unit who will in turn report the information to the quality improvement team. From there, the team will continue to analyze the effectiveness of the policy, as well as areas of improvement. Establish OutcomesAfter identifying a need for improvement in the CAUTI process, several goals were recognized that reflect the evidence-based practice for the protocol. The primary outcome of this quality improvement process is to reduce the incidence of CAUTIs hospital-wide. This will be achieved through evidence-based education and awareness of the clinical practice protocol change. To enhance the improvement, other goals were identified to successfully implement and measure the expected outcome. The goals established included increased education of the staff. This will be achieved through mandatory attendance educational meetings. Achieve compliance with the protocol. This will be measured through auditing of charts of all patients with urinary catheters. Lastly, decreased financial burden associated with CAUTIs. This will be measured by reviewing of financial reimbursement from Medicaid and Medicare and other insurance carriers. These goals are a standard of care that improves the safety, efficiency, and effectiveness of quality patient care.Implementation StrategiesIn an effort to decrease the rates of CAUTI’s within the healthcare facility a new policy centered on CAUTI prevention will be implemented. It will begin with implantation in the intensive care units, as they are among the highest rates of CAUTIs (Elpern, Killeen, Ketchem, Wiley, Patel, & Lateef, 2009). The policy will include an easy to follow flow chart to assist the staff in determining if an indwelling urinary catheter is appropriate for a patient. The flowchart is based on current evidence based practice. According to the Centers for Disease Control and Prevention (2009) the appropriate indications for use of an indwelling urinary catheter are:if the patient has acute urinary retention or bladder outlet obstruction, accurate urinary output measurement in critically ill patients, perioperative use for selected surgical procedures such as urologic surgery or organs of the urologic system, long surgeries, patients who are to receive large amounts of fluids or diuretics during surgery, and a need for intraoperative monitoring of urinary output, also to help with healing open wounds such as sacral or perineal in incontinent patients, to help with comfort for the terminally ill, and for patients requiring a long period of immobilization such as spine or pelvic injury. (table 2) The policy will also include a standard of work flow sheet describing the role of nurses, nurse aids, as well as the physicians when a patient has an indwelling catheter. Current practice states proper catheter care should be done at a minimum of once a shift (twice daily), however, current evidence based practice suggests this has no significant effect of bacteria introduction into the urinary tract. The Center for Disease Prevention (2015) states: “Unless clinical indications exist (e.g., in patients with bacteremia upon catheter removal post urologic surgery), do not use systemic antimicrobials routinely to prevent CAUTI in patients requiring either short or long-term catheterization”. The CDC feels there is not enough evidence to support the use of antibacterial cleansing of indwelling catheters, simple cleansing of the perineal and meatus is sufficient. Due to this, a change in evidence based practice is in order. The work flow sheet will not include routine catheter care. Rather, the policy will state the need to keep catheter clean and free of obvious soiling and cleansing of the perineal area with every bath. Along with implementation of the new policy, there will be frequent education opportunities for nursing staff. Mandatory attendance of one of the educational meetings is expected one week before the protocol's go-live date. Also included during education will be the current CAUTI incident rates of the facility, the goal of the new policy, and who to contact with any concerns or questions. Fliers will be distributed including information on alternatives to placing indwelling urinary catheters, proper routine catheter care, and the nurse’s ability to use a questioning attitude to determine whether an indwelling catheter is appropriate for a patient, and when they should be removed. Once a week, an updated educational flier will be distributed throughout the unit which consists of comparative statistics of the CAUTI incidence from the previous week.EvaluationThe evidence-based evaluation of the quality improvement process requires initial assessments, monitoring, analyzing, and educating. There will be education and training opportunities throughout the process to gain an insight on the initial protocol that will be necessary to initiate the change. Monitoring the process reinforces the implementation because compliance will determine the expected outcome. After the implementation of this new policy the occurrences of CAUTIs in the facility will be evaluated weekly. The CAUTI prevention committee will have meetings once a month to discuss how the policy has affected the nursing staff as well as the patient population. The improved CAUTI protocol policy will be implemented throughout the entire facility after six months of consistent positive feedback and compliance of the protocol from nursing staff. Once the expected outcome of reduced CAUTIs hospital-wide is established, the initiation of the protocol can be determine.ConclusionThe purpose of the Quality Improvement process is to determine an area of care that can be improved. An area in need of improvement is CAUTI’s. “Catheter acquired urinary tract infection is one of the most common health care acquired infections” (Nicolle, 2014, para. 2). Once data is collected, goals and outcomes are created to help decrease risk. Strategies are then created to meet the goals/outcomes; the overall process is then evaluated to determine the effectiveness of the plan. The process will be further critiqued to ensure best quality of care for patients.ReferencesCenters for Disease Control and Prevention. (2015). , E. H., Killeen, K., Ketchem, A., Wiley, A., Patel, G., & Lateef, O. (2009, November). Reducing use of Indwelling Urinary Catheters and Associated Urinary Tract Infections. American Journal of Critical Care, 18(6), 535-541. for Prevention of Catheter-associated Urinary Tract Infections, 2009. (2009). Retrieved March 18, 2015, from , L. E. (2014, July 25). Catheter associated urinary tract infections. Antimicrobial Resistance & Infection Control, 3(23). , S. K., McKay, N. L., Harman, J. S., Al-Amin, M., & Cook, R. L. (2013). Medicare Non-Payment of Hospital-Aquired Infections: Infection Rates Three Years Post Implementation. Medicare & Medicaid Research Review, 3(3). Retrieved from tract infection (catheter-associated urinary tract infection [CAUTI] and non-catheter-associated urinary tract infection [UTI] and other urinary system infection [USI]) events. (2015). Retrieved April 9, 2015, from criteria met?date of placementDid patient develop UTIchart audited# of days indwelling1 2 3 4 5 6 7 8 9 10 11 12 13 14 151 2 3 4 5 6 7 8 9 10 11 12 13 14 151 2 3 4 5 6 7 8 9 10 11 12 13 14 151 2 3 4 5 6 7 8 9 10 11 12 13 14 151 2 3 4 5 6 7 8 9 10 11 12 13 14 151 2 3 4 5 6 7 8 9 10 11 12 13 14 151 2 3 4 5 6 7 8 9 10 11 12 13 14 151 2 3 4 5 6 7 8 9 10 11 12 13 14 151 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Appendix A ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download