Nursing care and management on CAUTIs Paper INSTRUCTION:
Find an article that emphasize on Nursing care and management on CAUTIs.
Article Link: https://www.americannursetoday.com/targeting-zero-cautis/
Summarize the article
Use APA guidelines
No more than five pages; NOT including cover page and reference page
USE ARTICLES ONLY FROM NURSING JOURNALS, NO OLDER THAN FIVE YEARS
PROVIDE “URL” for article on reference page.
Article types should emphasize NURSING CARE AND MANAGEMENT!
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Appropriate topic-type of article
Able to summarize article into own perspective (cite paper/references appropriately using APA format when noting sources)
Quality; content shows mastery of articles emphasis
Clarity; able to follow train of thought Targeting zero CAUTIs
November 2018 Vol. 13 No. 11
Author(s): Lee Knill, BSN, RN, MEd, CMSRN; Ralitsa Maduro, PhD; Juanita E. Payne,
Empower nurses and proactively reduce
urinary catheter device use
A nurse driven quality improvement project improved catheter utilization rates in
A urinary catheter insertion decision tree provided alternatives to indwelling
The decision tree allowed nurses the autonomy to operate to the top of their
scope of practice.
CATHETER-associated urinary tract infections (CAUTIs) remain one of the most
common causes of healthcare-associated infections, despite extensive evidence-based
efforts to improve patient safety. (See CAUTI costs.)
To address CAUTIs at Sentara Healthcare, an initiative was implemented to standardize
appropriate indications for temporary urinary catheter insertions using the electronic
health record. The indications for temporary insertions were based on guidelines from
the Centers for Disease Control and Prevention’s Healthcare Infection Control Practices
Advisory Committee and the Association for Professionals in Infection Control and
Around the same time, Sentara Obici Hospital conducted a quality improvement (QI)
project to reviewCAUTIs by insertion indication, explore alternatives to placing a
catheter for that indication, and develop a plan for standardizing care.
Developing a plan
As part of the systemwide initiative, all providers were required to choose from a
standardized list of appropriate indications when they ordered a temporary urinary
catheter. This practice allowed the auditors, who were also members of theQI project
task force, including nursing leadership (the chief nursing officer and unit managers and
bedside nurses), to easily identify the original reason the catheter was inserted.
As the QI task force examined CAUTIs by indication, we discovered that most of the
patients who developed infections had the catheter placed for urinary retention or strict
intake and output. Our team questioned whether any alternatives to inserting an in
dwelling urinary catheter were available for these indications. Literature, including th e
American Nurses Association’s (ANA’s) Streamlined Evidence-Based RN Tool:
Catheter Associated Urinary Tract Infection (CAUTI) Prevention, recommends some
alternatives by indication. The ANA tool (download at tinyurl.com/y8rz6j85) focuses on
broad practice strategies to reduce CAUTIs (fewer catheters used, timely removal, and
insertion maintenance and post removal care), and many of these strategies had
already been implemented with great success in our facility. In our effort to proactively
reduce CAUTIs, we decided to build on the ANA tool and focus on using fewer
We started our effort by polling bedside nurses and staff urologists for ideas about how
we could reduce catheter insertions. After many alternatives were discussed and
refined, we developed a urinary catheter insertion decision tree in the form of an
algorithm to provide clinicians with alternatives to placing a catheter based on th e
indication. (See Urinary catheter insertion decision tree.) We presented this algorithm to
our medical staff executive team, which approved the protocol, giving bedside nurses
the autonomy to use these alternatives instead of inserting an in dwelling uri nary
catheter even if a provider ordered one.
Encouraging nurse autonomy
Using the algorithm, nurses are encouraged to provide care at the top of their scope of
practice, working through the decision tree for alternatives to the specified indication.
For instance, if the patient has a catheter order for urinary retention, the nurse assesses
for urinary retention (presence of bladder distention, evaluation of the patient’s intake
and output, signs of urine leakage), uses a noninvasive bladder scanner to determine
the current urine volume in the bladder, and then makes the best clinical decision for the
patient about the necessity for the catheter.
Training and implementing
In January and February 2015, Sentara Obici educators trained staff nurses, which
included one-on-one hands-on training and a “frequently asked questions” tip sheet with
different scenarios to guide nurses in their critical thinking. The algorithm went live in
March 2015. During daily rounding and huddles, nursing leadership focused on catheter
insertion critical thinking and early removal of necessary catheters.
By using the algorithm and evidence-based practices for catheter maintenance, the
hospital had no CAUTI events from September 2015 to January 2017. To empirical ly
evaluate the efficacy of the algorithm, the research committee, which included the
authors and a bedside nurse, obtained institutional review board approval for a
The data were divided into pre-implementation (March 1, 2013 to June 30, 2014) and
post-implementation (March 1, 2015 to June 30, 2016), excluding July 1, 2014 through
February 28, 2015 to create equivalent cohorts, accounting for seasonal and monthly
differences and the education period for the clinical staff. Use of urinary catheters and
CAUTIs decreased after implementation of the algorithm. (See Outcomes.)
Planning for the future
Implementing the algorithm, using noninvasive methods (condom catheters, bedside
commodes with measurable collection hats, urinals, and bedpans) for accurate urine
intake and output measurements, and avoiding in dwelling catheters unless medically
necessary, Sentara Obici has reduced the incidence of CAUTIs. Allowing nurses the
autonomy to operate to the top of their scope of practice and use their critical-thinking
skills at the bedside has improved patient safety and outcomes. After the success of this
QI project, the Sentara Healthcare System rolled out the urinary catheter insertion
decision tree system wide in an effort to reduce CAUTI rates in all of its facilities.
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