NURS FPX 4030 Assessment 3 PICOT Questions and an Evidence-Based Approach PS

NURS FPX 4030 Assessment 3 PICOT Questions and an Evidence-Based Approach PS

NURS FPX 4030 Assessment 3 PICOT Questions and an Evidence-Based Approach PS

PICO(T) Questions and an Evidence-Based Approach

Description of Practice Issue

In health care hospitals acquired infections represent nursing practice issues, which reduces quality of care and safety of the patients (Atkins et al., 2020). The purpose of the report is to identify a practice issue, evaluate the issue through PICO(T) approach, identify the relevant sources, and extract and analyze the evidence to find the relevance of evidence in addressing the issue.

One of the most important and effective infection is the catheter-associated urinary tract infection (CAUTI) as NHSN or National Health Care Safety Network reported that 75% cases of Urinary tract infections (UTIs) were CAUTI (Wanat et al., 2020). Reports from CDC highlighted that 15% to 25% patients receive different types of catheters and results in a mortality count of 13,000 cases every year (CDC, 2021). Further, the condition increases health care to $2400 from $1200 (Taha et al., 2017). Knowledge, attitude, interventions, competencies, practice methods, and skills of nurses and health care professionals (HCPs) play a critical role in preventing the CAUTI (Ruth & Gerti, 2021). It is critical to address the practice issues and challenges faced by nurses in effectively practicing. 

Description of Practice Issue Explored Via PICO(T) Approach

The PICO(T) approach is a research framework that helps in evaluating practice and research problem by identifying the population, which is affected by the practice problem, research and analyze an intervention, compare the intervention with other interventions or methods, and define the expected outcome along with expected time needed to conduct the research and obtain the outcome (Christenbery, 2017). 

Use of the PICO(T) Approach to Prevent CAUTI

NURS FPX 4030 Assessment 3 PICOT Questions and an Evidence-Based Approach PS

The approach of PICO(T) includes Population (P), Interventions (I), Comparison (C), Outcome (O), and Time (T). In health care, settings such as ICU and acute health care are more prone to CAUTI where adults who stay in health care for long-term need catheters and contract CAUTI. The group is the population (P). There are different interventions, which are used to treat and prevent CAUTI (Gauron & Bigand, 2020). Some of the interventions are nurse-driven protocol to manage catheter to prevent CAUTI, improving nursing CAUTI knowledge to prevent CAUTI, Lean Six Sigma quality improvement model for CAUTI prevention (Behrend, 2020), bundle treatment (Latief et al., 2020), a tiered approach for preventing CAUTI, and implementing multifaceted approach to prevent CAUTI (Gauron & Bigand, 2020). The approaches are interventions (I) and comparing their effectiveness is comparison (C). The time needed to train and implement the intervention and post intervention period makes period (T), which is more than six weeks. 

Identification of Sources of Evidence

Lean Six Sigma Quality Improvement Model with Multifaceted Approach

Patrone et al. (2020) conducted a systematic review with meta-analysis of different prospective studies to find effectiveness of lean sigma model to prevent infections and found that the model was effective in reducing infections. Lean Six Sigma (LSS) model, which included recognize, define, measure, analyze, improve, control, standardize, and integrate steps to find treatment plan and prevention protocols to address CAUTI issues. In this method, nurses, physicians, administrators, and pharmacists collaborated to implement policies, which included educating and training nurses, use of patient-centered catheter instead of standardized version, and bundling to improve practice (Behrend, 2020). 

A Multifaceted Approach to CAUTI Reduction

Allen et al. (2019) used the LSS model DMAIC (Define, Measure, Analyze, Improve and Control) approach where multifaceted approach model as a quality improvement (QI) model to increase skills of nurses and update CAUTI protocols to both prevent and treat the condition. The approach was beneficial in preventing hospital acquired infection (Kuwaiti & Subbarayalu, 2017). 

Nurse-driven Protocol to Manage Catheter to Prevent CAUTI

NURS FPX 4030 Assessment 3 PICOT Questions and an Evidence-Based Approach PS

Tyson et al. (2018) implemented nurse-driven protocol to implement catheter removal protocol to reduce CAUTI in surgical units. In this model, the nurses were specially trained to manage and remove catheters along with prevention bundles to increase quality of care and catheter handling to prevent infection secretion by periodically replacing them and handling the catheter effectively (Tyson et al., 2018). Johnson et al. (2016) also highlighted that pre and post implementation of protocol included utilization of the smaller bore catheters, catheter discontinuation, addition of the silver-based cleansing product for catheter care, and the education of staff. The protocol helped in reducing CAUTI. The same protocol was used for indwelling catheters by implementing communication to implement IUC removal protocol (DePuccio et al., 2020).

Tiered approach for preventing CAUTI

Meddings et al. (2019) conducted a randomized control trial by including nurses, infection prevention specialists, and physicians where tiered approach with three stages were used to avoiding catheter placement if possible, use of aseptic catheter insertion, maintaining awareness, use of proper care, and catheter use, and improve technical skills and clinical skills. The process used a multidisciplinary approach in the process to maintain and perform periodic reassessments to prevent CAUTI (Pepe et al., 2019). The process also included prompt removal of catheters, which were not needed and urine culture stewardship. Further, needs assessment, optimizing catheter use, real-time catheter observation, and root-cause analysis were used for the prevention and management (Patel et al., 2019). 

Findings from the Articles

Study by Behrend (2020) highlighted that after a 15-week period, the infection rate reduced significantly and reduced hospital stay and health care cost. Allen et al. (2019) concluded that the LSS approach with multifaceted intervention reduced CAUTI SIR and SUR values from 5.6 and 1.39 to 1.52 and 1.05 respectively. The intervention highlighted that Infection Preventionists increased quality care by collaborating with nurses and physicians (Allen et al., 2019). 

The results from study by Tyson et al. (2018) highlighted that nurse-driven protocol increased skill levels and knowledge of nurses, which resulted in decrease of catheter utilization from 0.78 to 0.70, which indicates that training and educating nurses to handle the catheter effectively is beneficial. Further, the bundle treatment coupled with nurse-driven protocol reduced CAUTI infections to 2.0 from 5.1 infections per every 1000 catheter days (Tyson et al., 2018). Johnson et al. (2016) showed that the intervention released CAUTI by 28% and increased professional practice. It is necessary to prevent CAUTI by using clinical indicators to improve patient safety (DePuccio et al., 2020).

Meddings et al. (2019) concluded in the study that tier approach was effective in increasing collaboration, increasing patient safety, knowledge, use of patient-centered catheters, removal of catheters in time, and increasing hygiene to prevent CAUTI and decrease CAUTI days and rates. The intervention reduced CAUTI standardized infection ratio (SIR), standardized utilization ratio (SUR), and device utilization ratio (DUR) to 1.08, 1.0, and 22% respectively (Pepe et al., 2019). 

Relevance of Findings from Articles

NURS FPX 4030 Assessment 3 PICOT Questions and an Evidence-Based Approach PS

Findings from Behrend (2020) and Patrone et al. (2020) are important to the CAUTI prevention PICOT approach because the studies highlight the need to define the problem, analyze it, find the solution, implement it, and then evaluate the outcome. Further, it is relevant as it highlights that CAUTI secretion is due to many reasons and as a result, a multifaceted approach needs to be considered to prevent and manage the catheter and infection. Evidence from studies by Allen et al. (2019) and Kuwaiti & Subbarayalu (2017) is critical for the PICOT as both the studies highlight the need for bundle treatment along with QI program to not only address the issue, but also increase quality practice. 

DePuccio et al. (2020), Johnson et al. (2016) and Tyson et al. (2018) all highlighted that nurse-driven protocol along with bundle treatment was beneficial as nurses felt that the program increased their knowledge to use catheters better, remove unwanted catheters in time, avoid initial catheter use based on patients and cases, and maintain and manage the catheter by implementing hygiene-based CAUTI interventions. Tiered approach used by Meddings et al. (2019), Pepe et al. (2019), and Patel et al. (2019) is relevant as PICOT approach for CAUTI includes population who are hospitalized for long term. This indicates a need for a multifaceted and tier-based approach where different interventions will be used to manage the patient and catheter use periodically based on the patient’s condition and expected outcome. 

Conclusion

  CAUTI is a high-priority practice issue, which has different intervention and treatment processes. By using the PICOT approach, it is possible to analyze problems and find evidence to improve practice by adopting EBP. Based on the current evidence, a multifactored prevention and CAUTI management plan should be adopted. The approach includes bundle treatment, tier process, nurse-driven program, and multifaceted LSS to fully prevent and manage CAUTI. 

References

Allen, B., Culbertson, J., Eyherabide, S., & Geca, M. (2019). A multifaceted approach to CAUTI reduction. American Journal Of Infection Control47(6), S40. https://doi.org/10.1016/j.ajic.2019.04.094

Atkins, L., Sallis, A., Chadborn, T., Shaw, K., Schneider, A., & Hopkins, S. et al. (2020). Reducing catheter-associated urinary tract infections: a systematic review of barriers and facilitators and strategic behavioural analysis of interventions. Implementation Science15(1). https://doi.org/10.1186/s13012-020-01001-2

Behrend, L. (2020). Revisiting CAUTI Prevention: a multifaceted approach using lean six sigma. SOAR@USA: Scholarship And Open Access Repository, 1-64. https://doi.org/10.46409/sr.ogph7615

CDC. (2021). Catheter-associated urinary tract infections (CAUTI) | HAI | CDC. Cdc.gov. Retrieved 20 May 2021, from https://www.cdc.gov/hai/ca_uti/uti.html.

Christenbery, T. (2017). Evidence-based practice in nursing (1st ed.).

DePuccio, M., Gaughan, A., Sova, L., MacEwan, S., Walker, D., & Gregory, M. et al. (2020). An examination of the barriers to and facilitators of implementing nurse-driven protocols to remove indwelling urinary catheters in acute care hospitals. The Joint Commission Journal On Quality And Patient Safety46(12), 691-698. https://doi.org/10.1016/j.jcjq.2020.08.015

Gauron, G., & Bigand, T. (2020). Implementation of evidence-based strategies to reduce catheter-associated urinary tract infections among hospitalized, post-surgical adults. American Journal Of Infection Control. https://doi.org/10.1016/j.ajic.2020.11.016

Johnson, P., Gilman, A., Lintner, A., & Buckner, E. (2016). Nurse-driven catheter-associated urinary tract infection reduction process and protocol. Critical Care Nursing Quarterly39(4), 352-362. https://doi.org/10.1097/cnq.0000000000000129

Kuwaiti, A., & Subbarayalu, A. (2017). Reducing hospital-acquired infection rate using the Six Sigma DMAIC approach. Saudi Journal Of Medicine And Medical Sciences5(3), 260. https://doi.org/10.4103/sjmms.sjmms_98_16

Latief, N., Kurniawati, N., & Pratiwi, I. (2020). Nurses’ compliance with the catheter associated urinary tract infection prevention bundle. International Journal Of Psychosocial Rehabilitation24(7). Retrieved 24 May 2021, from.

NURS FPX 4030 Assessment 3 PICOT Questions and an Evidence-Based Approach PS

McClusky, J. (2020). Small patients and tiny CAUTI rates: sustained CAUTI reduction in a children’s hospital. American Journal Of Infection Control48(8), S13. https://doi.org/10.1016/j.ajic.2020.06.171

Meddings, J., Manojlovich, M., Fowler, K., Ameling, J., Greene, L., & Collier, S. et al. (2019). A tiered approach for preventing catheter-associated urinary tract infection. Annals Of Internal Medicine171(7_Supplement), S30. https://doi.org/10.7326/m18-3471

Patel, P., Olmsted, R., Hung, L., Popovich, K., Meddings, J., & Jones, K. et al. (2019). A tiered approach for preventing central line‚Äďassociated bloodstream infection. Annals Of Internal Medicine171(7_Supplement), S16. https://doi.org/10.7326/m18-3469

Patrone, C., Cristina, M., Spagnolo, A., Schinca, E., Ottria, G., & Dupont, C. et al. (2020). Can lean reduce infections? A systematic review and meta-analysis of prospective studies. https://doi.org/10.21203/rs.3.rs-30832/v1

Pepe, D., Maloney, M., Leung, V., Harizaj, A., Banach, D., & Dembry, L. et al. (2019). 1162. An evaluation of metrics for catheter-associated urinary tract infections (CAUTIs): A Statewide Comparison. Open Forum Infectious Diseases6(Supplement_2), S415-S416. https://doi.org/10.1093/ofid/ofz360.1025

Ruth, A., & Gerti, H. (2021). Preventing CAUTI: improving nursing CAUTI knowledge and use of CAUTI prevention strategies. School Of Nursing (RBHS) DNP Projects. https://doi.org/10.7282/t3-3srs-dj72

Tyson, A., Campbell, E., Spangler, L., Ross, S., Reinke, C., Passaretti, C., & Sing, R. (2018). Implementation of a nurse-driven protocol for catheter removal to decrease catheter-associated urinary tract infection rate in a surgical trauma ICU. Journal Of Intensive Care Medicine35(8), 738-744. https://doi.org/10.1177/0885066618781304

Wanat, M., Borek, A., Atkins, L., Sallis, A., Ashiru-Oredope, D., & Beech, E. et al. (2020). Optimising Interventions for Catheter-Associated Urinary Tract Infections (CAUTI) in primary, secondary and care home settings. Antibiotics9(7), 419. https://doi.org/10.3390/antibiotics9070419

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