Introduction
This presentation is dedicated to a quality improvement project that targets catheter-associated urinary tract infections or CAUTIs. In particular, the presentation will summarize the key evidence that has been assembled so far over the past few weeks. Eight articles that contain information on the topics of CAUTIs, quality improvement, and change will be discussed in detail with attention paid to the methodology and applicability of findings. Furthermore, the articles will be compared and contrasted to make relevant conclusions about their value for the project. Other information that will be considered will provide the context for the project, describing its topic, questions, significance, and next steps.
Topic Area: CAUTI
As follows from the term, CAUTIs are the types of urinary tract infections that are associated with catheters, which means that they are hospital-acquired. Consequently, their prevention is crucial for the improvement of care quality, as well as patient safety: after all, infections can have significant negative outcomes. The discussed project is focused on a setting and population that are particularly CAUTI-prone; specifically, it will consider the prevention of CAUTI in patients with indwelling or suprapubic Foley catheters who are older than 65 and receive long-term care. Furthermore, the long-term care setting was chosen as the place of the researcher’s practice, and the age of the participants was limited to younger than 89 to avoid recruiting particularly vulnerable individuals.
Topic Area: Quality Improvement
The project is supposed to be a quality improvement (QI) effort, which is why the secondary topic area for this presentation is QI. QI can be described as the efforts that aim to support or advance the quality of care and patient safety or outcomes, as well as address problems that are identified for a particular setting. QI is supposed to be evidence-based as well, which is why the described project qualifies: it intends to prevent CAUTIs, which is an important quality and safety problem, with the help of chlorhexidine wipes, which are a tested solution to the issue (Blanck et al., 2014).
Question
To provide a better understanding of the project, its PICOT can be offered. As can be seen from the question, the described QI project will be a quasi-experiment focusing on older patients with catheters that will follow the participants for six weeks to determine if the application of chlorhexidine washcloths can prevent CAUTIs. Based on this information, the evidence to frame the project included peer-reviewed articles dedicated to the topics of CAUTI and QI.
Significance: CAUTI
A justification of the stated problems and questions can be provided as well. When discussing CAUTIs, it is necessary to affirm that they are extremely typical to the point of being the most commonly encountered hospital-acquired infection (Blanck et al., 2014, p. 101). This fact can be connected to the evidence which suggests that up to 16% of people who experience hospitalization may require a catheter at one point or another (Menschner, 2017). In the end, the number of CAUTIs in the US amounts to around 560,000 per year, and the most important aspect of this number is that almost 70% of such cases are estimated to be preventable (Blanck et al., 2014, p. 101). It is similarly crucial that CAUTIs do not just reduce the quality of life in patients but can become life-threatening; 100,000 deaths per year are associated with CAUTIs (Clarke et al., 2013). The fact that the issue is also costly can be viewed as some additional motivation to address this significant care quality problem.
Significance: Quality Improvement
The second topic area is also worth investigating. Indeed, QI is a necessary prerequisite for the ongoing support and advancement of patient safety and outcomes, as well as their satisfaction and care quality and organization. Depending on the situation, QI might also be unavoidable, and although the described project does not qualify as an example, it is not uncommon for care settings to have to adjust to new interventions or equipment. As a result, the fact that QI is subject to multiple barriers and difficulties needs to be taken into account (Tappen et al., 2017). Research indicates that QI can be difficult to carry out, which is why the investigation of the process, related facilitators, and potential difficulties is significant.
Overview of Clinical Practicum
The investigation of evidence pertaining to the two topics can be viewed as an aspect of the clinical practicum, which incorporates the described project. Indeed, the practicum involves preceptor-guided research activities, which are currently concerned with finalizing the project proposal and searching for evidence that supports it. In addition, the clinical practice incorporated in the practicum also contributes to the project’s development, especially from the perspective of choosing the setting and gaining hands-on experience related to catheters and CAUTI. This presentation will offer an overview of the evidence that can be used to provide an introduction to the project and the problem discussed.
Analysis of Evidence
Article 1
The first topic to consider is CAUTI, especially its prevention, and five of the discussed articles are dedicated to it. The first of them by Blanck et al. (2014) used a quasi-experiment, in which a CAUTI prevention bundle that incorporated chlorhexidine wipes was implemented in a 20-bed critical care unit and tested for three months. The study used a pre-post design with CAUTI rates as the targeted outcome; the pre-intervention data were gathered using a retrospective chart review. The pre-and post-intervention CAUTI rates for equivalent periods of time and similar numbers of patients (317 and 310) were compared using the Wilcoxon signed ranks test, and the findings did not prove to be statistically relevant. However, the CAUTI rates still dropped by 50%. This article, which has a limited timeframe, can be used as an example of a pre-post design, which is going to be employed in the described project, and as a study that yields important information on the topic of CAUTI and the methods that are typically used to prevent it.
Article 2
The article by Clarke et al. (2013) also employed a prevention bundle with four elements. None of them included chlorhexidine, which is why the application of this article to the specific project question is limited, but it still offers important information about CAUTI prevention and a helpful example of testing an intervention with the help of a pre-post data collection approach. Using Poisson regression analysis, the authors checked the effectiveness of the bundle in over 2220 patients from a community hospital. The results showed that seven months after the project’s intervention, the CAUTI rate reduction was statistically significant. The authors also estimated the annual cost of the bundle, which makes the article especially helpful for practitioners who want to implement it. This paper studied a CAUTI prevention bundle for a greater period of time and with a bigger sample than the previous one, which makes its results more reliable, and it presents an effective intervention.
Article 3
Meddings et al. (2014) offer a different type of research; they carried out a systematic review and meta-analysis, which focused on either experiments or quasi-experiments with pre-post design. Their area of interest consisted of preventing unnecessary catheterization; they looked for studies that tested the effectiveness of reminders and stop orders. Eleven articles contained some data on CAUTI rates, which allowed Meddings et al. (2014) to determine that CAUTI rates could indeed be reduced through reminders and stop orders. Furthermore, stop orders were proven as an effective solution to unnecessary catheterization. However, no statistically significant impact of reminders on this parameter was found. The article contains important information about CAUTIs and their prevention and offers a detailed plan on how to assess the quality of studies and evidence produced by them.
Article 4
Menschner (2017) used the pre-and post-intervention design to test the effectiveness of a QI project that consisted of the implementation of a checklist for nurse rounds aimed at reducing the number of unnecessary catheters. The project only lasted for six weeks; the number of patients amounted to 163, and only two cases of CAUTI were found. The results did not show a statistically significant reduction in CAUTIs following the intervention’s implementation. Still, the article can be viewed as a helpful example of a QI project that also supplies data on CAUTI and their prevention.
Article 5
Finally, the article by Welden (2013) also reports a QI project, which used a pre-and post-test research design. The pre-intervention data were gathered through a retrospective chart review, which involved looking over 42 charts. One-way ANOVA was used to check the complex EHR-supported QI effort that aimed to improve CAUTI preventative practices and adherence to them in several nursing units. The results showed statistical significance; the intervention successfully enhanced the site’s CAUTI-related practices. This article is another example of QI, which employs the pre-and post-test design. As a result, its focus on CAUTI prevention is very valuable for the proposed project.
Comparison
It makes sense to compare the CAUTI articles now and draw some conclusions for them. All the studies discuss CAUTI, especially the significance of this problem, and consider some of the relevant solutions. The articles represent different methodologies, including a literature review, even though many of them are pre-and post-intervention studies. Also, they report mixed results with some of them failing to demonstrate the effectiveness of their interventions. However, since the interventions differ, and all studies have limitations that may have affected their results, this aspect of their differences does not suggest significant evidence discrepancies. All the articles demonstrate a meticulously developed and described methodology, but they also have limited generalizability because of their samples and specific settings.
Implications and Use
From the perspective of the described project, the articles’ coverage of CAUTI and populations with CAUTI is important, but since there is not much evidence on chlorhexidine wipes, the applicability of this information is limited. However, the articles contain examples of QI projects and pre-and post-test design, which are going to provide relevant guidance for the planned project that is going to employ a similar methodology.
Article 6
The second topic was investigated through three articles. Negussie and Demissie (2013) studied nursing leadership styles to determine their impact on job satisfaction. Having reviewed the responses to established questionnaires from 175 nurses, the authors used regression analysis to determine correlations between the two variables and found that various aspects of transformational leadership had positive effects on satisfaction. The same was true for certain elements of transactional leadership as well, but laissez-faire methods were shown to be ineffective.
Article 7
Sfantou et al. (2017) also investigated leadership styles, but they focused on the effects that could be found on care quality outcomes. They used the systematic literature review approach and managed to locate 18 quantitative articles. However, none of them incorporated a comparison group, and they described different countries and settings. Still, the review allows suggesting that many leadership styles can have positive outcomes, but the laissez-faire approach is not one of them.
Article 8
Tappen et al. (2017) presented a qualitative investigation of QI projects with a focus on barriers and facilitators. Tappen et al. (2017) used a large QI effort that involved several hundreds of nursing homes and studied them for 12 months. Seventy-one of them submitted reports on the process of change, which allowed the authors to conclude that issues like the lack of resources or change resistance could be barriers, oversight and engagement could be facilitators, and leadership could be both. This article demonstrates the significance of the two studies that precede it since it indicates that leadership is crucial for QI. In general, it is an important source to consider for a nurse busy with a QI project.
Comparison
These three articles are diverse in their methods, but they are similar in their focus on nursing change, QI, and leadership. There are no inconsistencies in the findings; in fact, the articles support the idea that particular types of leadership might not be helpful. Just like the previous set of materials, these studies have well-developed and sufficiently-described methodologies, but their limitations make their findings not very generalizable.
Implications and Use
Still, the articles are of use in that they demonstrate the importance of leadership for QI and offer some guidance on the barriers and facilitators that can be present during one. In addition, their use for the investigation of different methodologies can be worthwhile.
Next Steps
To summarize, the presented articles offer multiple opportunities for investigating the two topics of interest, as well as different approaches to research design. The incorporation of this information and related lessons into the project preparation process can make it more informed. The next steps, therefore, would involve the use of this new information to proceed with the finalization of the proposal and the application of the skills acquired and developed during the activity.
References
Blanck, A., Donahue, M., Brentlinger, L., Stinger, K., & Polito, C. (2014). A quasi-experimental study to test a prevention bundle for catheter-associated urinary tract infections. Journal of Hospital Administration, 3(4), 101-108.
Clarke, K., Tong, D., Pan, Y., Easley, K. A., Norrick, B., Ko, C.,… Stein, J. (2013). Reduction in catheter-associated urinary tract infections by bundling interventions. International Journal for Quality in Health Care, 25(1), 43-49.
Meddings, J., Rogers, M., Krein, S., Fakih, M., Olmsted, R., & Saint, S. (2014). Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: An integrative review. BMJ Quality & Safety, 23(4), 277-289.
Menschner, E. (2017). Decrease urinary tract infections with leader rounding using a checklist. Web.
Negussie, N., & Demissie, A. (2013). Relationship between leadership styles of Nurese managers and nurses’ job satisfaction in Jimma University Specialized Hospital. Ethiopian Journal of Health Sciences, 23(1), 50-58. Web.
Sfantou, D., Laliotis, A., Patelarou, A., Sifaki- Pistolla, D., Matalliotakis, M., & Patelarou, E. (2017). Importance of leadership style towards quality of care measures in healthcare settings: A systematic review. Healthcare, 5(4), 1-17.
Tappen, R., Wolf, D., Rahemi, Z., Engstrom, G., Rojido, C., Shutes, J., & Ouslander, J. (2017). Barriers and facilitators to implementing a change initiative in long-term care using the INTERACT® quality improvement program. The Health Care Manager, 36(3), 219-230.
Welden, L. M. (2013). Electronic health record: Driving evidence-based catheter-associated urinary tract infections (CAUTI) care practices. Online Journal of Issues in Nursing, 18(3). Web.