Capstone Part 1

  

Capstone Paper, Part I

· Introduction (Completed in Week 1) 

o State the practice problem in measurable terms and that reflect quality indicators. 

This is the same problem described in the Week 1 Practice Experience discussion. 

Provide the rationale for selecting the practice problem

o Include a purpose statement.

· Analysis of Evidence (Completed in Week 2) 

o Synthesize a minimum of 5 evidence-based practice resources that support your practice problem. Include a minimum of two to three research studies obtained from the Walden Library. 

· Quality Improvement Process (Completed in Week 3)

o Describe the quality improvement process and a brief overview the quality model that will be used to improve your practice problem. Include a description of a quality tool that will be used in the quality improvement plan. 

o This process will be used to support the detailed proposed quality improvement plan in Week 4

o Explain why the specific quality model was selected and document your explanation with references.

o Summary  

§ Summarize the key points discussed in the paper. 

Week 1

Catheter-Associated Urinary Tract Infections

Hospital-acquired infections cost healthcare organizations billions of dollars every year. They are the leading courses of the extended length of stay in a hospital, increased use of resources and a decreased patient outcome. After speaking with nursing management and infectious control department, it is clear that Catheter-Associated Urinary Tract Infections has become a menace in our healthcare facility with a higher acute rehabilitation unit incidence (Saini et al., 2017). I also noted that low hygiene and poor catheter insertion and removal techniques are the leading causes of organism inoculation inside the bladder promoting bacterial colonization through providing adhesion surfaces and resulting in irritation of the mucosal membrane in the perineal area.

Unnecessary and prolonged use of the indwelling urinary catheters is the major predisposing factor leading to (CAUTI) Catheter-Associated Urinary Tract Infections ((Felix, et al., 2016), and more so failure to adequately clean the perineal area and on daily basis. Alone, CAUTI causes approximately 13000 deaths annually, causing increased mortality and morbidity arête and increased healthcare costs. Yet hospital-acquired infections such as CAUTI can be easily prevented (Healthcare-associated infection, 2018). Indwelling urinary catheters are external catheters used by in cooperative urinary tract male patients with a dysfunction of bladder emptying or such conditions as a spinal injury. Therefore the urinary tract catheter device is inserted by a physician to help in managing the flow of urine in cases where there is no bladder obstruction or urinary retention.

Indwelling urinary catheter insertions (IDC) is done mostly in the admission room which is where I work in a community hospital. CAUTI has become a serious infection concern which occurs when urinary catheter insertion or removal is inappropriate or unjustified and lack of frequent cleaning of the perineal area (CDC, 2016). Working in an environment where most patients get urinary tract catheter insertions makes those patients more prone to acquiring infections while in the hospital.

 

CAUTI can be devastating complications for patients that are already critically ill in the intensive care unit. According to (Curiej, 2019), hospital-acquired infections affect 1.7 million patients annually and result in 9,000 deaths each year. Research has shown the risk of developing bacteriuria on catheterized patients as high as 3% to 10% per day and close to 100% after the catheter has been in place for 30 days (McNeill, 2017). In the United States, the statistics are alarming, approximately five million catheters are placed annually, and 50% of the patients do not meet appropriate criteria, and 40% of physicians are unaware of their patients have a urinary catheter in place (Mori, 2014).

After discussing with the critical care manager and infectious control team, it was agreed that perineal area damage during insertion and removal of the urinary catheter in the urethra and lack of frequent cleaning is detrimental to patient outcomes which include the entry of gram-negative bacteremia, sepsis, and high mortality (Skanlon, 2017). We discussed many ways to prevent CAUTI which include use of the long-term acute care hospital (LTACH), that involve frequent and regular cleaning of the perineal area. extra catheter care supplies, such as Foley catheter bags, tubing, stat locks, perineal soap, etc. and providing educational resources for staff and patients on recognizing CAUTI, ways of preventing CAUTI and general care for an indwelling catheter. It is very important to prevent any complications when it comes and the quality of care that is provided is the main contribution to whether an infection is either obtained or prevented.

References

European Society of Radiology (ESR. (2019). Patient safety in medical imaging: A joint paper of the European Society of Radiology (ESR) and the European Federation of Radiographer Societies (EFRS). Insights into imaging, 10(1), 45.

Gould, C. V., Umscheid, C. A., Agarwal, R. K., Kuntz, G., Pegues, D. A., & Healthcare Infection Control Practices Advisory Committee. (2010). Guideline for prevention of catheter-associated urinary tract infections 2009. Infection Control & Hospital Epidemiology, 31(4), 319-326.

McNeill, L. (2017). Back to basics: How evidence-based nursing practice can prevent catheter-associated urinary tract infections. Urologic Nursing, 37(4), 204-207.

Oliveira, P. R., Carvalho, V. C., Felix, C. D. S., Paula, A. P. D., Santos-Silva, J., & Lima, A. L. L. M. (2016). The incidence and microbiological profile of surgical site infections following internal fixation of closed and open fractures. Revista brasileira de ortopedia, 51(4), 396-399.

Saini, H., Vadekeetil, A., Chhibber, S., & Harjai, K. (2017). Azithromycin-ciprofloxacin-impregnated urinary catheters avert bacterial colonization, biofilm formation, and inflammation in a murine model of foreign-body-associated urinary tract infections caused by Pseudomonas aeruginosa. Antimicrobial agents and chemotherapy, 61(3), e01906-16.

Scanlon, K. A., Wells, C. M., Woolforde, L., Khameraj, A., & Baumgarten, J. (2017). Saving lives and reducing harm: A CAUTI reduction program. Nursing Economics, 35(3), 134-141.

 

Practice Experience Discussion -Catheter Associated Urinary Tract Infection

 

           Hospitalization or prolonged stay in hospitals is becoming one of the most dangerous ways of contracting catheter-associated urinary tract infections (CAUTI). Indwelling catheters cause this problem among patients.  An indwelling catheter is a tube-like structure inserted into a urethra of a patient. This tube drains patient urine from the bladder into a collection bag. Patients who had surgery or are not able to control the functioning of their bladder require a catheter. It is very critical to monitor the amount of urine that kidneys produce. Limited resources at a healthcare facility are one of the most contributing factors to the prevalent of CAUTI. As a result, CAUTI causes an increased rate of hospitalization, 30-day readmission, poor quality care services, and increased healthcare costs.

            After conducting a 20-minute interview with a hospital nurse leader and hospital manager, the outcome revealed that CAUTI is a leading challenge in the provision of quality care services and the enhancement of patient safety. These two leaders highlighted strong urine odor, chills, blood in the urine, unexplained fatigue, cloudy urine, and leakage of urine around the catheter are significant symptoms of a patient with CAUTI (Goldstein, MacFadden, Karaca, Steiner, Viboud, & Lipsitch, 2019). The two leaders stated that the diagnosis of CAUTI is challenging, especially when a patient has been admitted. The reason for diagnosis challenges are due to similar symptoms that may be part of a patient’s original illness.

            A nurse leader noted that when bacteria enter a patient’s urinary tract through the catheter, chances of being infected with CAUTI are high. When a catheter is contaminated, or a drainage bag is not frequently emptied often, a patient is also likely to get infected. Other ways in which an infection occur include a dirt catheter and a backward flow of urine in the catheter into the bladder. National Healthcare Safety Network (NHSN) Report indicates 449, 334 CAUTI cases yearly in the United States (Richards, 2017). The report further reveals that CAUTI rates range from 0.00% per 1,000 catheter days to high of 53.2 per 1,000 catheter days between location types, type of medical institute affiliation of the hospital, and location bed size.

I work in the admission room at The Royal Children’s Hospital, where most of the Indwelling urinary catheter insertions (IDC) is done. Preparation of environment and equipment at the room ensure dressed trolley, catheterized pack and drapes, and sterilized gloves (HanCHett, 2012). Only a trained and competent nurse and doctor in urinary catheterization do the Insertion of an IDC. Between 12% to 16% of inpatients are likely to have indwelling urinary catheters during their treatment (hospitalization). Daily, a patient has a 3% to a 7% high risk of contracting CAUTI (Richards, 2017). More than 13, 000 deaths every year result from CAUTI according to the Center for Disease Control (CDC) statistics. A nurse leader and hospital manager identified CAUTI preventions outlined in the CDC, where preventive measures are given. These prevention measures are minimization of urinary catheter use and usage period among patients, avoiding the use of urinary catheters in patients to manage incontinence, and using urinary catheters in operative patients when critical.

After an in-depth discussion on CAUTI, it was agreed that inappropriate uses of dewing catheters are worsening the situation and leading to the delivery of low-quality care services. For instance, the hospital manager identified a prolonged postoperative period with inappropriate indications as improper use of indwelling catheters. Also, a substitute for the care of a patient without incontinence is the wrong use of indwelling catheters. Nurses, clinicians, and doctors must ensure quality care services through an appropriate removal of urinary catheter insertion and cleaning perineal area frequently.

References

Goldstein, E., MacFadden, D. R., Karaca, Z., Steiner, C. A., Viboud, C., & Lipsitch, M. (2019). Antimicrobial resistance prevalence, rates of hospitalization with septicemia and rates of mortality with sepsis in adults in different US states. International journal of antimicrobial agents, 54(1), 23-34.

HanCHett, M., & Rn, M. (2012). Preventing CAUTI: A patient-centered approach. Prevention, 43, 42-50.

Richards, D. E. (2017). Catheter-Associated Urinary Tract Infection (CAUTI) Targeted Assessment for Prevention (TAP) Effective Practices. American Journal of Infection Control, 45(6), S10-S11.

 
 

Applying Process Improvement Models

I shall use the Plan-Do-Study-Act (PDSA) cycle as the process improvement model in developing my practice project on Catheter-Associated Urinary Tract Infections (CAUTI) management plan. The PDSA cycle was modified from Walter A Stewhart’ Plan-Do-Check-Act (PDCA) cycle by one W Edwards Edwards Deming. According to Deming, the ‘check’ phase in the PDCA cycle emphasized inspection over-analysis. PDSA has grown to become the most commonly used model for process improvement, and it encompasses completing the sequences, then repeating the process until the achievement of the desired outcomes

 

(Spath, 2013). CAUTIs comprise one of the most prevalent hospitals acquired infections (HAI) globally. Furthermore, the prevalence of the cases is subject to changes. In my view, PDSA is the most appropriate model for long-term management of CAUTIs in hospitals because it caters for any changes that may come with a new infection conditions.

1). Plan: The phase would involve objectives, processes, and action-plan establishment for the delivery of the results that are desired. CAUTI infections will be reduced through the creation and implementation of a multidisciplinary CAUTI prevention plan. The plan would be a master-piece on how the process improvement for CAUTI prevention would be implemented. There would also be a plan for performance measurements across the organization. There should be a plan to integrate CAUTI risk prevention strategies into the organizations’ processes.

2). DO: The members of the the multidisciplinary team would include staff from all the concerned departments. Successful CAUTI prevention teams include a team leader, nurse, and physician champions, executive partners, frontline nurses, infection prevention and discharge planners or case managers, risk managers, etc. Apart from being in charge of the CAUTI management, the team of planners would give weekly, monthly, annual reports concerning the progress of their undertakings. Furthermore, they would be responsible for educating the staff and patients and their families regarding CAUTI infection preventions.

Lastly, they shall be in charge of case risk evaluations and risk scoring throughout the hospital. Secondly, the CAUTI prevention team, all the staff, and patients, especially in the acute care unit, will have a weekly CAUTI risk meeting. All the case and risk reports will be dispatched to the concerned individuals, such as department managers, patients, and the Board, etc., on a weekly, monthly, annual basis. A dedicated CAUTI risk management head shall be appointed to be in charge of the management of all cases, including prevention and treatment strategies. The prevention strategies would be based on evidence-based measures, including care for urinary catheter during placement, urinary catheters’ timely removal based on nurse-driven processes, and inappropriate short-term catheter use’ prevention (American Nurses Association, 2020).

3). Study: The phase would involve analyzing the incident monitoring reports and other scoring tools to determine whether all the implemented prevention strategies for CAUTI have yielded any positive results. The necessary the information would be collected from the patients and their families, facility staff, prevention committee, hourly-round feedbacks, etc.

4). Act: The phase would involve acting on the outcome or result gathered from the previous phase ad making appropriate and necessary changes. For instance, the facility would need to fine-tune the prevention measures to optimize the positive outcomes or find other alternative CAUTI prevention strategies if the current ones have not been successful.

References

American Nurses Association. (2020). ANA CAUTI Prevention Tool. Retrieved March 10, 2020, from Nursing World: https://www.nursingworld.org/practice-policy/work-environment/health-safety/infection-prevention/ana-cauti-prevention-tool/

Spath, P. L. (2013). Continuous Improvement.  Introduction to Healthcare Quality Management (2 ed., pp. 117-119). Chicago, Illinois, the United States of America: Health Administration Press.

 

PAGE

1

Title of the Capstone

in Full Goes Here

Student Name Here

Walden University

Abstract

This is the abstract, which is typed in block format with no indentation. It is a brief summation of your paper and should be 120 words or less. It should be accurate and concise. Your abstract should also be written in a self-contained way so people reading only your abstract would fully understand the content and the implications of your paper. It may be helpful to write this section last when you have collected all the information in your paper. See section 2.04 APA for helpful tips and for more information on writing abstracts.

Title of the Capstone

Do not add any extra spaces between your heading and your text (check Spacing under Format, Paragraph in your word processor, and make sure that it’s set to 0”)—just double space as usual, indent your work a full ½ inch (preferably using the tab button), and start typing. Your introduction should receive no specific heading because it is assumed that your first section is your introduction section.

Once you’ve considered these formatting issues, you will need to construct a thesis statement, something that lets your reader know how you synthesized the literature into a treatise that is capable of advancing a new point of view. This statement will then provide your reader with a lens for understanding the forthcoming research you’ve decided to present in the body of your essay (after all, each piece of literature should support and be made applicable to this thesis statement).

Once you’ve established your thesis, you can then begin constructing your introduction. An easy template is as follows:

1. Start with what’s been said/done regarding your topic of interest.

2. Explain the problem with what’s been said or done.

3. Offer your solution, your thesis statement (one that can be supported by the literature).

Level 1 Head

This will be the beginning of the body of your essay. Even though it has a new heading, you want to make sure you connect this to your previous section so your reader can follow you and better understand your hard work. Remember to make sure your first sentence in each paragraph both transitions from your previous paragraph and summarizes the main point in your paragraph. Stick to one topic per paragraph, and when you see yourself drifting to another idea, make sure you break into a new paragraph. Try to avoid long paragraphs to avoid losing your reader and to hold his or her attention–it’s much better to have many shorter paragraphs than few long ones. Think: new idea, new paragraph.

Level 2 Head

The Level 2 heading here implies that we are in a subsection of the previous section. Using headings are a great way to organize your paper and increase its readability, so be sure to review heading rules on APA 3.02 and 3.03 in order to format them correctly. For shorter papers, using one or two levels is all that is needed. You would use Level 1 (centered, bold font with both uppercase and lowercase) and Level 2 (left aligned, bold, both uppercase and lowercase).

Level 3 heading.
The number of headings you need in a particular paper is not set, but for longer papers, you may need another heading level. You would then use Level 3 (indented, bold, lowercase paragraph heading).

One crucial area in APA is learning how to cite in your academic work. You really want to make sure you cite your work throughout your paper to avoid plagiarism. This is critical: you need to give credit to your sources and avoid copying other’s work at all costs. Look at APA starting at 6.01 for guidelines on citing your work in your text.

References

(Please note that the following references are intended as examples only.)

Alexander, G., & Bonaparte, N. (2008). My way or the highway that I built. Ancient Dictators, 25(7), 14-31. doi:10.8220/CTCE.52.1.23-91

Babar, E. (2007). The art of being a French elephant. Adventurous Cartoon Animals, 19, 4319-4392. Retrieved from http://www.elephants104.ace.org

Bumstead, D. (2009). The essentials: Sandwiches and sleep. Journals of Famous Loafers, 5, 565-582. doi:12.2847/CEDG.39.2.51-71

Hansel, G., & Gretel, D. (1973). Candied houses and unfriendly occupants. Thousand Oaks, CA: Fairy Tale Publishing.

Hera, J. (2008). Why Paris was wrong. Journal of Greek Goddess Sore Spots, 20(4), 19-21. doi: 15.555/GGE.64.1.76-82

Laureate Education, Inc. (Producer). (2007). How to cite a video: The city is always Baltimore [DVD]. Baltimore, MD: Author.

Laureate Education, Inc. (Producer). (2010). Name of program [Video webcast]. Retrieved from http://www.courseurl.com

Sinatra, F. (2008). Zing! Went the strings of my heart. Making Good Songs Great, 18(3), 31-22. Retrieved from http://articlesextollingrecordingsofyore.192/fs.com

Smasfaldi, H., Wareumph, I., Aeoli, Q., Rickies, F., Furoush, P., Aaegrade, V., … Fiiel, B. (2005). The art of correcting surname mispronunciation. New York, NY: Supportive Publisher Press. Retrieved from http://www.onewaytociteelectronicbooksperAPA7.02.com

White, S., & Red, R. (2001). Stop and smell the what now? Floral arranging for beginners (Research Report No. 40-921). Retrieved from University of Wooded Glen, Center for Aesthetic Improvements in Fairy Tales website: http://www.uwg.caift/~40_921

Capstone Paper, Part I

· Introduction (Completed in Week 1)

· State the practice problem in measurable terms and that reflect quality indicators.

This is the same problem described in the Week 1 Practice Experience discussion.

Provide the rationale for selecting the practice problem

· Include a purpose statement.

· Analysis of Evidence (Completed in Week 2)

· Synthesize a minimum of 5 evidence-based practice resources that support your practice problem. Include a minimum of two to three research studies obtained from the Walden Library.

· Quality Improvement Process (Completed in Week 3)

· Describe the quality improvement process and a brief overview the quality model that will be used to improve your practice problem. Include a description of a quality tool that will be used in the quality improvement plan.

· This process will be used to support the detailed proposed quality improvement plan in Week 4

· Explain why the specific quality model was selected and document your explanation with references.

· Summary

· Summarize the key points discussed in the paper.