The current procedure that is being performed in my facility for the insertion of a urine catheter with one licensed professional is as follows: Introducing yourself to the patient, wash your hands, identify the patient by date of birth and first and last name, and informing them of the procedure that is about to take place. The patient lays down in a supine position and legs are spread apart. After opening the kit the sterile gloves are placed on. One hand is placed on the genital area which no is longer sterile, the other hand is used to clean the area with the provided swabs in the sterile box. The urethral area is swabbed three times from the center of the urethral outward. Once cleaned the catheter is then lubricated and placed inside the urinary tract until you see the return of urine. Once you see the return, the balloon is inflated in order to hold the catheter in place. A secure clip is attached to the patient’s leg and bag is hung below the level of the bladder.
The current process that is being performed in the facility is a procedure that has been used for the past 50 years but just recently the infection rate has increased drastically that it needs to be changed. An article that was published in Infection Control & Hospital Epidemiology discusses how aseptic techniques were unsuccessful many times. “A total of 81 insertion attempts among 65 patients were observed. Registered nurses attempted to insert 77 catheters (95%); a helper assisted with 64 (79%) of these 81 attempts. Major breaks in aseptic insertion technique occurred in 48 (59%) of 81 insertion attempts.” (Indwelling Urinary Catheter Insertion Practices in the Emergency Department, 2016). The percentage of 59% is actually scary not only to myself but to the patient’s care and safety. The current policy is not working anymore and the numbers of the infection rate shows that. In the medical field it is a constant changing field and it’s always for the better. The healthcare facilities have to see what can be improved on and how to protect the patients from infectious situations. Based on the article by Nazarko, “Urinary catheterisation is an aseptic procedure and should be performed by staff who are trained and competent to carry out this procedure.” (Nazarko, 2012) although the licensed professionals are trained there is no current competency that are in place within the facility. The aseptic rate of 59% shows that although these registered nurses are trained, their education level is not appropriate to practice.
The urinary catheterization procedure was placed by the infection control administration. They stay up to date on infection rates in regards to the catheterizations that are being placed continuously. The current use of urinary catheterization for different medical issues are as follows: urinary retention, bladder obstruction, prolonged duration of surgery, prolonged immobilization, and end of life care. Infection control administration follows the current guidelines that the CDC and JCAHO recommends in order to maintain patient safety and appropriate care. By following the CDC and JCAHO recommendations, the infection rate according to the facility should be maintained at a low level.
The current process of inserting a urinary catheter is done by one licensed professional at my facility. I have been working in my current facility for over 5 years and started to become involved with different types of committees. One of the committees that caught my eye was the infection control committee. The facility had started to notice that the infection rates of urinary catheters have increased within the past few years. My suggested practice change would be to add an additional licensed professional when inserting the indwelling catheter in order to decrease the level of infection rates by maintaining aseptic technique. According to Davey articles, “Urinary catheters account for more healthcare-associated infections than any other device (Kleinpell et al, 2008), therefore managing them effectively is key” (Davey, 2015). By adding an additional licensed professional, I believe it can improve on the infection rates of urinary tract infections. Aside from adding an additional licensed professional an annual competency exam should be given out to all licensed professionals in order to keep everyone updated on current events. Education is key when treating patients and their safety.
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Based on the article by Woodward, “If an indwelling urinary catheter is clinically indicated, then nurses must do their utmost to minimise the risk of their patient developing a complication.” (Woodward, 2014). If the change were implemented, the patient would benefit from this because he/she is now receiving treatment from not just one licensed professional but from two. This may ease the patient from the anxiety they may have from the procedure knowing that patient safety is the number one priority. Based on the article by Bernard, Hunter, & Moore, “Further research could assess the benefit of targeted education of nurses about indwelling urinary catheters cessation and the effect that education has on systems to ensure catheter removal at appropriate end points.” (Bernard, Hunter & Moore, 2012). Education comes a long way when it comes to the medical field. It is how we as medical professionals can teach the patients about the procedure and explain to them the best way to prevent infections. By continuing education annually this not only helps us in our field but if any questions arise we will be able to answer them, which will keep them educated and comfortable at the same time. Based on the article by Davey, “If a decision is made to catheterize a patient, then choosing the correct type of catheter is essential to prevent potential problems.” (Davey, 2015). By having two licensed professionals in the room when a urinary catheter is being placed in the correct order it is also double checked by the second nurse. By preventing any medical issues that may occur for the patient this allows for a quick turnaround for the patient. If the procedure is not done the right way this could keep them in the hospital setting longer than expected which mentally/physically the patient would not handle very well.
Based on the article in Infection Control and Hospital Epidemiology, “Aseptic insertion technique is strongly recommended because bacteria ascending after catheter insertion come from the patient’s own flora or the hands of healthcare providers and can lead to significant bacteriuria.” (Indwelling Urinary Catheter Insertion Practices in the Emergency Department, 2015). If the infection rate is due to the hands of the health care provider adding an additional licensed professional will lower the infection rate. By having another set of sterile hands or another eye on making sure the professional who is performing the task will the facility to maintain accurate treatment without the patient feeling uncared for and filing a complaint which can result into a law suit that could have been prevented by the new policy. By changing the policy, the patients would be discharged quicker from the hospital because they would appropriately discharge for their original diagnosis that they came in with and not for an infection that was acquired while staying there saving money by giving appropriate care. Based on the article by Davey, “In the community, good management means ensuring that nurses' catheter-management skills are well-enough developed to prevent patients simply being sent to A&E.” (Davey, 2015). Since the current policy only allows one licensed professional and the help of one non-licensed professional the education level of the procedure may not be as helpful because the second person is non-licensed and unable to perform the procedure. Maintaining an annual competency on Urinary Catheters should be included in this new policy that I am suggesting in order to keep the licensed professionals well educated. A huge problem that does occur when the patient is in the hospital setting is contacting a urinary tract infection during their stay; the medical insurance does not pay for it since they see it as a problem that came from within the hospital. This is why it’s important to change the policy in order to keep the rate low. Based on the work by Nazarko, “Staff providing care should be educated and enabled to help the person with a catheter to maintain good hygiene.” ( Nazarko, 2012). Our facility is all about education and how important it is to stay on top of annual competency. Not only does this provide the care the patient deserves but it will increase the revenue of the hospital by positive treatment the patients are receiving.
In order to involve key stakeholders in this change of process that I am proposing, I would gather all of the information that I have collected. I would type up the policy as if it was in effect; it would clearly state from beginning to end of how the new process should be done properly. After gathering all of my articles and policy, I would gather a few nurses to find out their thoughts on this new policy that could take in effect. I would also gather a few MDs and PAs as well. I would gather signatures from the colleagues that believed that this new policy may indeed decrease the infection rate. I would then bring it to the attention of the infection control committee in order to see if this policy could be changed. A few barriers that may occur with the new policy that I feel that may occur are the nurses falling back into old routine by not having the second licensed professional present. They may give excuses such as, they couldn’t find anyone because everyone was busy or they didn’t want to fall back on their work so they performed it on their own. Another barrier that that could possible occur in this setting, the licensed professionals may feel that it’s not necessary to bring anyone else into the room because they feel they are well educated enough to do it on their own.
Two strategies that I would use in order to overcome the barriers that were discussed, I would try to convince the staff by simply showing them how high the infection rates have gone up within the facility and how important it is to stay educated on this topic because in the medical field everything is constantly changing. I would show them the research that was done and how important it is for the patient’s safety to decrease the infection rate. I would also consider on speaking to the charge nurse and request that during morning, evening, and night huddles to remind the staff the importance of following the new procedure in order to maintain the infection rate down. If the procedure is only spoken about once the nurses will fall back into the old routine without allowing the new procedure to sink in and actually get used to doing it the new way.
The new policy which consists of providing two licensed professionals inserting a foley catheter would be implemented by a few ways. One of the ways that I would implement this new policy would be a red sticker that is attached to the computer on wheels. As the nurse is pulling the computer on wheels by the patient, he/she is reminded that before he/she places the foley in, you need to have a second licensed professional present. Based on the article by Quinn, “One nurse with accountability for implementing a simple evidence-based protocol can dramatically decrease the total incidence of hospital-acquired CAUTI.” (Quinn, 2015). Decreasing the number of infection is key and that is my patient safety goal. Another way that I would implement this new policy is making it mandatory sign off by the second licensed professional on the patient’s chart. Based on the article by Underwood, “It is also important to establish catheter care guidelines and assure this care is being properly carried out, which can decrease preventable complications, such as CAUTI.” (Underwood, 2015). By making it a part of the guideline, the licensed professional is being held responsible. Based on the work of (Bernard, Hunter, & Moore, 2012; Davey, 2015; Nik & Pettis, 2012), they discuss how important it is to maintain education level on catheterizations. I would implement an annual competency in order to maintain every licensed professional up to date on any new information that may help decrease the level of infection.
References
Bernard, M. S., Hunter, K. F., & Moore, K. N. (2012). A Review of Strategies to Decrease
the Duration of Indwelling Urethral Catheters and Potentially Reduce the Incidence of
