The procedure that I will examine is the overuse of urinary catheterizes prior to surgery. I work in a busy post-surgery office and it seems as the more we catheterize patients not taking into consideration of length or type of surgery one is having the more the infection rate goes up. According to the CDC 75% of hospital acquired UTIs are due to urinary catheterization (Catheter-associated Urinary Tract Infections, 2015). It is this reason my colleagues and I have questioned why we do this for all of our patients. The doctors are the ones that determine the basis for this process. The basis for placing the catheter prior to surgery is because the patient will be unconscious for the procedure and without it the patient may void and possibly contaminate the sterile field and research shows that one’s bladder could become distended during such procedures. (Newman, 2011) The decision makers implemented the current process because during surgery the bladder will not distend. This can interfere with the surgery itself, creates discomfort, and can possibly increase a patient heart rate and blood pressure. My recommendation would be to only catheterize patients that are expected to be under anesthesia for more than three hours. The evidence to support this change as discussed by Getz is that there is an increase of infection rate, catheter discomfort for the patient, and possible trauma. The need for catheterization can be limited by administering less IV fluids during surgery (Getz, 2015). Many hospitals and outpatient clinics have already implemented changes in their catheterization policies. The recommendation of practice change is evident by
List of Sources
Catheter-associated Urinary Tract Infections. (2015). Retrieved from CDC: http://www.cdc.gov/HAI/ca_uti

Clark, C. (2013, May 28). Three Reasons Urinary Catheters are Overused in Hospitals. Retrieved from Health Leaders: http://www.healthleadersmedia.com/content.cfm
Getz, L. (2015). Catheter Conundrum: Reducing Unnecessary Placement. Aging Well, 14.
Jain P, P. J. (2013, February). Overuse of the Indwelling Catheter in Hospitalized Medical Patients. Retrieved from PubMed: http://www.researchgate.net/publication/15405298/Overuseoftheindwellingcatheter
Newman, D. (2011). Evidenced Based Practice: intermittent caheterization versus indwelling foley. Urologic Nursing, 31.

The possible clinical and practice implications that would result in my recommendation would include less infection, false passage, urethral strictures and infections. (Jain P, 2013) According to the CDC all catheters should be removed if the patient is conscious and there are no other complications within 48 hours of postop. The evidence collected in the sources in which this writer used shows that 25% of all hospitalized patients end up with a foley catheter and the most common hospital acquired infection is due to urinary catheters. “The duration of catheterization is the most important risk factor for development of infection.” (Olson, 2008) If the number of urinary infections decreased because of this implement change then the stakeholders would see the value of how cost effective this would be. Medicare and many insurances will not pay for hospital acquired infections and this is very costly to hospitals. (Medicare Nonpayment for Hospital Acquired Conditions, 2015) The stakeholders can be involved in the decision to make the recommended policy change by having the physicians come to board meetings and explain the benefits medically and financially. The stakeholders should be an important asset in order to ensure the policy change is relevant and appropriate. It is imperative that they all be included and not limited to the direct recipients of the change. The main strategy that is useful in the change process is communication. Understanding their agenda will aide in the implementation process and lead to success and help decrease any conflicts that can arise. The influence of the stakeholders can affect the success of the process change. To have success is a direct reflection of the power stakeholders. A good question to ask yourself is how much capacity the stakeholders can contribute. You then can come up with a plan on how to roll out the new initiative and gain invaluable insight of their perspective.
There will be barriers whenever something new is implemented. The hospital that I work at is a teaching hospital which means there are always new residents and interns. With so many doctors coming and going this maybe a difficult change for them to make. It has been ingrained in them to catheterize surgery patients. Also, sometimes nurses will want the doctor to leave the catheter in because it is less time consuming if she has a busy load. This is very unethical but does happen. Several strategies can be put in place to help overcome these barriers. One is when a new set of residents come onboard there can be a place in their orientation to let them know about this new initiative. Also there can be a watchful eye. This means a nurse can be assigned to double check how long a patient has had a catheter and report to the physician if it has been over 48 hours. It is also important to share the research that I have gathered and implement the findings to the entire staff to show why we are making this change.

References
Clark, C. (2013, May 28). Three Reasons Urinary Catheters are Overused in Hospitals. Retrieved from Health Leaders: http://www.healthleadersmedia.com/content.cfm
Getz, L. (2015). Catheter Conundrum: Reducing Unnecessary Placement. Aging Well, 14.
Jain P, P. J. (2013, February). Overuse of the Indwelling Catheter in Hospitalized Medical Patients. Retrieved from PubMed: http://www.researchgate.net/publication/15405298/Overuseoftheindwellingcatheter
Medicare Nonpayment for Hospital Acquired Conditions. (2015, Febrary). Retrieved from NCSL: http://ncsl.org/research/heatlh/medicare-nonpayment-for-hosptal-aquired.aspx
Newman, D. (2011). Evidenced Based Practice: intermittent caheterization versus indwelling foley. Urologic Nursing, 31.
Olson, D. (2008). SHEA-IDSA Compendium. IDSANews, 10-18.