Introduction
There is an enhanced need for healthcare coupled with nurse staff shortages leads to poor documentation and maintenance of patient health records. In recent years, several hospitals have implemented electronic health records (EHRs) as a part of quality improvement efforts to enhance care quality (Rojas & Seckman, 2014). The US, for instance, has witnessed increased adoption of EHRs because of regulations and financial resources invested in quality improvement. These facilities have implemented EHR based on the promise of improved efficiency attained through integration and quick access to patient data, cost-cutting, improved relationships, and/or the need to adapt to evolving healthcare settings.
One must, however, appreciate that the implementation of an EHR system is a complicated initiative that accounts for multiple factors, including organizational culture, structure, technical skills, financial resources, IT infrastructure, and support from multiple sources (Boonstra, Versluis, & Vos, 2014). It is observed that information system implementation in healthcare facilities is usually complex and more puzzling due to numerous medical data involved, data capture and entry constraints, data security and confidentiality issues, and low awareness among end-users on benefits of the system (Boonstra et al., 2014).
Moreover, healthcare facilities differ from other organizations because of multiple factors. First, they focus on curing, caring, and nurse, physician, and patient education. Second, organizational structure and procedures are intricate. Finally, there is multiple personnel in healthcare facilities with different levels of experience, expertise, autonomy, and roles. As such, it is imperative to understand how EHR implementation, as a part of quality improvement efforts, is conducted in hospitals.
Problem Statement
Catheter-associated urinary tract infection (UTI) is a rampant device-related infection in the US and other regions globally. Nearly 60% of catheter-associated UTIs are seen as preventable if the recommended infection control measures are implemented (Saint et al., 2016). It is also noted that about 50% of the catheter of patients who receive an indwelling catheter does not have any documentation based on evidence-based care (Welden, 2013).
Available guidelines insist on the effective application, aseptic insertion, care, well-timed withdrawal of indwelling urinary catheters, and prevention strategies, such as hand washing. Effective prevention strategies tend to focus on bacterial infection controls and restrict the use of an indwelling catheter and discontinue the use when clinically sound. Amidst all these efforts, infection control efforts require the implementation of EHR systems to monitor and capture data to control catheter-related UTIs.
Consequently, there would be surveillance of use, effective use, and complication monitoring (Nicolle, 2014). However, challenges associated with EHR implementation are numerous and could hinder intended outcomes. Besides, most inpatients do not have sufficient documentation (Welden, 2013). Based on the PICOT question (can the implementation of EHR help in reducing catheter-associated UTIs among patients?), this research paper investigates if EHR implementation can improve quality outcomes among patients with indwelling urinary catheters by capturing appropriate data for decision-making.
The objective of this quality improvement research was to reduce cases of catheter-associated urinary tract infections by using EHR implementation to aid in promoting evidence-based quality care. The major focus was on the prevention of unwarranted insertion and well-timed removal of the urinary catheter when it was no longer clinically necessary (Parry, Grant, & Sestovic, 2013).
Review of Relevant Literature
The evolving healthcare landscape is characterized by a heightened need to enhance patient safety and improve outcomes. Data from hospitals gathered by the Centers for Disease Control and Prevention (CDC) on catheter-associated UTIs in patients with urinary catheters have shown high rates of infections with adverse outcomes (Gudino, 2015).
Notably, increased bacterial colonization is known to facilitate the spread of hospital-related infections. Such infections occur within the hospital but are usually preventable if effective care is taken. Catheter-associated UTIs are considered as hospital-acquired infections. When they occur, in most instances, there is no record to support the use of the catheter or its timing. As such, it is difficult to claim that effective care was administered in the absence of documentation for decision-making (Welden, 2013).
It was observed that clinical nurse specialists noted some drawbacks in current practices, which required multiple interventions, including evidence-based use of indwelling urinary catheters supported with EHR (Purvis, Gion, Weber, & Kennedy, 2014). Purvis et al. (2014) also established that effective implementation of intervention strategies led to declines in infection rates and catheter days. According to Gould et al. (2010), most hospital records have shown that about 50% of patients who receive an indwelling catheter do not have any documentation based on evidence-based care (cited in Welden, 2013).
Thus, the decision to use the catheter is not supported by any data. When documentation is lacking, nurses cannot claim that appropriate, quality care was offered. Thus, EHR systems have been implemented to improve quality of care by providing evidence-based care practices, and they are usually associated with positive catheter care usages and documentation to support indwelling urinary catheter insertion and removal. Hence, there are benefits associated with the use of EHRs to control usages of the urinary catheter.
Method
A comprehensive systematic literature review was conducted using relevant terms to the study. Various databases, including the Cochrane Library, PubMed, and Sigma Theta Tau International were chosen for the literature search.
Keywords for the search included EHR implementation in hospitals; EHR implementation and evidence-based catheter-associated urinary tract infections care practices; catheter-associated urinary tract prevention; and quality improvement (QI) and EHR implementation.
The inclusion and exclusion criteria were
- selected articles were peer-reviewed,
- focused on EHR implementation, quality improvement, and catheter-associated urinary tract prevention,
- demonstrated the relevance of EHR implementation, benefits, and challenges.
The abstract of the selected articles was reviewed to determine their aims to facilitate inclusion.
Data Analysis
After a systematic literature review, it was noted that studies focused on infection prevention by restricting the insertion of catheters and durations of use in order to control cases of hospital-acquired infections related to catheter usage. The quality improvement project that focused on EHR to help in the adoption of evidence-based practices to improve the quality of care was noted as a successful initiative. The EHR systems were used as platforms for capturing patient data for clinical decision-making. Consequently, they were used to drive evidence-based practices in care delivery among patients and ensure sustained usages.
The results generally showed improved outcomes when quality improvement project was implemented successfully. There were notable declines in infections, enhanced catheter usages, and documentation for evidence-based practices in care delivery.
Discussion and Findings
The major goal of EHR implementation was to control catheter-associated urinary tract infections by enhancing documentation to collect data for decision-making on the use and duration of an indwelling urinary catheter. Inappropriate use of a urinary catheter, including prolonged periods of usages, was directly linked to increased risks of catheter-associated UTIs. It was observed that EHR implementation was important for accelerating documentation of patient daily condition (Welden, 2013).
The collected data were used to drive evidence-based intervention in the use of an indwelling catheter to control UTIs. A notable decline was noted in patients with inserted catheters, durations of usages, and timing of removal. As such, the quality improvement effort was successful because of controlled insertion and/or continued usage (Gudino, 2015).
Based on these findings, a change project would focus on quality improvement by implementing EHR to drive evidence-based practices in the insertion and duration of catheter usage. It is important to recognize that there would be challenges during the implementation. As such, an implementation process was developed to eliminate numerous challenges, including staff learning. These barriers could negatively impact EHR implementation, documentation, and core measures.
The change process is a multistep process and, therefore, it would be done carefully to eliminate barriers (Gershengorn, Kocher, & Factor, 2014).
The evaluation would be conducted after six months after EHR implementation by analyzing data before and after implementation to determine changes in catheter insertion rates and durations of use (Chenoweth & Saint, 2013). It determines the effectiveness of the EHR system in enhancing quality care practices.
The implication would present an opportunity for quality improvement teams, nurses, and physicians to adopt EHR systems for improving the quality of care by facilitating documentation and decision-making associated with evidence-based patient care and best practices.
Conclusion
Quality of care improvement continues to pose challenges to hospitals. EHR systems have demonstrated enhanced safety, efficiency, and quality of care delivery. It was concluded that EHR implementation could significantly transform catheter practices based on documentation and decisions supported by patient data. Hence, the platform was suitable for supporting, facilitating, and sustaining evidence-based practices in catheter-associated urinary tract infection prevention and patient data capture.
References
Boonstra, A., Versluis, A., & Vos, J. F. (2014). Implementing Electronic Health Records in Hospitals: A Systematic Literature Review. BMC Health Services Research, 14, 370. Web.
Chenoweth, C., & Saint, S. (2013). Preventing Catheter-Associated Urinary Tract Infections in the Intensive Care Unit. Critical Care Clinics, 29(1), 19-32. Web.
Gershengorn, H. B., Kocher, R., & Factor, P. (2014). Management Strategies to Effect Change in Intensive Care Units: Lessons from the World of Business. Annals of the American Thoracic Society, 11(3), 444–453. Web.
Gudino, C. (2015). Eliminating Catheter-Associated Urinary Tract Infections: Implementing a Quality Improvement Project. Web.
Nicolle, L. E. (2014). Catheter Associated Urinary Tract Infections. Antimicrobial Resistance and Infection Control, 3, 23. Web.
Parry, M. F., Grant, B., & Sestovic, M. (2013). Successful Reduction in Catheter-Associated Urinary Tract Infections: Focus on Nurse-directed Catheter Removal. American Journal of Infection Control, 41(12), 1178-81. Web.
Purvis, S., Gion, T., Weber, J., & Kennedy, G. (2014). Catheter-Associated Urinary Tract Infection A Successful Prevention Effort Employing a Multipronged Initiative at an Academic Medical Center. Journal of nursing care quality, 29(2), 141-8. Web.
Rojas, C. L., & Seckman, C. A. (2014). The Informatics Nurse Specialist Role in Electronic Health Record Usability Evaluation. Computers, Informatics Nursing, 32(5), 214-20. Web.
Saint, S., Greene, T., Krein, S. L., Rogers, M. A., Ratz, D., Fowler, K. E.,… Fakih, M. G. (2016). A Program to Prevent Catheter-Associated Urinary Tract Infection in Acute Care. New England Journal of Medicine, 374, 2111-2119. Web.
Welden, L. M. (2013). Electronic Health Record: Driving Evidence-Based Catheter-Associated Urinary Tract Infections (CAUTI) Care Practices. OJIN: The Online Journal of Issues in Nursing, 18(3). Web.