Quality healthcare delivery in hospitals can be achieved by developing a patient safety culture grounded in evidence-based practice (Magers, 2013). Effective CAUTI prevention is a quality improvement project. Reducing CAUTI rates at KRMC will involve a 3-step action plan focused on instilling best clinical practice and cultural change.
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The education/communication plan will pass the message that CAUTI prevention is KRMC’s priority to the staff. The plan will involve the following strategies:
- Incorporation of CAUTI reduction in the KRMC’s strategic plan to emphasize the priority of this QI project
- Educate staff about CAUTI prevention best practices through short catheter insertion videos
- Communicate CAUTI data, e.g., death and cost
- Patient/family education
Implementation and Evaluation of Timelines
The execution and evaluation of the education/communication plan will span 12 weeks as shown in Table 1 below.
Table 1 – Implementation and Evaluation Timelines (2017).
|Time||Week 1-2||Week 3-4||Week 5-7||Week 8-11||Week 12|
|Implementation||Execute the CAUTI bundle||X|
|Offer patient/family and staff education||X|
|Data monitoring and regular reporting||X|
|Evaluation||Determine and report process and outcome measures||X|
|Compare CAUTI data to baseline, state, and national values||X|
Summary of the Plan
The provision of information on the technical interventions for CAUTI prevention will be a key goal of the plan. The education of the clinical staff (nurses) will center on appropriate catheter insertion, maintenance, and prompt removal to minimize the CAUTI risk (Hanchett, 2012). Other training areas will include using a CAUTI checklist, catheter review during rounding, and utilizing alerts to ensure prompt catheter removal (Oman et al., 2012). Further, according to the Agency for Healthcare Research and Quality (2013), patient/family education on CAUTI risk factors will improve the identification of lapses and errors. Patient/family feedback will also be considered during the evaluation process. CAUTI reduction progress will be measured against state and national values.
The resources required to implement the CAUTI education/communication plan include monetary resources, time, human resources, and equipment. Funds will be required to develop educational videos and literature for staff and patient/family and procure whiteboards and projectors for formal training. A classroom will also be required. Further, shift readjustments will create ample time for nurses to attend educational sessions.
Role of Technology
Virtual training tools will be useful in educational support and catheter insertion videos for nurses. Further, CAUTI surveillance programs will support catheter maintenance audits for prompt removal. Such systems allow ‘super-users’ to “drive the educational initiatives” at the ward level (Davis et al., 2014, p. 148). Therefore, technology will help integrate the CAUTI insertion/maintenance bundle into practice.
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The infection prevention officer and education manager will involve nurses throughout the CAUTI reduction project. The staff meeting will focus on vendor products, the rationale for the intervention, and the case for CAUTI prevention. Further, the nurses will be trained on the insertion, maintenance, and removal procedure before the implantation. The staff will also participate in project evaluation through reporting of CAUTI incidents in the wards.
Ideas to Leverage on Creative Tension
- Explain indications for Foley catheter insertion/removal.
- Address staff concerns and issues to trigger cultural change.
- Use unit champions to enforce compliance.
- Engage – provide a rationale for CAUTI prevention and its impact on quality.
- Educate – Train staff on prevention methods, educate patients/families, and share data.
- Implement – Execute the CAUTI bundle, educate staff, and monitor and report data.
- Evaluate – Report on the identified outcome and process measures.
Agency for Healthcare Research and Quality. (2013). Healthcare-associated infections program: Tools & resources to prevent HAIs. Web.
Davis, K., Colebaugh, A., Eithun, B., Klieger, S., Meredith, D., Plachter, N.,…Coffin, S. (2014). Reducing catheter-associated urinary tract infections: A quality-improvement initiative. Pediatrics, 134(3), 145-152.
Hanchett, M. (2012). Preventing CAUTI: A patient-centered approach. Web.
Magers, T. L. (2013). Using evidence-based practice to reduce catheter-associated urinary tract infections. American Journal of Nursing, 113(6), 34-44.
Oman, K. S., Makic, M. F., Fink, R., Schraeder, N., Hulett, T., Keech, T., & Wald, H. (2012). Nurse-directed interventions to reduce catheter-associated urinary tract infections. American Journal Of Infection Control, 40(6), 548-553.