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Patient Safety Score Improvement Plan

 

 

 

 

 

 

 

 

Patient Safety Score Improvement Plan for the Progressive Care Unit

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Patient Safety Score Improvement Plan for the Progressive Care Unit

Increased CAUTI cases have widespread financial, mortality and morbidity implications. Research shows CAUTIs are difficult to treat as they resist treatment compared to other UTIs. In this case, focusing on preventing them is critical to ensure patient safety and improve the Safety Score, which is a mark of how well a unit, a healthcare profession or a hospital has upheld patient safety standards to prevention complications associated with lack of safety. In this light, this paper seeks to design a Safety Score improvement plan for CAUTI for the PCU unit, which has  experienced increased CAUTI cases that threaten patients’ life and could deny the hospital Medicare and Medicaid reimbursements.

Study of Factors

Patient Safety Issue: Catheter-associated Urinary Tract Infection (CAUTI)

Urinary tract infections make up 40% of all infections occurring in acute care hospitals. Over 80% of UTIs are catheter associated (CAUTI). Most patients in PCU receive catheters.  CAUTIs may involve the entire urinary system, including the ureters, bladder, kidney and urethra (Nicolle, 2014). This increases the mortality and morbidity causing over 13,000 deaths each year. CAUTI is also contributes to secondary bloodstream infections that contribute to 10% mortality in acute care.  Other complications include increased costs amounting to 0.5 billion annually, unnecessary use of antimicrobial and increased length of stay. CAUTI may also compromise immunity, as well as, complicate the primary health issue that the patient suffers from. In the PCU unit, these implications, ranging from increased morbidity to mortality have been experienced (Gould, 2014).

Nursing Leadership Influence

As in the case of driving other changes to ensure patient safety, nursing leadership has a critical role in driving changes to facilitate reduction of CAUTI incidences. Saint et al. (2010) note that nursing unit leaders are primarily important because they help  cultivate clinical excellence, as a culture, develop clear visions, as well as, articulate the vision of preventing CAUTI to nurses. In addition, they serve the role of inspiring, motivating and energizing nurses based on their actions, which help them garner respect from other nurses. Nurse leaders are also solution-oriented, thus at the forefront of countering barriers to implementing changes that will prevent CAUTI. They deal with tough issues head-on, thus critical in communicating with other nurses to identify barriers to change.

Importantly, the prevention of safety issues is effectively done within a patient safety culture, where the norms, beliefs, values and practices of the organization and those involved in it are consciously aware of  issues sabotaging patient safety and seek to address/prevent the issues continually.  PCU nurse leader in collaboration with the head nurse conduct safety culture survey of the unit to assess conditions that may lead to CAUTI, raise awareness of the severity of CAUTI among nurses,  as well as, use it to monitor effectiveness of interventions made.  Nurse leaders can promote attitudes oriented towards implementing the recommendations. In building a culture of safety, nurse leaders can advocate for teamwork, a learning and just culture, patient-centeredness, evidence-based practice and communication, all which must be oriented towards implementing recommendations suggested to prevent CAUTI (Sammer & James, 2011).

Effects of Current Policies and Procedures

Patient safety is implemented within the context of organizational procedures and policies, which influence how employees act to ensure patient safety, including preventing CAUTI.  They act as a framework that guide employees, including nurses, physicians and other staff members on how to act to prevent eruption of safety concerns. Healthcare institutions with effective procedures and policies on preventing CAUTI high adherence/compliance to CAUTI preventive measures, thus low incidences of CAUTI. Such organization have specific instructions, such as assessing CAUTI risk factors, reservoir/drainage back for  transmission, as well as, strategies for detecting CAUTI, such as surveillance approaches. This also goes for primary and secondary prevention strategies/procedures, including assessing patient to prevent unnecessary and prolonged use of catheters, changing the drainage bag, as well as, using antibiotics. Nonetheless, Revello and Gallo (2013) note that policies must work in synergy with strong nursing leadership and a certified infection preventionist to ensure compliance and successful prevention of CAUTI. However, the PCU does not does not have strong leadership oriented towards preventing CAUTI, clear procedures and policies on CAUTI, as well as, a certified infection. While the need for catheter may be clear, decisions on when to stop catheter use do not have a strong policy basis. Some nurses often forget to empty the drainage bag, as often as needed especially if they have work overload (Conway et al. , 2012).

Recommendations

Current evidence show “bundles” of interventions are being used extensively to prevent CAUTI with immense success. In this case, the ABCDE bundle or approach will be used. It advocates for Adhering to standard infection control approaches, such as education, hygiene, aseptic insertion and surveillance among others. This also goes for undertaking Bladder ultrasound to prevent indwelling catheterization, using Condom catheter, as well as, alternatives  when possible, ensuring nurses Do avoid unnecessary catheter use and ensure Early catheter removal using appropriate protocol.  This approach potentially helps prevent up to 80% CAUTI when implemented appropriately (Meddings, 2013).

Plan for Collecting Information

Information about CAUTI will be collected using safety culture survey to help determine loopholes/causes of CAUTI, as nurses will indicate if they follow all safety measures or not and the reasons behind their responses (Sammer & James, 2011). This will help determine major reasons behind  increased CAUTI infections.

Implementation and Monitoring Plan

There will be a change of procedures and policies to accommodate ABCDE bundle, as well as, clearly outline the specific ABCDE’s needed to prevent CAUTI. This will be followed by staff training, where nurses will be educated about the changes in procedures and policies, roles, as well as, their responsibilities in effecting the changes. A certified infection preventionist with collaboration from the lead nurse will conduct training; the training will be based on theory, which will take place in a conference room, as well as, hands on. After training, nurses will be expected what has been learnt under the supervision and motivation of the nurse leader, who will report to the certified infection preventionist. The outcomes will be monitors through periodic safety surveys, in which nurses will report whether they are using safety measures and have experienced reduction of CAUTI cases. Outcomes will also be measured using statistics  by comparing CAUTI statistics before and after implementing the intervention to note if there are any changes (Revello & Gallo, 2013).

Conclusion

CAUTI is a serious safety concern at PCU, which has reduced Safety Score and has major negative implications.  These include increased mortality and morbidity rate, as well as, loss of reimbursements. Nonetheless, with the incorporation of proper leadership, redesign of policies and the use of ABCDE bundle, which will be facilitated by an effective leadership plan, the unit can reduce CAUTI cases by up to 80%.

 

 

 

References

Conway, L. J. et al.  (2012). Adoption of policies to prevent catheter-associated urinary tract infections in United States intensive care units. Am J Infect Control, 2012(7), 22-29.

Gould, C. (2014). Catheter-associated Urinary Tract Infection (CAUTI) Toolkit Activity C: ELC prevention collaborative. Retrieved from http://www.cdc.gov/HAI/pdfs/toolkits/CAUTItoolkit_3_10.pd

Nicolle, L. E. (2014). Catheter associated urinary tract infections. Antimicrobial Resistance and Infection Control, 3,23 – 29. Doi: 10.1186/2047-2994-3-23.

Saint, S. et al. (2010). The importance of leadership in preventing healthcare-associated infection: results of a multisite qualitative study. Infect Control Hosp Epidemiol., 31(9), 901–7.

Sammer, C. E., & James, B. R. (2011).Patient safety culture: The nursing unit leader’s role. OJIN: The Online Journal of Issues in Nursing, 16 (3), n. p.