Methods of Obtaining the Necessary Approval and Support
The initial approach of seeking approval and support will entail the identification of the facilitators who will oversee the implementation process. The administrators and nurses at the nursing home are the key persons who will be affected by the proposed change. First, the nursing managers must approve the project because they will provide the needed resources to implement the proposed solutions successfully. Thus, the development of a business case will be essential to frame the problem in context. This formal document will identify the evidence that justifies the need to revise the current policies and guidelines to enhance clinical practice.
Secondly, the nurses will assume a critical role in incorporating the proposed solutions into the clinical practice. As such, their support is very crucial. It will be critical to introduce training and education programs, which will be essential to improve the nurses’ knowledge of evidence-based practice (EBP). The practitioners will be more confident in using EBP guidelines since the training will strengthen their competencies and beliefs. Further, the development of an environment that supports an inquisitive approach will be essential to broaden the scope of practice. Gale and Schaffer (2009) have found out that nurses are more receptive to change if the management values their input and recommendations.
The Scope and Limitations of the Current Policy
The hospital’s current policy regarding the prevention of UTIs involves three measures. Firstly, the administrators have introduced a new system, which requires nurses to minimize the use and duration of catheterization. Despite this requirement, the nurses still catheterize the patients unnecessarily. On the one hand, the nursing home has not established clear guidelines for selecting the patients who require catheterization. In addition, some of the nurses are not aware of the new guidelines because they did not participate in the planning and decision-making processes. On the other hand, the nurses have not received additional training regarding the new policy. Consequently, the implementation process has been slow and complicated.
Secondly, the nursing home requires the staff to perform perineal cleaning three times per day. The nurses use antiseptic cleansing regimens to clean the urinary meatus routinely as a means of maintaining the catheter. Although regular cleaning is a standard procedure for preventing CAUTIs, it presents practical challenges. First, the heavy workloads, coupled with understaffing are contributing to the low rates of adherence. Second, the nursing home has not developed standardized guidelines for perineal cleansing. For instance, some nurses use water and soap while others use antimicrobial agents. Thirdly, the majority of the nurses are not adhering to hand hygiene practices.
The nursing home has also developed a supervision program. The primary purpose of this initiative is to ensure that the members of the staff adhere to the recommended guidelines. Although these measures have reduced the rate of infection, they raise practical concerns. First, the facility is yet to develop standard guidelines since the nurses are not using uniform procedures to diagnose the risk of UTIs. The lack of uniformity has contributed to the inconsistent results, which makes it difficult to enhance the preventive measures. Second, the nursing home does not have enough qualified professionals to facilitate the supervision process. Third, the facility lacks efficient systems for reporting incidences.
The Proposed Solution
The proposed solution will not involve the introduction of a single intervention. By contrast, this implementation plan a raft of recommendations to prevent UTIs based on the best available evidence. First, the nursing home should introduce checklists to enhance the effectiveness of supervision. Beveridge, Davey, Phillips, and McMurdo (2011) have found out that urinary catheter checklists play a fundamental role in minimizing the incidences of omissions. The standardization of the checklists enhances the quality and safety of the prevention and control guidelines (Liang & Mackowiak, 2007). For instance, Trinkoff et al. (2015) found out that the rate of adherence increased by 44.4% following the combining the supervision program with urinary catheter checklists.
Secondly, hand hygiene is one of the most feasible strategies for preventing catheter-associated urinary tract infections (Daniels, 2012). Haas and Larson (2007) have identified hand washing as the first and most elemental preventive measure in clinical practice. The essence of hand hygiene stems from the realization that the colonization of urinary catheters is inevitable in older patients (Blango & Mulvey, 2010). Haas and Larson have indicated that most nurses do not adhere to hand hygiene practices when managing indwelling catheters. Thus, the nursing home should develop robust systems to monitor the level of compliance. Chang et al. (2014) found out that the rate of hand hygiene compliance increased by 56.4% in a residential home that employed regular audits. The continuous revision of the handwashing guidelines contributed to this increase (Figueiredo, 2014).
Thirdly, the unnecessary catheterization of patients increases the risk and incidences of CAUTIs (Liang & Makowiak, 2007). The development of organizational guidelines will be crucial to managing the insertion, use, and preservation of the catheters. Blango and Mulvey (2010) have underscored the significance of having written policies that specify the indications for using these catheters. According to Ping, Traynor, and Hailey (2014), patients who have appropriate signs do not require urinary catheters. The new policies should also delineate the individuals who have the most appropriate training and qualifications to insert the urinary catheters. Figueiredo (2014) has stated that only the most trained personnel should perform the preceding task to minimize the risk of infection.
The Rationale and Supporting Literature
Urinary tract infections (UTIs) represent some of the most frequent bacterial infections in humans (Agata, Loeb, & Mitchell, 2013). Although UTIs affect both men and women, the majority of urinary tract infections affect the latter disproportionately. The primary concern over UTIs is that they can chronically recur (Blango & Mulvey, 2010). Carlsson, Haglin, Rosendahl, and Gustafson (2013) have indicated that UTIs recur in approximately twenty percent of women who have one infection. In addition, Carlsson et al. have affirmed that 30% of this group of women will have a second recurrence whereas 80% will have subsequent repetitions. The rate of recurrent UTIs depends on the number of infections that an individual has had previously (Hyang, Blegen, & Harrington, 2014).
Urinary tract infections are often complicated, involving the occurrence of functional or structural abnormalities of the genitourinary tract system (Beveridge et al., 2011). Despite the asymptomatic nature of UTIs, these infections commonly present with deleterious clinical manifestations. Frequent symptoms of UTIs include pain in urination, the frequent urge to urinate, and difficulty in passing urine. Other clinical manifestations include pain or pressure above the pubic bone and fatigue (Liang & Mackowiak, 2007). The elderly patients who live in long-term care facilities experience debilitating health consequences that include dehydration, delirium, increased hospitalization, urosepsis and even death (Figueiredo, 2014).
The growing prevalence of UTIs has become a pressing public health concern across the world (Beveridge et al., 2011). The growing aging population in developed nations has increased the rate of hospitalization and residential care. The indwelling urinary catheters inherent in this population group increase the risk of healthcare-associated UTIs (Carlsson et al., 2013). The female gender, older age, catheter care violations, and duration of catheterization have been linked to the development of catheter-associated urinary tract infections in the future (Agata et al., 2013).
Catheter-Associated UTIs (CAUTIs) are the most frequent hospital-acquired infections (HAIs) in nursing homes and among hospitalized patients. According to Liang and Mackowiak (2007), CAUTIs account for approximately 40% of all nosocomial infections. The principal concern over CAUTIs is that they increase mortality and morbidity rates. In addition, these clinical conditions increase the length of hospital stay, which contributes to the escalating costs of medical care (Flanagan et al., 2014). Ping et al. (2014) have also asserted that CAUTIs expose patients to the risk of HAIs. Further, Blango and Mulvey (2010) have demonstrated that catheterization causes virtually all UTIs in healthcare settings.
The proposed plan recommends the incorporation of new catheterization guidelines into the local protocols. This process will require a review of the current procedures and systems to identify gaps and opportunities for improvement. The nursing home will have to conduct baseline investigations, which will include gathering information from nurses and other key individuals. The development of data collection instruments (such as surveys, interview schedules, and focus group discussions) will be a time-consuming and resource-extensive procedure. The nursing home will have to establish a panel of experts that will review the current practices and policy and make proposals for implementing the proposed solutions.
Secondly, the proposed catheterization and supervision policies require the hiring of skilled and competent personnel. Nonetheless, this process will not have immediate effects. It will be imperative for the nursing home to introduce in-house training for all the nurses and other caregivers. The training and education programs will require massive financial resources to hire professional trainers and for develop instructional materials and equipment. For instance, the facility should consider using simulations and other computer-aided systems to enhance the efficiency of the training. It is also essential to establish systems that will facilitate continuous education through regular interactive lectures and workshops.
Thirdly, one of the proposed solutions entails the development of organizational guidelines to govern urinary catheterization. Conversely, the effectiveness of this approach necessitates the implementation of a system that will support effectual documentation. The nursing home can only make the necessary changes if it documents the insertion and removal of the urinary catheters. The administrators should also develop guidelines and checklists for monitoring the duration and need of catheterization. These processes will require the overhaul of the current system. The primary concern is that the nurses may not be willing to adopt the new practices. As such, the nursing home will have to educate the staff about the imminent changes.
The Required Resources
The implementation of the proposed solutions will require the continuous training of the nursing staff. The education programs mandate the nursing home to reproduce training materials. The development of pamphlets, posters, and handouts will be essential to disseminate information about the proposed policies and guidelines. Secondly, the hospital administrators will also have to gather information from the nurses and other stakeholders about the performance of the current systems. Thus, it will be necessary to produce PowerPoint presentations, questionnaires, and interview schedules to collect raw data. The nursing home will also develop new policy documents that will contain evidence-based guidelines. The facility should purchase sophisticated data analysis software to analyze and disseminate crucial information.
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