Developing an Evaluation Plan

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Introduction

Infections are common adverse outcomes associated with catheterization. CA-bacteriuria is a frequent health care–associated infection that accounts for a significant percentage of hospital-acquired infections in the United States’ hospitals. The hospitalized patients have many episodes of nosocomial bacteremia. CA-bacteriuria leads to a significant use of an antimicrobial in hospitals and makes up a large pool of antimicrobial-resistant organisms associated with cross-infection. It has considerable implications for patients and be the main concern for infection prevention programs. Not surprisingly, perhaps the most effective way of improving practice on catheter placement and removal requires measures to change habits of nurses and physicians about the need for urinary catheters. The outcome would be a reduction of unnecessary catheterization and the prompt removal of catheters when they are no longer required. The solution requires educating nurses and other healthcare professionals on the issue. The education program would focus on reducing unnecessary catheter placements and removal of unnecessary Urinary catheters.

Methods used to evaluate effectiveness of proposed solution

A survey would be an appropriate method to evaluate the effectiveness of the proposed solution. Simply put, Patients who do not use catheters cannot develop CAUTI.  A survey of the number of patients with CAUTI would help determine the effectiveness of the solution. A reduction in the number of patients would mean that the solution is effective while stagnation or an increase in number would mean that the solution is not effective. A decrease in number would help determine that catheters are placed in patients who have an appropriate indication and therefore needed a catheter.

Reducing unnecessary catheter placements is an important first step to reducing inappropriate catheter use. While the step is effective and potentially more sustainable, removal of unnecessary Urinary catheters goes a step further by reducing infections in patients. Protocols that govern the two steps are important in regulating the inappropriate use of catheters. Protocols can generate accountability among nurses for placement of each patient urinary catheter. However, intervention outcomes can only be measured in patients(Lo et al., 2014).

Described variables to be assessed when evaluating project outcomes

Various before-and-after studies of interventions to reduce inappropriate catheter placement have resulted in a decrease in the proportion of catheters in use without the order of a physician, a low proportion in the use of urinary catheters and a decrease in the proportion of catheters in place without an appropriate indication(Meddings et al., 2013). The variables are reflected in the number of patients with CAUTI.

Developed tools necessary to educate project participants

There are various tools that may be used in the education of project participants. The reduction of unnecessary catheter use often necessitates a change of well-established habits and beliefs of physicians and nurses. To ease the implementation of the project, Johns Hopkins University collaborative model for transformational change may be used. The model is based on four E’s that comprise of Engage, Educate, Execute, and Evaluate. Engagement and education require provision of information in various formats detailing the required intervention steps and measures of outcomes.  Execution requires participation in workshops and conference calls as well as the provision of expert and coaching. Execution steps require measures such as daily patient rounds or known as catheter patrol necessary to assess catheter necessity and presence and necessity. Feedback should be provided to specific units, and strategies on should be implemented at this step. Strategies may include promotion of the use of catheter alternatives or reminder catheter system. A baseline assessment and periodic reassessments may be conducted to measure sustainability and progress. A model is an important tool that has been effective in various studies.

Guidelines may also be used as tools to educate participants. Such guidelines may be found in websites owned by CDC and HICPAC. The model and guidelines should be tailored to include other indications based on specialized patient populations and local opinion. A Urinary catheterization policy may be used as a tool to embed evidence-based practice in the organization. A bladder scan policy is an important tool used in the assessment and confirmation of urinary retention to determine whether catheterization is justified. Posters on indications for Urinary catheters and urinary catheter risks and indications are also important tools that may be used in educating project participants’ appropriate indications and non-indications and risks associated with the use of Urinary catheters. Others may include urinary catheter decision-making algorithm and info-graphic posters on prevention of CAUTI (Shekelle et al., 2013).

Developed assessment tool necessary to evaluate project outcomes

Reducing unnecessary catheter placements and removal of unnecessary Urinary catheters requires ongoing surveillance to evaluate outcomes. Observations can be conducted to assess whether catheters are left in place when not needed or whether they have been removed. By default, hours may go by before unnecessary catheters are removed or even recognized. Thus, additional assessment tools may be required to evaluate project outcomes. Such may involve assessing daily checklist used by participants in the project. A survey may also be used as an effective tool that reflects the long-term gains of interventions employed.  A survey would involve comparing the proportion of patients with CAUTI before the introduction of interventions with the proportion of patients with CAUTI after the introduction of the intervention.

References

Lo, E., Nicolle, L. E., Coffin, S. E., Gould, C., Maragakis, L. L., Meddings, J., … & Yokoe, D. S. (2014). Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35(S2), S32-S47.

Meddings, J., Rogers, M. A., Krein, S. L., Fakih, M. G., Olmsted, R. N., & Saint, S. (2013). Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review. BMJ quality & safety, bmjqs-2012.

Shekelle, P. G., Wachter, R. M., Pronovost, P. J., Schoelles, K., McDonald, K. M., Dy, S. M., … & Larkin, J. W. (2013). Making health care safer II: an updated critical analysis of the evidence for patient safety practices. Evidence report/technology assessment, (211), 1-945.



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