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Patient Safety & Quality: Preventing Urinary Tract Infections Dana L Knoll Ferris State University

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Patient Safety & Quality: Preventing Urinary Tract Infections Throughout history nursing has transformed and continues to change to better reflect research proven best practices. Nursing has become a science that is focused not only on the patient, but also on safety and quality of care. Procedures and techniques that were once just the way things are done are continually examined and reviewed so that only those techniques proven to be the best practice for patient safety and quality of care continue to be applied. One such technique that is still being fine-tuned is catheter insertion/care/removal. Catheterassociated urinary tract infections (CAUTIs) account for 565 million dollars annually and have caused an estimated 8,205 deaths per year (Liljenstope, 2013). The goal of reducing CAUTIs is best addressed by emphasizing patient safety and quality of care. Defining Standards As defined by the World Health Organization, patient safety is the prevention of errors and adverse effects to patients associated with healthcare (2013). The American Nurses Association defines quality care as the degree to which health servicesincrease the likelihood of desired outcomes and are consistent with current professional knowledge (2010, p. 67). When a patient acquires a CAUTI both patient safety and quality of care are being dishonored. The safety of a patient is compromised once they acquire a CAUTI because this can lead to further complications if left untreated. Quality care has not been provided because the initiated health services (catheter insertion) have not resulted in a desired outcome. Indwelling catheter insertion is meant to be a sterile process to help safeguard against possible infections. Additional steps have been initiated countrywide by many different hospitals to decrease the incidence of CAUTIs.

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Liljenstolpe writes about the Surgical Care Improvement Project (SCIP), a movement supported by the Centers for Medicare and Medicaid Services, and the protocol they have developed to decrease incidence of CAUTIs. Statistically, risk for UTI rises to 9.4% if an indwelling catheter remains in place for 2 days and increases by 5% for each day past that (Liljenstolpe, 2013). According to SCIP protocol indwelling urinary catheters should be removed before midnight of the second postoperative day and patients and nurses alike should be educated regarding the importance of this step (2013). By simply limiting the number of days of an active indwelling catheter, nurses can greatly decrease the incidence of CAUTIs. Buchmann & Stinnett (2011) write about Huntsville Hospital System of Huntsville, Alabama. In an effort to decrease CAUTIs, a hospital wide task force was developed. The task force established a Plan-Do-Check-Act model to be implemented in units throughout the hospital. The model was used to develop protocol to determine best practice for catheter use, insertion, care and removal, implement an assessment checklist to further ensure use of protocol and lastly collect data across the hospital for two years to determine progress. After 2 years, some units of the hospital saw a 61% reduction in urine NIMs [nosocomial infection marker] ( Buchmann & Stinnett, 2011). Nursing Theory Ida Jean Orlando was a nursing theorist who thought that the nursing process involved nurse reactions to patients verbal and nonverbal needs. By understanding and reacting to these needs, the nurse is able to not only treat the distress, but also prevent such distress. As this applies to actual practice, the nursing process should not only focus on providing solutions, but also preventing future problems (Taylor et al, 2011, p. 74). In the situation of CAUTIs,

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Orlandos nursing process is perfectly applicable. Both protocols related to CAUTI reduction identified a problem and worked to not only fix the problem, but also prevent such infections from occurring in the future. Conclusion CAUTIs pose a major threat to maintaining patient safety and quality of care. Not only do CAUTIs threaten patient safety and care, but our changing model of healthcare and insurance are affected as well. If a patient comes into a hospital for treatment and develops a UTI while receiving care, insurance companies can (and are starting to) refuse to pay for treatment related to the new hospital-acquired infection. By recognizing this problem as preventable, nurses are able to not just treat CAUTIs when they arise, but hopefully prevent them from occurring in the first place. Although medicine has not found the answer to 100% prevention, the wheels are finally in motion and progress is made everyday.

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American Nurses Association. (2010). Nursing scope and standards of practice (2nd ed.). Silver Spring, MD: Nursesbooks.org Buchmann, B., & Stinnett, G. (2011). Reducing rates of catheter-associated urinary tract infection. Alabama Nurse, 38(2), 5. Liljenstolpe, S. (2013). Don't Skip the SCIP. Arizona Nurse, 66(2), 6. Retrieved June 13, 2013, from the Academic OneFile database. Patient Safety. (n.d.). World health organization regional office for Europe. Retrieved June 13, 2013, from www.euro.who.int/en/what-we-do/health-topics/Health-systems/patientsafety Taylor, C. (2011). Theory, Research, and Evidence-Based Practice. Fundamentals of nursing: the art and science of nursing care (7th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.