This assignment will utilize the ACE Star Model of Knowledge Transformation to explore a nursing practice issue and guide the change process. Follow the outlined steps without referencing Nurse Daniel’s example. The focus should be on your specific topic, intervention, and change project.
Star Point 1: Discovery (Identify Topic and Practice Issue)
Topic and Nursing Practice Issue
The topic of focus is healthcare-associated infections, specifically Catheter-Associated Urinary Tract Infections (CAUTIs). These infections, acquired in medical settings, represent a major nursing practice issue.
Rationale for Topic Selection
CAUTIs are a critical concern due to their preventable nature. Addressing this issue can significantly improve patient outcomes, reduce hospital stays, and decrease healthcare costs. With proper catheter management, the incidence of CAUTIs can be minimized, if not entirely eliminated.
Problem Scope
Urinary tract infections are among the most common healthcare-associated infections. Around 80% of these infections are linked to long-term catheter use, with approximately 13,000 annual deaths attributed to catheter-related UTIs. This issue increases both the length of hospital stays and overall healthcare costs.
Star Point 2: Summary (Evidence to Support Need for Change)
Practice Problem
Since 2008, Medicare has stopped reimbursing for CAUTI treatment, as these infections are considered preventable. Although nurse-driven protocols have been suggested to promote timely catheter removal, research analyzing their impact on clinical outcomes remains limited.
PICOT Question
In acute care patients (P), does a nurse-driven protocol (I), compared to traditional management (C), reduce the incidence of catheter-associated urinary tract infections (O) within six months (T)?
Systematic Review
Durant, D. J. (2017). Nurse-driven protocols and the prevention of catheter-associated urinary tract infections: A systematic review. American Journal of Infection Control, 45(12), 1331-1341. https://doi.org/10.1016/j.ajic.2017.07.020
Additional Sources
Russell, J. A., Leming-Lee, T., & Watters, R. (2019). Implementation of a nurse-driven CAUTI prevention algorithm. Nursing Clinics of North America, 54(1), 81-96. https://doi.org/10.1016/j.cnur.2018.11.001
Wood, K. L. (2018). Do nurse-driven protocols have an impact on the prevention of catheter-associated urinary tract infections? American Journal of Infection Control, 46(6), S83. https://doi.org/10.1016/j.ajic.2018.04.162
Key Findings and Evidence Strength
The review suggests that nurse-driven protocols have a favorable impact on reducing CAUTI incidence, though more rigorous studies are needed. The review demonstrates strong methodological transparency and an effort to reduce bias, but there is room for improvement in quality improvement study designs.
Evidence-Based Solutions
One solution includes forming a multidisciplinary taskforce to oversee CAUTI prevention. Studies indicate that such teams can drive significant improvements in infection rates by implementing quality control measures.
Star Point 3: Translation (Action Plan)
Care Standards and Protocols
Key protocols include hand hygiene before catheter handling, using aseptic techniques for insertion and removal, securing the catheter and drainage bag, and maintaining sterility.
Stakeholders and Roles
- Nurse Leader: Oversees the trial and ensures smooth project operations.
- Unit Nurses: Responsible for catheter care and replacement procedures.
- Patients: Provide informed consent and assist in identifying signs of CAUTI.
- Medical Doctor: Orders the indwelling catheter and monitors patient care.
- Certified Nursing Assistants: Provide daily catheter care.
Nursing Role in the Change Process
As the nurse leading the trial, I will ensure all materials, training, and documentation are in place to facilitate the change process. The nursing team will handle catheter care and participate in the trial’s success by adhering to the new protocols.
Cost Analysis
A cost-effectiveness analysis will be needed to assess the intervention’s financial viability. The finance department must be involved to allocate resources and manage the budget for the trial.
Star Point 4: Implementation
Permission Process
Before initiating the trial, permission from the healthcare administration is required, along with collaboration from the finance department to secure funding.
Staff Education
Staff education will be conducted through the involvement of a nurse educator, who will train staff on CAUTI prevention and best practices. Continuous training will be offered throughout the trial.
Implementation Timeline
The trial will span six months, starting with staff training, followed by the trial phase involving patients who provide informed consent.
Measurable Outcomes
The primary measurable outcome will be the reduction in CAUTI incidence over six months. This will be tracked using event reports, medication records, and catheterization frequency.
Forms for Recording
Staff self-assessment forms and patient care tracking sheets will be used to document progress and staff preparedness during the trial.
Available Resources
Additional catheter care supplies, educational resources on CAUTI prevention, and staff support tools will be made available throughout the trial.
Stakeholder Meetings
Stakeholders will meet weekly during the first month and bi-weekly thereafter to review progress and make necessary adjustments.
Star Point 5: Evaluation
Reporting Outcomes
Trial outcomes will be summarized in a report displayed in common areas and presented at a final meeting.
Next Steps
Based on trial outcomes, future CAUTI prevention strategies will be refined, focusing on scaling effective interventions and improving patient care.
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