Assignment
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CLC EBP Research Table
CLC: EBP Research Table
Citation Include the APA reference note. | Abstract/Purpose Craft a 100-150 word summary of the research. | Research/Study Describe the design of the relevant research or study in the article. | Methods Describe the methods used, including tools, systems, etc. | Setting/Subject Identify the population and | Findings/Results Identify the relevant findings, including any specific data points that may be of interest to your EBP project. | Variables Describe the independent and dependent variables in the research/study. | Implication for Practice Articulate the value of the research to the EBP project your group has chosen. | ||
Independent Variable | Dependent Variable | ||||||||
Black, M., Singh, V., Belostotsky, V., Roy, M., Yamamura, D., Gambarotto, K., & ... Kam, A. J. (2016). Process Mapping in a Pediatric Emergency Department to Minimize Missed Urinary Tract Infections. International Journal Of Pediatric , 1-4. doi:10.1155/2016/2625870 https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=119493418&site=eds-live&scope=site | A quality improvement initiative was undertaken to reduce CAUTIs in tertiary pediatric ER. A retrospective study was done on children less than 3 years old with positive urinary cultures. In 12% of the children presented with a UTI there was not treatment of follow up. A process map was implemented to determine how many UTI where missed. After the implementation of the PM, it was noted that only 1% of those patients had a missed UTI. | A QI study was put together from a retrospective study was used to collect data and to review current practices used to identify and manage current UTI’s in the pediatric ER. Patients that where seen by a subspecialist where removed from the study. The ER used paper charts that where scanned electronically. These charts where then review by two researchers. The main focus was to evaluate if the wrong antibiotic was used or if a follow up was performed using a PM (process mapping) tool. | A follow up chart review was performed to evaluate the impact of mapping process (MP) as an analytical tool. This MP tool can be used to effectively reduce missed UTI diagnosis and reduce future UTIs in pediatric ER patients. | All children less than 3 years old coming to the ER with a UTI where considered. | In the initial chart review, identified 159 patients under 3 years of age. Of the 159 cases, 82 charts where eligible for the study. 46 percent of the cases, or 38 cases received antibiotics. In 17 percent of the cases, 14 cases, antibiotics where given but no follow up was conducted. In 18 percent of the cases, or 15 cases no antibiotics where given, but a follow up was arranged with a pediatrician. Of the 15 cases, 5 did not have a UTI, 4 had a possible, and 6 had a UTI. In the subsequent chart review, of the 80 qualified charts it was revealed that 76 cases had a follow up and 4 cases did not have a follow up. | Identifying Patient coming into the ER, with urinary tract infections. | Pediatric patient coming into the ER. | ER with high pediatric volume are at risk for inefficiency. Improving the process in reporting the inefficiency of missed laboratory diagnosis in the ER can lead to a major decrease of UTIs in pediatric patients. | |
Davis, K. F., Colebaugh, A. M., Eithun, B. L., Klieger, S., B., Meredith, D. J., Plachter, N., ... & Coffin, S. E. (2014). Reducing catheter-associated urinary tract infections: a quality-improvement initiative. Pediatrics, peds-2013. Retrieved from http://pediatrics.aappublications.org/content/pediatrics/early/2014/08/06/peds.2013-3470.full.pdf | This article discusses Catheter Associated Blood Stream Infections (CAUTIs) and interventions to prevent this occurrence in hospitalized children over the course of three years. The study about CAUTIs was conducted by an observational study with a retrospective analysis. The researchers implemented a CAUTI prevention bundle to see if this would help reduce the CAUTI rates on the pediatric unit studied. The prevention bundle includes primary interventions or “drivers,” such as, “minimize exposure to devices, evidence-based practices of catheter insertion, communication and transparency, infrastructure support, compliance with basic standards of urinary catheter care, and education/training” (Davis, 2014, p. 859). The result of the prevention bundle was favorable and showed a decrease of 50% of CAUTI rates in the chosen population. | Observational study: “assess changes in infection rates before and after a multidisciplinary QI project was initiated (July 2010) to reduce the rate of pediatric CAUTI throughout the institution, a 500-bed tertiary care children’s hospital where ∼40% of beds are in ICUs” (Davis, 2014, p. 858). Data collection was done by “CHOP Department of Infection Prevention and Control to identify all CAUTIs and capture hospital-wide urinary catheter device days” (Davis, 2014, p. 860) Retrospective analysis: “For our analysis of epidemiologic characteristics of CAUTI, we performed univariate analyses to summarize patient-level demographic, clinical, and microbiologic characteristics. We summarized results as frequencies and percentages. Comparisons were made by using Fisher’s exact test or Wilcoxon rank-sum (Mann-Whitney) test” (Davis, 2014, p. 861). | “An observational study was conducted to assess the impact of a CAUTI quality improvement prevention bundle that included institution-wide standardization of and training on urinary catheter insertion and maintenance practices, daily review of catheter necessity, and rapid review of all CAUTIs” (Davis, et. al, 2014, p. 857). | Pediatric patients of a tertiary care children’s hospital from June 2009- June 2012 | “50% reduction in the mean monthly CAUTI rate (95% confidence interval: 21.28 to 20.12; P= .02) from 5.41 to 2.49 per 1000 catheter-days. The median monthly catheter utilization ratio remained unchanged; ∼90% of patients had an indication for urinary catheterization. Forty-four patients experienced 57 CAUTIs over the study period. Most patients with CAUTIs were female (75%), received care in the pediatric or cardiac ICUs (70%), and had at least 1 complex chronic condition (98%). Nearly 90% of patients who developed a CAUTI had a recognized indication for initial catheter placement” (Davis, 2014, p. 857). | CAUTI prevention bundle | Reduced CAUTI rates in hospitalized children | The value this EBP practice has on nursing practice is substantial. With reduction in CAUTI rates, children can have improved outcomes and experienced decreased lengths of stay in the hospital compared to not implementing the EBP practices described in the bundle. | |
(Quantitative article) Marra, A. R., Camargo, T. Z., Goncalves, P., Sogayar, A. M., Moura Jr, D. F., Guastelli, L. R., . . . Edmond, M. B. (2011). Preventing catheter-associated urinary. American Journal of Infection Control, 1-6. | The article identifies CAUTIs one of the major illnesses that affect patients in the critical care setting. Research undertakes a quasi-experimental study with several interferences that lessen the occurrence of CAUTI in an intensive care unit (ICU). The study also analyzes the differences in causative microorganisms and CAUTI rates. The conclusions of the survey were that there was a statistically meaningful decline in the cases of CAUTI in the ICU. The other results of the investigation are that lessening the rates of CAUTI in the ICU context is a complicated process that requires the health professionals to make multiple performance measures and interventions. | The study utilized the quasi-experimental design. This design is applied in the study because the study involves a group of the patients in the ICU and SDU but do not use any random pre-selection processes. | The investigation was conducted in two phases. In the first stage, the nurses and physicians in the ICU implanted urinary catheters (UCs) using the aseptic procedure. The insertion and maintenance of the catheters were done according to the CDC requirements. UCs were replaced regularly with the patient’s physician having the sole responsibility of making the decision to remove the UC. The catheters maintained up to the point where the occurrence of an adverse effect requires its removal. The nurses working in these two units were assigned to directly observe UC insertion in a convenience representation of subjects and provide feedback on how the ICU team implemented the practices. The second phase of the process involved continuing the processes started in step 1 but included undertaking monthly audits of the processes in a small sample of subjects using the UC. The phase also included the implementation of a bladder bundle. The collected data include the quantity of CAUTI incidents before and after the interventions and interventions. | The population was the patients in a 38-bed ICU and two 20-bed SDUs with a similar that had similar features in a private hospital that offers tertiary care. The investigation was conducted at the hospital in the two units. | The results of the survey are that most of the CAUTIs cases that occurred in the SDUs and the ICU in both stages of the investigations were in the form of monomicrobial infections, but the implementation of the interventions led to a statistically notable decline in the CAUTI rate in both hospital settings used for the investigation. | The independent variable is the periods before and after the interventions. | The dependent variable was the quantity of CAUTI instances | The value if this research to the EBP project is that it provides evidence that implementation of evidence-based practices can make significant contributions to the reduction of CAUTIs in the inpatient acute care setting for pediatric patients in the ICU. | |
(Qualitative Article) Safdar, N., Codispoti, N., Purvis, S., & Knobloch, M. J. (2015). Patient perspectives on indwelling urinary catheter use in the hospital. American Journal of Infection Control, 1-2. | The article starts by stating that UTIs are one of the most common infections acquired in a hospital with most of them resulting from the CAUTIs. The purpose of this research was to find out the perspectives of patients on the indwelling urinary catheters. The investigations figured out that there was the need to improve the awareness and patient engagement concerning the use of indwelling urinary catheters. The findings of this research were that the health care sector requires implementing educational programs for both patients and health care workers. The implementation has the potential to increase the involvement of patients in making decisions about the use of catheters and may lead to a decline in the occurrence of CAUTIs in the hospitals and the ICU. | The study uses the grounded theory qualitative research design. The study uses this model because it derives its interpretations from raw data collected using qualitative methods. | The methods of the study involved the use of a semi-structured interview guide that the investigators used for interviewing patients in their rooms one at a time where there were no visitors in the rooms but after getting the treating team’s approval. Each patient gave a written consent before the participation in the study. The interviews were recorded and transcribed. After data collection, a systematic textual inquiry was used to code the qualitative data to detect trends. | The population was twenty adults. The relevant findings that may be of interest to my EBP project were that most of the participants had got been informed about any risks they faced for the use of the catheter and were not notified of any alternative ways of excretion. The study also found out improving patient awareness and engagement on the use of catheters has the potential to reduce the occurrence of CAUTIs in patients hospitalized with indwelling urinary catheters. The study was conducted in a hospital setting in the patient rooms. | The relevant findings that may be of interest to my EBP project were that most of the participants had got been informed about any risks they faced for the use of the catheter and were not notified of any alternative ways of excretion. The study also found out improving patient awareness and engagement on the use of catheters has the potential to reduce the occurrence of CAUTIs. | The independent variable was being hospitalized and using a urinary catheter | The dependent variable is the patient’s perspectives on urinary catheters | The value of this research to the EB project is that if provides vital information on how patients and health care workers can assist in reducing the rates of CAUTIs in the inpatient care setting for pediatric patients in ICU. | |
Palmer, J. A., Lee, G. M., Maya Dutta-Linn, M., Wroe, P., & Hartmann, C. W. (2013). Including Catheter-Associated Urinary Tract Infections in the 2008 CMS Payment Policy: A Qualitative Analysis. Urologic Nursing, 33(1), 15-23. doi:10.7257/1053-816X.2013.33.1.15 | The Centers for Medicare and Medicaid Services (CMS) aimed to study “views about the inclusion of CAUTIs in the 2008 CMS payment policy and its potential impact on hospital practices” (Palmer, et. al, 2014). The policy change took place as a result of increased costs of preventable hospital-acquired ailments, such as, Catheter-Associated Urinary Tract Infections (CAUTIs). If there was no longer a reimbursement for such ailments, the CMS wanted to see if this would encourage a change in practices to decrease the number of CAUTIs in their patients served. Thirty-six infection preventionists were interviewed nationwide. The participants offered a variety of reviews. Some stated that they felt CAUTIs do not have as much of an impact to cost, while others felt the impact was large. Some felt that this change would create a change among all staff involved with the care of the indwelling catheter and ensuring the proper techniques are used in its’ care. | Cross sectional qualitative study with “open coding and constant comparative analysis” (Palmer, et. al, 2013). | “Participants were interviewed between September 2009 and February 2010” (Palmer, et. al, 2013). “Specific interview questions and probes that pertained to CAUTIs in relation to the CMS policy were reviewed in the analytic process” (Palmer, et. al, 2013). | Infection preventionists nationwide with a “nursing, medical, public health, or epidemiology degree. They perform such tasks as gathering and analyzing trend data on hospital infection rates, designing and implementing evidence-based infection prevention interventions, and teaching hospital personnel and the public about how to contain the spread of infectious disease” (Palmer, et. al. 2013). | “Two main themes emerged: 1) participants’ attitudes toward the inclusion of CAUTIs in the CMS policy, including issues of the infection’s significance, opportunity costs, and financial incentives; and 2) participants’ views about advances in clinical organizational behaviors and limited defensive practice” (Palmer, et. al, 2013). Other themes gathered describe that the study about CAUTI: “focuses on a relatively minor complication, may divert resources away from other prevention activities, may have minimal financial impact on hospitals’ bottom line, [result in] less frequent use of catheters for staff convenience, [improve] CAUTI prevention activities” and also show no impact (Palmer, et. al, 2013). | Inclusion of CAUTI in the CMS payment policy regarding reimbursement | Decreased incidents of CAUTIs | Based on this article, the value of the research to our EBP project is important. This article describes that if the payments for CAUTIs are not reimbursed, there can be an influence on creating changes in the methods of prevention. | |
Williams, L. (2016). Zeroing in on Safety: A Pediatric Approach to Preventing Catheter-Associated Urinary Tract Infections. AACN Advanced Critical Care, 27 (4), 372-378. doi:10.4037/aacnacc2016297 https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=120221582&site=eds-live&scope=site | An interdisciplinary team approach was taken to study CAUTI’s and how to reduce CAUTI’s in future Foley catheter insertion. The EBP research was conducted in Wisconsin Hospital where, 85 of 100 patients where noted as incurring a CAUTI, that’s an 8.5 percent in a 6 month period. The majority of the units where CAUTIs were identified where considered to be underperforming based on the NDNQI database. In a two-year period, several interventions where implemented and rigorously followed to minimize and even prevent future CAUTIs. The interventions included the re-educating of staff on the insertion of Foley catheters. Other measures that where implemented including establishing a strict bladder protocol to properly document and manage all future Foley insertions. This included mandatory data reporting and identifying when it is best to discontinue the Foley. | The implementation of the EBP was modeled from successful CAUTI studies performed in the adult hospital. | A team made up of administrative supportive personnel, clinical nurse specialist, pediatric urologist, infection control clinician, nursing staff trained with CAUTIs where all selected to reduce or eliminate future CAUTIs in the children hospital. A sterile process was developed and implemented with every Foley insertion. Every Foley remaining after the procedure was completed was followed by the team assuring those Foley catheters received meticulous care to avoid infection or complications. | The population studied were all pediatric patient needing a Foley insertion. This included patients coming into the emergency room, and patients in the perioperative arena, where most of the Foleys where inserted. | This study helps eradicate any CAUTI in the pediatric patient concurrently for two years in the children’s hospital. Foleys were not inserted for convenience purposes, instead a straight cath was performed when necessary. Strict mandatory documentation assured that every patient receiving a Foley was followed throughout their hospital stay. This assured that multidisciplinary rounds where conducted with every Foley patient, and that the Foley was discontinued if it was no longer required. Alternatives were readily available, such as condom catheters, urinals and other products. | Identify patient coming into the ER, with urinary tract infections. | Every Foley inserted was performed with meticulous care, using sterile drapes, sterile gloves. Providers hands where cleaned with hand scrub solution prior to donning sterile gloves. Cultures were ordered routinely prior to a Foley being inserted. | Adding a specialized multidisciplinary team to every Foley insertion will help reduce or eradicate future CAUTIs in pediatric patients. Closely monitoring and documenting in the EMR will increase multidisciplinary team to proactively reduce all future pediatric CAUTIs. |
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