Developing an Implementation Plan

Running head: DEVELOPING AN IMPLEMENTATION PLAN Developing an Implementation Plan Ancy Vallavanatt Grand Canyon University Professional Research Project NRS-441 Joyce Morrison September 10, 2011 Developing an Implementation Plan Implementation Strategy 1.Obtain necessary paper work for approval from superiors and fellow staff members 2.Highlight current problems related to catheterization and CAUTI 3.Present proposed solution 4.Provide detailed explanation of the proposed solution a.Proper assessment for catheterization b.Explore other options c.Proper catheter type and size d.Proper process of insertion e.Proper anchoring or securing f.Proper maintenance and timely removal 5.Provide implementation logistics 6.Present resources needed for implementation a.Staff members b.Educational materials like power point presentation, c.Assessment tools like questionnaires, d.Technology e.Funds Implementation Plan Obtaining Necessary Approvals The initial step in the implementation plan is to establish different committees that will focus on the proposal, implementation and evaluation process. The goal of the proposal committee is to obtain necessary approvals, support, and feedback from Nursing Management, the Chief Nurse, and other staff members of the institution, like pharmacists, dieticians, and others. Part of the committee`s goal is to make sure that any mission, views or objectives of the institution are not compromised. Presenting the proposal to the concerned health care providers can be done through electronic means but presenting a hard copy is a better and more formal approach. When the approvals have been obtained, the implementation group will begin their tasks. Current Problem One of the traditional responsibilities of a nurse is urinary bladder catheterization. In the hospital setting, up to 31% of patients has a urinary catheter CITATION Nic05 \l 1033 (Nicolle, 2005). This commonality of catheterization does not ensure its safety. In relation to the issue of CAUTI, nurses play a major role. Maintaining the urinary catheters sterility and patency is their primary goal. Despite this, 80% of all urinary tract infections are associated with the insertion of a urinary catheter CITATION Ven07 \l 1033 (Venkatram, Grosu, Torchon, & Soni, 2007). Many factors can affect the risk for CAUTI like the process of insertion, the type catheter used, and the patient`s hygiene. However, all these factors can be influenced by the nurse. That is why nurses are the major contributors CITATION Pel09 \l 1033 (Pellowe, 2009) for this project. The unnecessary prolonged use of a urinary catheter is a major problem which increases the risk for CAUTI CITATION JMT09 \l 1033 (Barford & Coates, 2009). According to Foxley (2011), evidence shows that most cases of catheterizations are unjustified and exposes patients to significant risk for urinary tract infection. Appropriate indication for catheterization should be properly assessed before deciding to insert a catheter. The issue of aseptic and sterile technique is also important since catheterization is a very invasive procedure. Choosing of the proper type and size of catheter is also relevant to avoid further damage or injury to the patients which also increases the risk for infection CITATION Poi10 \l 1033 (Poisson, Johnston, & Josephson, Urinary Tract Infections Complicating Stroke, 2010)as well as the proper securing or anchoring of the catheter CITATION JMT09 \l 1033 (Barford & Coates, 2009). Maintaining a closed system is also important when a urinary catheter is already in place CITATION Pel09 \l 1033 (Pellowe, 2009). Proper patient hygiene especially for women is necessary to avoid any infection, even those not related to catheter insertion CITATION MND09 \l 1033 (Dudley & Barriere, 2009). The timely removal of the urinary catheter is also a vital factor in the risk for CAUTI CITATION Nic05 \l 1033 (Nicolle, 2005). Each of these problems involving the urinary catheter can be influenced by the nurse that is why focus on this project is on them. Proposed Solution and Rationale This proposed solution includes providing detailed information for the health care practitioners as well as to the family on the proper process of catheterization. First and foremost, indication for catheter insertion should be assessed properly and thoroughly. Other options should be explored first before finally deciding to insert a catheter. According to Makic, VonRueden, Rauen & Chadwick (2011), clear indications for catheterization include the following: urinary retention or obstruction, alteration in volume status or blood pressure, need for accurate input and output where a patient cannot use a urinal or bedpan, emergency surgery, major trauma, urologic procedures, bladder irrigation, management for stage III or above pressure ulcers and comfort care for terminally ill patients. The health care practitioner, knowing these indications is the first step to prevent CAUTI. When there are no other options except to catheterize, the choice of catheter type and size is very important (Slater, 2011). Every health care facility must consider exploring other alternatives to indwelling urinary catheter like external catheters, intermittent catheterization or suprapubic catheters for selected patients when appropriate (Gould, Umscheld, Agarwald, Kuntz & Pegues, 2009). In relation to Urinary catheter size, according to Pratt & Pellowe (2010) and Gould et al. (2009), the smallest appropriate catheter gauge should be selected to allow free urinary outflow and to minimize bladder neck and urethral trauma. Larger catheters may cause leakage and increased pain; however they are useful after urologic advice (Madeo & Roadhouse, 2009). In relation to the balloon size of the indwelling catheter, a 10ml catheter balloon should be used for adults while a bigger size may be required for urologic patients (Pratt & Pellowe, 2010). The next factor to be considered in preventing CAUTI is to take note is the material of the catheter. There are two types of material used for catheters: latex and silicone CITATION Sai99 \l 1033 (Saint & Lipsky, 1999). Latex catheters coated with polytetraflouroethylene are said to reduce urethral irritation CITATION Nic05 \l 1033 (Nicolle, 2005). Hydrogel-coated latex cores become smoother upon insertion when it comes in contact with the moisture inside the urethra CITATION Ven07 \l 1033 (Venkatram, Grosu, Torchon, & Soni, 2007). A hydrogel-coated latex catheter is also resistant to bacterial colonization and encrustation. Silicone catheters have wider lumens that promote better drainage (Madeo & Roadhouse, 2009). However, it is quite stiff which can be uncomfortable. The most approved type of catheter is the silver alloy and hydrogel-coated catheters (Gentry & Cope, 2005; Kassler & Barnett, 2008; Seymour, 2006; Jenkinson, 2006; Scott, 2010). Catheterization is an aseptic procedure which requires sterile equipments. It is a fundamental skill learned by nurses (Makic et al., 2011). Suffice to say that catheterization requires trained and competent personnel for its insertion and maintenance (Gould et al., 2009; Pratt & Pellowe, 2010). The most primary step before catheter insertion is to perform hand hygiene. Equipments are then prepared, like sterile gloves, drapes, sponges, antiseptic solution and single-use lubricant pack (Gould et al., 2009). Meatal care is also part of proper catheter care. Research shows that the use of antiseptics cleansers, creams or lotions made no difference from the use of soap and water for perineal care to reduce CAUTIs. Some antiseptics may even increase the risk for irritating the urethral meatus (Makic et al., 2011). Proper securing of the catheter prevents urethral trauma or traction, erosion and accidental removal (Gould et al., 2009). Experts also suggest securing the outer part of the device to the upper thigh in females and abdomen in males (Makic et al., 2011). It may be through the use of adhesive tapes to prevent it from being dislodged when the patient moves. These techniques and methods will then be used for the actual implementation of interventions. Catheter maintenance involves keeping a closed drainage system which is central to the prevention of CAUTIs. This entails connecting the catheter to a sterile and sealed urinary drainage system. When an open system is used there is a 97 percent risk for infection whic...