Running head: CAUTI PREVENTION

Leadership Strategy Analysis: Catheter Associated Urinary Track Infection Prevention Victoria DesJardins Emily Kosmicki Ferris State University

CAUTI PREVENTION Abstract Making a change in policy at a hospital can be a difficult and time-consuming process.

An area for improvement was discovered involving the prevalence of catheter associated urinary tract infections (CAUTI) on the orthopedic and progressive unit, in addition to other areas of Butterworth hospital. By using a transformational leadership approach, a group of staff from different disciplines was gathered, and a plan was developed. The change involved reducing the amount of urinary catheters used hospital wide and decreasing the length the catheters were in place. By using a prove it or remove it practice, the length of time a urinary catheter was in place greatly decreased. By implementing this change, the quality of care and patient safety and improved. The purpose of this paper is to discuss the steps that were taken to develop and implement the change in the urinary catheter use policy to decrease the amount of CAUTIs and improve patient satisfaction.

CAUTI PREVENTION Leadership Strategy Analysis: CAUTI Prevention Indwelling urinary catheters are commonly found in the hospital setting with

about 15-25% of all hospitalized patients having a catheter placed to monitor strict intake and output or following a surgery (Griffiths & Fernandez, 2007). The orthopedic and progressive care unit at Butterworth hospital cares for many surgical patients who often have urinary catheters placed. Unfortunately, CAUTIs are common concern when urinary catheters are used (Oman et al., 2012). In order to ensure the quality and safety of the patients, a change in policy is required to decrease the rate of CAUTIs on the unit and hospital wide. Research has shown that limiting the amount of catheters placed was determined to be a positive outcome in decreasing CAUTIs. Since urinary catheters cannot always be avoided, another intervention that was found to have a positive outcome was removing the urinary catheter immediately when no longer needed (Griffiths & Fernandez, 2007). By decreasing the rate of CAUTIs on this unit, it will provide a safer environment for the patients, improve infection control, be cost effective, and increase the quality of patient care. When initiating a plan of action for CAUTI prevention on this unit, a transformational leadership approach will be used. Yoder-Wise (2011) describes this approach as an inspiring vision that changes the framework of the organization for employees (p.42). Using this style of leadership, employees are encouraged to voice their ideas and opinions regarding the problem at hand (Yoder-Wise, 2011, p.42). YoderWise (2011) states, leadership is the ability to influence people to work toward meeting certain goals (p.42). The employees involved are the ones who will be implementing the change. Without their dedication and willingness to incorporate new protocols, this

CAUTI PREVENTION change will not be effective. Using the transformational leadership approach will empower the employees and help further motivate them to initiate the change by involving them in the process (Yoder-Wise, 2011, p.42). Clinical Need During a meeting regarding patient satisfaction scores, hospital leadership recognized an opportunity to change regarding CAUTIs. In addition to not being financially reimbursed in the care of these infections, the patients were also discussing their negative experiences involving urinary catheter use. Research was done to determine ways to prevent CAUTI occurrence in the hospital. A study done by Bernard, Hunter, & Moore (2012) found that reducing the length of urinary catheter duration

showed to decrease the incidence of CAUTIs. Another study they looked at also showed a decrease in CAUTIs from using fewer urinary catheters and limiting the duration they are used (Rothfeld & Stickley, 2010). It was determined by the leadership team that in order to decrease the rate of CAUTIs in the hospital, a change was to be made regarding when to use urinary catheters along with the duration they were in place for. This change helps decrease the patients risk of getting an unnecessary infection, which not only improves the quality of care they receive but also ensures their safety. The money the hospital saves by reducing CAUTI occurrence could be used in other areas to improve the quality of patient care in addition to improving patient satisfaction. Interdisciplinary Team When making a change, it is important to involve an interdisciplinary team in the planning and implementation of the process. Those involved included physicians, nurse

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managers, bedside nurses, care managers, infection control, hospital board members, and finance. Most of these members involved were also part of a committee called Team Butterworth. The purpose of this committee is to develop ways to improve patient satisfaction at Butterworth hospital. The physicians role was important in this process because they are the ones who put the order in to discontinue the urinary catheter. The surgeons also needed to reevaluate the need to use urinary catheters during certain surgeries or if they could still ensure patient safety without using them. Infection control was key in providing research regarding CAUTIs and effective interventions to reduce them. The finance members discussed the costs of each infection and the amount of money the hospital could potentially save. In order to get the final approval on the change in policy, it was to be approved by the board members. It is their responsibility to ensure that the new change will continue to follow the standards made by the Joint Commission along with ensuring patient safety. Data Collection After it was determined a change was needed, research was done to discover effective interventions to decrease CAUTI occurrence. This research was important in ensuring the new policy is current with evidence-based research. The new policy included a prove it or remove it scenario. A list of specific instances where urinary catheters were appropriate to stay in was developed. Nurses were to evaluate their patients daily to determine if they could prove that the urinary catheter should not be removed. If determined the catheter was inappropriate, a communication note was written to the doctors involving why the nurse believed the catheter should be removed.

CAUTI PREVENTION A unit in the hospital was then chosen to pilot the new policy. The unit was

selected based on the amount of urinary catheters used and the reason for their use. After trialing the new policy for two months, data was collected to determine if the rate of CAUTIs on the unit had decreased. Outcomes This change was proposed in order to increase quality of care the patients receive during their hospital stay and to ensure their safety. By changing their practice and implementing this change, the nurses are able to continue to up hold the tenth standard of nursing, quality of practice. The American Nurse Associations (2011) tenth standard of nursing care states that nurses are to develop, implement, and/or evaluate policies and procedures to improve the quality of patient care (p.52). This new policy change was developed using evidence-based nursing research. By implementing this new policy to create a positive change for the patients and improve the quality of care, the nurses are maintaining this standard of nursing practice. Implementation Strategies The three dimensions of strategic change is a three step process developed by Pettigrew and Whip that is thought to be an effective way to implement change in the health care setting (Stetler, Ritchie, Rycroft-Malone, Schultz, and Charns, 2007). The three steps to this strategy are content, process, and context. The content phase is the step where the goals and objectives are developed (Stetler et al., 2007). The goals of the hospital are to reduce the CAUTI occurrence and increase patient satisfaction and quality of care. The second phase of this process is the process step. During this phase, implementation is focused on and plans are developed on how the goal or objectives are

CAUTI PREVENTION going to be met (Stetler et al., 2007). For the urinary catheter policy change, this is the stage where the research was done to determine the best interventions to use to see a positive outcome. This is also where the plan was developed to implement the prove it

or remove it protocol. The last step of the strategy is the context phase. This step is used to determine where this change is going to take place (Stetler et al., 2007). The hospital decided to start with implementation just on one unit. After positive results were seen, the policy was to take affect hospital wide. Evaluation Whenever a plan is implemented, it is important to evaluate the progress to ensure the plan is effective. The main goal of this policy change was to prevent and decrease the rate of CAUTIs in patients at Butterworth hospital. By making this change, patient satisfaction was predicted to increase in areas involving catheter use. To evaluate the progress of this plan, the rates of CAUTIs were measured and analyzed each month. This enabled leadership to see whether or not there was an improvement in the occurrence of CAUTIs on each floor and hospital-wide. The patient satisfaction surveys were also reviewed to determine if patients had an overall better experience during their stay. It may take more time to see an improvement in patient satisfaction due to the amount of time it takes to receive the surveys after completion. Conclusion The occurrence of CAUTIs was determined to be having a negative affect on patient satisfaction and affecting patient safety. In order to improve this problem, and improve quality of care and patient safety in Butterworth hospital, a change in the urinary catheter use policy was needed. Making a change in policy at a hospital can be a difficult

CAUTI PREVENTION and time-consuming process. Many different disciplines were involved in making this change. By working together and using evidence-based research, a positive change has occurred and patient safety and quality of care has improved. Research is always

changing and discovering better way to care for our patients, making it important to have an effective and thorough method to making changes to the way we provide care.

CAUTI PREVENTION References American Nurses Association (2010). Nursing: Scope and Standards of Practice (2nd ed.). Silver Spring, Maryland Bernard, M. S., Hunter, K. F., & Moore, K. N. (2012). A Review of Strategies to Decrease the Duration of Indwelling Urethral Catheters and Potentially Reduce

the Incidence of Catheter- Associated Urinary Tract Infections. Urologic Nursing, 32(1), 29-37 Griffiths, R., & Fernandez, R. (2007). Strategies for the removal of short-term indwelling urethral catheters in adults. Cochrane Database Of Systematic Reviews, (2). Oman, K. S., Flynn, Fink, R., Schraeder, N., Hulett, T., Keech, T., & Wald, H. (2012). Nurse-directed interventions to reduce catheter-associated urinary tract infections. American Journal Of Infection Control, 40(6), 548-553. doi:10.1016/j.ajic.2011.07.018 Rothfeld, A., & Stickley, A. (2010). A program to limit urinary catheter use at an acute care hospital. American Journal Of Infection Control, 38(7), 568-571. doi:10.1016/j.ajic.2009.12.017 Stetler, C., Ritchie, J., Rycroft-Malone, J., Schultz, A., & Charns, M. (2007). Improving quality of care through routine, successful implementation of evidence-based practice at the bedside: an organizational case study protocol using the pettigrew and whipp model of strategic change. Implementation Science, 2(3), 1-13. doi: 10.1186/1748-5908-2-3 Yoder-Wise, P. (2011). Leading and managing in nursing. (5th ed.). St. Louis, MO: Elsevier Mosby.