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March 25, 2011 > Creating Healthier Hospital Stays

Creating Healthier Hospital Stays

Washington Hospital Nursing Team Wins Award for Clinical Evidence Based Practice Project

For the nurses at Washington Hospital, quality patient care means a lot of hard work and effort aimed at constantly improving patients' outcomes so that they can go home healthier than when they came to the hospital.

According to the American Nurses Association (ANA), patient outcomes are often influenced by nursing sensitive indicators - areas of care that improve based on a greater quantity or quality of nursing care, such as pneumonia, falls and pressure ulcers.

Last year, a team from Washington's 6 West nursing unit began working on a project to improve upon one of these nursing-sensitive indicators by reducing the number of catheter-associated urinary tract infections (CA-UTI) on the unit.


It Takes Teamwork

As one of the 10 evidence-based practice (EBP) teams created for the first time at the hospital, the multidisciplinary group included four 6 West staff nurses, the unit's manager and assistant manager, two physician champions, an information technology expert, the infection control coordinator, the hospital librarian, the evidence-based project manager and the clinical nurse specialist as project mentor.

"After looking at research findings on catheter-associated UTIs and national guidelines for Foley catheter care, the 6 West EBP team determined that there was a need to implement a quality improvement program on this unit due to lack of standardized Foley catheter care among doctors and nurses alike," explains Lauren Lucas, R.N., nurse manager of Washington Hospital's 6 West nursing unit.


The Quality Goal

The goal of the project, according to Lucas, was to study the quality of Foley catheter care the 6 West nursing unit by monitoring adults patients (18 years and older and excluding obstetrics) being treated on an acute medical/surgical unit to find out how evidence-based guidelines compared with the current practices at Washington Hospital.


Why?

"National guidelines from the Society for Healthcare Epidemiology of America and the Infectious Disease Society of America, as cited by the Institute for Healthcare Improvement (IHI), show that the duration of catheterization is the most important risk factor for development of infection," Lucas says.

"Furthermore, catheter-associated bacteriuria - the presence of bacteria in urine not due to contamination from urine sample collection - is common and increases by 5 percent to 8 percent each day during the catheterization period."

During the course of the study the team found no incidence of catheter-associated UTIs, according to the project's mentor, Jovie De Leon-Luck, R.N., M.S. Instead, to track progress, the team measured catheter days.


Keeping Score

"Pre- and post-intervention data for total catheter days was 341 days in March and 142 in July, a reduction of 58 percent," according to De Leon-Luck. "The average number of catheter days per patient was 3.22 for March and 1.55 for July, a reduction of 52 percent. Pre- and post-intervention compliance with the Foley Catheter Monitoring Tool was 75 percent in March and 91 percent in July, an improvement of 17 percent."

According to Lucas, the results highlight the positive impact nursing staff can make through interdisciplinary work with the physicians.

"Nurses are primarily the ones involved in direct patient care and are in an excellent position to monitor and prevent nosocomial - hospital-acquired infections like UTIs - incidences," Lucas says. "These indicators are used to assess the quality of nursing care given to patients and provide opportunities to improve outcomes and processes of care.

"Since performance data are made available to the public, consumers are able to determine how a certain hospital compares to national standards that set the guidelines for what is safe, beneficial and patient-centered nursing care."


A Well Deserved Honor

In June 2010, the Hospital's 6 West team represented by Carolyn Bradon, R.N.; Maria Ploscaru, R.N.; Bernadette Maglalang, R.N.; Elite Huerta-Pascua, R.N.; and Donna Duran, R.N., presented its findings at the 10th annual Evidence Based Practice Conference at Arizona State University and was honored with the "Best
Symposium Award" amongst three others.

But winning an award wasn't the point of the study, De Leon-Luck points out.

"Clinical effectiveness is enhanced because the health-care giver delivers patient care according to what current clinical evidence has shown to be best practice, and not just according to what has always been done before," she says.

This article is also featured in the current issue of Health Signs, a quarterly magazine published by Washington Hospital Healthcare System. If you would like to be added to the Health Signs mailing list, please call Washington Hospital's Community Relations Department at (510) 791-3417.


A New Era in Health Care

To learn more about quality initiatives at Washington Hospital, visit www.whhs.com/quality

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