Implications for practice
Focusing on nursing-driven interventions to improve the
nursing care of IUCswas found to positively impact CAUTI rates. Reeducating
on the importance of a perceived “basic” skill and
infusing best evidence into current practice were important to raise
awareness of simple interventions that positively impacted patient
outcomes.
Limitations
There were several limitations in this quality improvement
project. First, because this was an uncontrolled pre/post intervention
study, we cannot exclude the possibility that factors other than
our intervention were responsible for the changes in catheter
duration and CAUTI rates observed. Conversely, our assessment of
the focused interventions within 2 units may have provided only
a snapshot of the overall effectiveness of the education, policy, and
product changes implemented in this study as a more comprehensive
assessment of the impact of the intervention were not
undertaken. In addition, the number of CAUTIS on the intervention
units during the study period was low, and the confidence intervals
around the CAUTI rates were relatively large, making it difficult to
assess the impact of the intervention on the outcome of interest.
Abstracting data and providing feedback in a timely manner of the
IUC utilization were a challenge and might limit the dissemination
of this data collection strategy to other settings without the use of
an electronic means of tracking patient-level catheter duration.
This project focused on nursing management of IUC to reduce
CAUTIs; engaging physician and other health care providers who
direct insertion and removal of bladder catheters was not
addressed in this study. Additionally, while patient and family
information flyers were developed, the impact of the educational
flyer was not measured.
To effectively change practice, multifaceted efforts are necessary
to reduce CAUTI in hospitalized patients. IUCs are often indicated in
the management of patients in acute care hospital facilities, and
efforts that re-examine practice and strategies for care management
based on best evidence are needed and must be continuously
revisited. The findings of this project support the effectiveness of
implementation of a CAUTI program that encompasses nursing
education, competency training, products, and surveillance to
positively impact patient outcomes. Re-examining a common
nursing procedure resulted in improved practice with IUC care and
improved patient outcomes.