“Implementing this approach in any hospital environment is possible with good communication among members of the health care team and with the development of an interdisciplinary team to address and implement the program. Implementation requires commitment from many areas: nursing, education, infection prevention, central distribution, supply and equipment vendors, and biomedical engineering, as well as specialized areas that focus on patient care,” McLaughlin told Oncology Nurse Advisor.
As part of this program, vendors of the catheter supplies and bladder scanners were invited to the medical facility to assist with education about using their products. In addition, nurse champions of the CAUTI bundle were identified and received additional education. As part of this initiative, education was deemed mandatory for all clinical nurses. McLaughlin said prolonged use of a urinary catheter increases the risk for CAUTI by 5% each day. UTIs increase cost by approximately $600 and can increase length of stay by 1 day.
This initiative could be an invaluable part of caring for patients with cancer, who are at increased risk for infection due to their disease processes and treatment regimens, often related to neutropenia. The risks of developing a urinary tract infection are greater in the oncology population and can sometimes include serious complications such as sepsis, prolonged hospital stays, and increased cost of care, explained McLaughlin.
NURSE AUTONOMY IS KEY
The benefits of the bundle approach include focus on best practices for patient care, fewer CAUTIs, reduced use of antibiotics, shorter length of stay, and greater patient comfort. “The most important message for oncology nurses is that they are bedside leaders, and their care has a direct impact on decreasing and even eliminating CAUTIs in their health care facilities.”
Oncology nurses need to constantly be on the lookout for more opportunities to prevent infections because their patients are predominantly immunocompromised. The bundle approach involves a collaboration of disciplines, and included eliciting input from clinical nurses to develop a patient care algorithm that would support autonomous decision-making by nurses.
Cathie Limbaugh, MSN, APRN, ACNS-BC, OCN, program educator for Oncology Services at Barnes-Jewish Hospital, in St. Louis, Missouri, said giving nurses more autonomy may be part of the success of this program. “Assessment of continued need for most urinary catheters is certainly within the capacity of registered nurses. At Barnes-Jewish Hospital, we have an evidence-based protocol that guides nurses in assessing when a Foley catheter can be safely removed from patients in noncritical care areas. If after reviewing the brief and clear protocol, the nurse is unsure, a provider is to be consulted,” Limbaugh told Oncology Nurse Advisor. “For uncomplicated patients, this standard saves nursing time contacting providers and has resulted in catheters being discontinued sooner, leading to reduced risk of urinary tract infection.”
John Schieszer is a medical journalist based in Seattle, Washington.
1. CAUTI maintenance bundle. http://health.nv.gov/HCQC/HAI/CAUTI_Maintenance_Bundle.pdf. Accessed November 7, 2014.