Discuss the Safety Score Improvement Plan for By-Faith Intensive Care Unit (ICU).
The inception of the hospital safety score was a prudent move that aimed to guide the public on selecting the safest hospital; but, the public is not knowledgeable about interpreting these scores. Hence, individuals may not apply these scores appropriately. Nonetheless, a low hospital safety score is deemed the best as it indicates high hospital performance in assuring the safety of its clients. It is possible for all hospitals to have low hospital safety scores resulting in harmonious data regarding hospital performance. Among the various determinants of the hospital safety score, hospital-acquired infections are a major threat to the health of the patients, resulting in increased medical expense and increased hospital stays. Catheter-acquired urinary tract infections (CAUTI) are the most common of these hospital-acquired infections. The By-Faith hospital recently experienced a high hospital score due to CAUTI resulting in the call for a SMART mitigation plan. Thereby, this is a report that aims to delineate a safety score improvement plan to ensure that the prevalence of CAUTI in the hospital remains considerably low and lowers the hospital score in the public domain.
Even after ensuring that sterile techniques for placement of catheters are adhered to, closed drainage systems are used, and revised daily care, the occurrence of CAUTIs continues to be high (Parry, Grant, & Sestovic, 2013). Also, there seems to be limited evidence-based interventions that would be used to reduce these infections. However, as noted by the American Association of Critical-Care Nurses (2016), 90% of individuals in the ICU have a urinary catheter; yet, there no clear indications that govern the insertion of these catheters. However, as the nurse manager, it is my responsibility to ensure that a patient culture is established. Therefore, I will begin by using the Hospital Survey of Patient Safety Culture (HSOPSC) to determine the current safety culture and factors resulting in high CAUTIs rates at the By-Faith hospital. Lack of a strong reporting system to inform the healthcare fraternity on required changes thwarts improvement efforts; thereby, institutions remain attached to old and inefficient policies and procedures that affect the quality of healthcare delivery.
As noted above, the prevalence rate of CAUTIs is high, and understanding the factors associated with the occurrence of these nosocomial infections is imperative because among the causative factors, organizational factors are involved (Kleinpell, Munro, & Giuliano, 2008). The HSOPSC noted earlier will help to identify these factors that are specific to the By-Faith hospital and form basis for the development of a safety score improvement plan. CAUTIs are largely attributed to an indwelling urethral catheter, and Lo et al. (2015) indicate that the main factors associated with the occurrence of these CAUTIs are length of placement, type of condition, age and gender, as well as the type of drainage system.
Given the interconnectedness of the various systems involved in reducing hospital-acquired infections, a dynamic framework focusing on teamwork, information, financing, governance, and research domains should be looked into if CAUTIs should reduce in the By-Faith ICU. After determining the culture and factors associated with high CAUTIs in the hospital, as the nurse manager of the ICU, I will engage my fellow nurses to find solutions as a means of encouraging commitment to solving the issue. An education session of two hours by an external trainer and nurse manager will suffice in which awareness and a laid out ongoing plan on nurse-directed procedures to remove catheters would be communicated to entire nursing fraternity. This would be governed by the four-tier paradigm highlighted in the IOM report, “To Err is Human: Building a Safer Health System.” This approach advocates for strong leadership that steers the use of research and innovation to develop feasible tools and protocols, and a monitoring and evaluation system through which errors would be continually remedied. The two strategies act as a basis for the other two strategies that include raising hospital performance standards and ensuring safety at the delivery point of healthcare.
Just like Sammer and James (2011) state, the nurse manager should mobilize his or her fellow subordinates so that together they can work towards identifying the factors that result in such mishap in the provision of safe healthcare. The nurse manager has the responsibility of spearheading activities aimed at establishing a safety culture within a hospital. Parry, Grant, and Sestovic (2013) and the American Association of Critical-Care Nurses (2016) advocate for the removal of catheters that are not needed. Therefore, a chart to indicate nurses’ evaluation of the need for the catheter and daily improvements as each nurse receives the mandate to contribute towards improving the quality of care provided by being his or her friends’ keeper through identifying misses and working towards eliminating them. Ultimately, a feeling of ownership and complacency would ensure the sustenance of the monitoring and evaluation to ensure continued improvement. Rates of catheter insertions, CAUTIs, stays at the ICU, and duration of the indwelling catheters will be used as the quality indicators.
The nurse manager has the power to negotiate with the hospital’s administrative body to ensure adequate allocation of the resources to ensure that all the activities as mentioned above are implemented. According to the Institute of Medicine's Committee on Quality of Health Care in America (2001), adequate resources are pivotal in establishing a patient safety culture. There is need to develop a tracking system that will aid in the daily tracking of catheters used and feedback received from both nurses and patients to guide in daily improvements. Ultimately, positive results will inform practice and form basis to review the hospital’s policies that govern catheter insertion among adult ICU patients.
A patient safety culture is imperative in ensuring that patients receive quality and cost-effective healthcare. Hospital-acquired infections are a major cause of morbidity and mortality among patients, resulting in increased hospital stays and increased medical costs. Nurse Managers and team leaders in a unit have the responsibility of ensuring that a safety culture is established through an accurate tracking system characterized by monitoring and evaluation to ensure routine improvements. An education session to guide the nurses at the ICU in the By-Faith hospital will guide nurses on the procedures to undertake in reducing CAUTIs.
American Association of Critical-Care Nurses. (2016). Catheter-associated urinary tract infections. Retrieved from nov11.pcms?menu=practice.
Ceballos, K., Waterman, K., Hulett, T., & Maki, M. B. (2013). Nurse-driven quality improvement interventions to reduce hospital-acquired infections in the NICU. Advances in Neonatal Care, 13 (3), 154-163.
Institute of Medicine's Committee on Quality of Health Care in America. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.
Kleinpell, R. M., Munro, C. L., & Giuliano, K. K. (2008). Targeting health care–associated infections: Evidence-based strategies. In R. G. Hughes (Ed.), Patient Safety and Quality: An Evidence-Based Handbook for nurses (vol. 2) (pp. 577-600). Rockville (MD): Agency for Healthcare Research and Quality (US).
Lo, E., Nicolle, L. E., Coffin, S. E., Gould, C., Maragakis, L. L., Meddings, J., …Yokoe, D. S. (2014). Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infection Control and Hospital Epidemiology, 35(5), 464- 479.
Parry, M. F., Grant, B., & Sestovic, M. (2013). Successful reduction in catheter-associated urinary tract infections: Focus on nurse-directed catheter removal. American Journal of Infection Control, 41(12), 1178-1181.
Sammer, C., & James, B. (2011). Patient Safety Culture: The Nursing Unit Leader’s Role. OJIN: The Online Journal of Issues in Nursing, 16(3), Manuscript 3. doi: 10.3912/OJIN.Vol16No03Man03.