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Nursing Manager Evaluation in Health Care

Accreditation Standards Impacted

Work at a medical facility is always associated with a variety of risks, both for the staff and the patients. During the process of care for a human body, many procedures and practices require interventions that are difficult to fully control, regulate, or perform to ensure that the patients are not exposed to any risks in the process. Securing the patient’s health and wellbeing is the primary goal of a nurse, and every conceivable measure needs to be taken to procure a swift and fruitful recovery for everybody. However, risks and accidents are still bound to happen. Such dangers are especially relevant when talking about medical equipment that has direct contact with the human body.

Such tools as needles and catheters are an especially large liability. Infections caused by the presence of a catheter can cause a variety of issues for both the patient, as a danger to their health, and the medical facilities, who face the risk of being sued and garnering a negative reputation. Health risks also put into question the licenses and accreditation a facility has, meaning that its main credentials can be scrutinized. Standards put forth by the Joint Commission International are a necessary part of managing a PACU’s work and continued operation. One of the standards for accreditation for general or specialty hospitals is ensuring patient safety and quality improvement of their condition (Joint Commission International). This means that securing the well-being of patients is one of the most important parts of working in a hospital.

Preventing and controlling infections is similarly important, as it contributes to the general quality of work (Joint Commission International). Infections caused by catheters, therefore, are a major liability to the accreditations a facility possesses.

Fiscal Impact of Increased Infection

As a starting point, it is important to understand the level of danger catheter infections in the work practice can present. An inability to abide by the standards of healthcare and safety set forward for a hospital can be especially damaging to its operation, affecting it financially. The primary way it can affect the operation of a hospital is by becoming a source of lawsuits and legal action from the patients. An infection born from faulty equipment or an inability to follow proper procedure can be classified as malpractice and brought up in a court of law.

Current precedent shows that there was a significant amount of cases filed under claims of injury from catheters or malpractice, meaning that there is a certain degree of danger to the hospital in this situation (Awad et al., 2016). Financial fines for cases of improper treatment and malpractice are also quite a common result of catheter-related trauma, which can make a medical institution a major amount of trouble. Furthermore, replacing, supplying, and re-examining equipment to ensure its quality in the face of an incident can also cost quite a bit of money, draining the limited budget of a hospital further.

Physical Impact of Increased Infection

Physically, an infection from a catheter presents a major health risk for the patient subjected to it. Urinary tract infections are the most common type of catheter infection and can lead to a variety of health complications depending on the severity of the case (Warren, 2001). A catheter has the ability to introduce the urinary canal of the human body to unwanted bacteria, leading to infections of varying severity.

The effects of the improper procedure can range from catheter encrustation or bladder stones to cases of septicemia, endotoxic shock, and pyelonephritis (Cortese et al., 2018). There are currently no standardized ways of testing the applicability of different urinary catheters to measure their effectiveness, making the process of safety checking more complicated. If a person becomes infected, the occurrence constitutes additional treatment from the hospital, and additional expenses on medicine, accommodation, food, and other necessities. Even worse, complications arising from catheter infections lead to complications of the patient’s condition, which is often already weighed down by other factors, leading to higher fatality rates and increased costs for the medical facilities.

The Change Plan

Generally, there are a number of practices and considerations that need to be taken into account when implementing a new strategy. There are a number of specific approaches to nursing practice that are recognized to be both efficient in their application and effective in benefiting the organization and the patients (Baker, 2017). Research shows that principles of nursing research, quality improvement, and evidence-based practice are what are necessary for implementing change. By guiding the practical work with complementary current research, nurses can guarantee that their efforts are backed up by scientific guarantees and are the best currently available methods of providing assistance to the patients (Baker, 2017).

Data can be generally taken from research, articles, guidelines, databases, and systematic research can be used to find the best types of practices in applying and utilizing catheters, to best approach the need to use them responsibly. Finding and utilizing, as well as creating new nursing research can also be an effective way of gaining further insight into the problem of catheter infections. The unit can either comprise a research project after the successful implementation of the program to quickly share the main findings and results with the rest of the nursing community or find information on a similar project in other medical facilities.

As a nurse manager, it is important to recognize and address the problem of increased catheter infection, as it both endangers the health and wellbeing of patients and leads to major financial losses for the hospital. With the limited budget and the need to meet the expectations of the patients, the medical facility must find a suitable solution to the issue as soon as possible. The issue is understood to be highly preventable, meaning that sufficient adjustment and preparation are able to significantly reduce the risks it presents.

The biggest liability, in this case, is the misuse or unnecessary use of catheters in medical practice. A proper strategy to address the practices of the unit and the employee culture is necessary, as they are the major contributing factors to the problem.

There are a few factors that need to be taken into account, including the appropriate use of catheters among the staff, proper maintenance, insertion, and removal of catheters. A proper approach to the issue would be to combine cooperation between the hospital workers and the promotion of proper practices and work knowledge. Developing a proper understanding of the issue through describing the impact catheter infections have on a patient’s condition can be effective, as it allows the engagement of the staff, creating better understanding and a sense of urgency. The process should cover all types of workers that are engaged with the procedure, to cover as much ground as possible.

After the nurses and other professionals have been informed on the need to change their approach and pay more attention to the problem, the topic of catheter infection reduction needs to be set as a primary goal for the hospital unit (Toolkit for Reducing Catheter-Associated Urinary Tract Infections in Hospital Units: Implementation Guide). This would allow the workspace to better direct its efforts and get all people on the same page. Then, sharing possible solutions and approaches to the problem is necessary, to foster courage and create better engagement in the team (Toolkit for Reducing Catheter-Associated Urinary Tract Infections in Hospital Units: Implementation Guide).

After a particular set of actions and regulations have been decided upon, it is time to apply them in practice. Focusing on the proper use of catheters and determining when their use may not be needed is key here, as it promotes a practitioner-driven approach to solving the issue (Toolkit for Reducing Catheter-Associated Urinary Tract Infections in Hospital Units: Implementation Guide). Improving performance coupled with constant evaluation practices will be effective in addressing the problem on a hospital-wide scale, and guiding the informed practices of hospital workers.

Other frameworks are also open for consideration, such as the system introduced by the paper: “Reducing catheter-associated urinary tract infections using a multimodal approach — the NSQIP experience of Oakville Trafalgar Memorial Hospital” (Rozario, 2018). The paper lists the system adopted by the author and their team, which presents 4 main goals in the process of managing the catheter infection rates. First, the reduction of time catheters is used as a preventive measure to reduce the risk of infection (Rozario, 2018). Second, the changes in the placement of catheters promote better quality and cleanliness standards (Rozario, 2018). The last two-step argues for better maintenance of catheters and protocols for removing catheters easily and quickly.

Evaluation of the Plan

The most effective type of evaluation would be conducted with the passage of time, which can allow one to compare the unit’s catheter infection rates with the global statistic on the issue, as well as its own measurements before following the program. Records showing the total number of infection cases over a few months before the implementation of the program need to be accessed and compared with the progress made over the time a proper approach has been adhered to (Toolkit for Reducing Catheter-Associated Urinary Tract Infections in Hospital Units: Implementation Guide). The evaluation needs to further take into account the condition of the patients and the acuity of their condition to make the data as accurate as possible.

The guide published by the AHRQ also suggests another method of tracking the progress of implementation, the one that involves counting the number of days since the last case of catheter infection. It allows the management to directly engage the frontline staff and quickly illustrate the level of success an initiative has had. Furthermore, it can promote personal responsibility and accountability from the nursing staff. Daily routines and evaluations also need to be carried out, as a way to measure the appropriateness of the catheter insertion, removal, and usage throughout the hospital. By setting standards for the staff, comparing the previously recorded numbers with the newer ones, and encouraging proper procedures, a medical facility can see to the implementation of a proper anti-catheter infection strategy.

References

Awad, M. A., Osterberg, E. C., Chang, H., Gaither, T. W., Alwaal, A., Fox, R., & Breyer, B. N. (2016). Urethral catheters and medical malpractice: a legal database review from 1965 to 2015. Translational Andrology and Urology, 5(5), 762–773. Web.

Baker, J. D. (2017). Nursing Research, Quality Improvement, and Evidence-Based Practice: The Key to Perioperative Nursing Practice. AORN Journal, 105(1), 3–5. Web.

Cortese, Y. J., Wagner, V. E., Tierney, M., Devine, D., & Fogarty, A. (2018). Review of Catheter-Associated Urinary Tract Infections and In Vitro Urinary Tract Models. Journal of Healthcare Engineering, 2018, 1–16. Web.

Joint Commission International. JCI Hospital Standards. Joint Commission Resources. Web.

Rozario, D. (2018). Reducing catheter-associated urinary tract infections using a multimodal approach — the NSQIP experience of Oakville Trafalgar Memorial Hospital. Canadian Journal of Surgery, 61(4). Web.

Toolkit for Reducing Catheter-Associated Urinary Tract Infections in Hospital Units: Implementation Guide. AHRQ. Web.

Warren, J. W. (2001). Catheter-associated urinary tract infections. International Journal of Antimicrobial Agents, 17(4), 299–303. Web.

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