6052N_WK10_PART4_ Assigment5

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Module4_fourpeerreviewedarticles.doc

CRITICAL APRAISAL

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Evaluation Table

Full APA formatted citation of selected article.

Article #1

Article #2

Article #3

Article #4

(Parker, Giles, Graham, Suthers, Watts, O’Brien, & Searles, 2017).

(Scanlon, 2017).

(Ferguson, 2018).

(Menegueti, et al, 2019)

Evidence Level *

(I, II, or III)

Level III

Level II

Level III

Level II

Conceptual Framework

Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**

The basis for the study was to minimize IDC usage rates by minimizing improper urinary catheterization and duration of catheterization.

The basis for the study was to boost nurses’ knowledge on how to reduce NSUH ICU and NSLIJHS ICU CAUTI.

The basis for the study was to lower the cases of CAUTIs and enhance quality.

The basis for the study was to analyze the impact of adopting a HWCs educational program and checklist for indwelling urinary catheter indication among critical patients on the incidence of CAUTI.

Design/Method

Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).

The study design used was multiple pre-post control interventions. In four acute care hospitals in Australia, the complex approach will be adopted and analyzed.

The data will be collected from all adult inpatient wards excluding operating rooms, emergency departments, and day-only wards.

The study design used to collect data is scorecards. The scorecards that were used include patient care services scorecard, unit-based scorecards, collaborative care, and council scorecard. The data will be collected from CAUTI ICU patients and CAUTI NON-ICU patients.

The design that was used is non-probability sampling. In this study, it was optional for the nurses to attend education training for CAUTI prevention. CAUTI patients that were at risk in a hospital setting were involved in the study.

The design that was used to collect data was a Quasi-experimental study. It was carried out in nine beds general intensive care public hospital in Southeast Brazil. An exclusion criterion was not indicated.

Sample/Setting

The number and characteristics of

patients, attrition rate, etc.

500 patients per district will be used in the study. Patients using indwelling catheters.

20 hospitals in the organization will be involved in the study. Both CAUTI ICU patients and CAUTI NON-ICU patients will be involved in the study.

The research entailed two units, a 393- bed acute care hospital and 59 nurses. CAUTI patients that were at risk in a hospital setting were preferred.

230-247 patients per month participated in the study. Both male and female patients in general public ICU wards were studied. The study was done in four phases.

Major Variables Studied

List and define dependent and independent variables

Dependent variables

Training nurses and other clinical experts

Adherence to BCC

Independent variables

Length of stay with IDC

Catheter usage rate

Dependent variables

Opportunities for improvement

Independent variables

CAUTI reduction processes.

Dependent variables

Education intervention

Independent variables

CAUTI rates

Catheter rates.

Dependent variables

HCWs education

Indwelling urinary indications

Independent variables

CAUTI incident rates

Urinary catheter utilization

Measurement

Identify primary statistics used to answer clinical questions (You need to list the actual tests done).

A total number of 500 patients per Health district will be used to detect a 40% fall (15-9%) in relative IDC insertion rates with a power of 0.8 and alpha 0.05.

Adoption and implementation of the NSUH CAUTI reduction processes and best practices selected in 20 hospitals in the organization.

The statistics used to answer the clinical question are a 393- bed acute care hospitals and 59 nurses. 120 patients with urinary catheters were admitted. The total number of catheter days and CAUTI rates were compared.

230 to 247 patients were used to answer the clinical question.

The study was carried out in a 9-beds general ICU unit of a tertiary-care-public affiliated hospital in southeast Brazil. The study consisted in the implementation of the protocol insertion and maintenance of indwelling urinary catheters.

Data Analysis Statistical or

Qualitative findings

(You need to enter the actual numbers determined by the statistical tests or qualitative data).

Qualitative analysis

Patient safety will be improved through embracing and a solid examination of clinical practice and practice transformation. There was a decrease of about 50% in IDC insertion after the interventions were adopted.

Descriptive statistics.

The direct cost of NSUH ICU CAUTI was reduced by 89%, while NSLIJHS ICU CAUTI reduced by 81% after the implementation of the intervention in 2015. Additionally, the number of NSUH& NSLIJHS ICU Catheter days reduced by 58% and 56% consecutively.

Quantitative/descriptive statistics.

Total catheter days reduced by 10.1%, and CAUTI incidence reduced by 74% after the education intervention.

Quantitative findings

The rate of urinary catheter utilization reduced from phase I to Phase IV from 73.1%, 74.1%, 54.9%, and 45.6% respectively.

Findings and Recommendations

General findings and recommendations of the research

There are reduced research studies using a control design in CAUTI intervention appraisals. More research should be done to develop more interventions o reduce ICD use or CAUTI rates.

The NSUH non-ICU units’ outcomes lagged slightly behind. More resources should be allocated to improve their outcomes.

The urinary catheter days and CAUTI incidence rates reduced after education intervention was implemented.

From the beginning of the study to the end the rate of CAUTI were decreased from 14.9 to 1.1 episodes per one thousand catheters-days.

Appraisal and Study Quality

Describe the general worth of this research to practice.

What are the strengths and limitations of study?

What are the risks associated with implementation of the suggested practices or processes detailed in the research?

What is the feasibility of use in your practice?

This article is worthy because it addresses the clinical issue at hand extensively.

It promotes scholarly interaction. Besides, it also provides robust, valid, and most reliable results because two methods were used.

Cost-effectiveness is the risks associated with its implementation.

It is highly feasible in my practice.

The study is worthy because it provides data for three consecutive years on reduction of CAUTI.

The scorecards used, provided different information from different areas. However, a lot of resources were required in the implementation of the interventions.

Economic risks

Loss of patient’s confidentiality and privacy

The information provided is appropriate for further testing.

The article is worthy and valuable because it had some level of control, there were no randomization.

Its strength was evaluating nurse knowledge using pre-test and post-test. Lack of randomization and gathering of a small sample size is its limitation.

There are little and at times no harm to patients.

It is highly feasible in my practice.

This article is worthy because it uses Quasi-experimental design.

The limitation of this study is that the aggregated data for patient days and catheter days by month was the only data present.

Loss of patient’s confidentiality and privacy is part of the risks associated with implementation.

Further research can be done on the study. All participants were exposed to the same EBHR formulation in each study period.

Key findings

There is limited interventional research that aims to decrease IDC use or CAUTI rates in Australia.

The NSUH non-ICU units’ outcomes lagged slightly behind

After the implementation of education intervention and evidence-based urinary protocol, there was a great decrease in total catheter days and CAUTI rates.

Health Care Workers’ training and assessment of indwelling urinary catheters indications on daily basis were successful in the decrease of catheter utilization rates. In addition, it is effective in reducing the incidence of CAUTI among critical patients admitted to an intensive care unit.

Outcomes

The study will improve patient safety through embracing and a solid examination of clinical practice and practice transformation.

The resources used to implement NSUH CAUTI interventions were highly reduced in 2015.

There was a great decrease in total catheter days and CAUTI rates after the implementation of the education program.

There was a great reduction of indwelling catheter usage and incidence density of CAUTI among critical patients admitted to general ICU.

General Notes/Comments

The article provided robust evidence from both qualitative and quantitative research. It will also add to the evidence-based through improving comprehension of interventions to minimize CAUTI.

Re-dosing education for nurses and other clinical staff enhances reduction of CAUTI cases.

The research gives additional evidence proper education and training of nurses and enhances quality of care for indwelling urinary catheters and how to prevent CAUTIs.

The article is valuable because it showed that HWCs training and implementation of a daily checklist for reviewing the indication of indwelling urinary catheters had a long-term positive impact on reduction of the CAUTI rates in the general ICU.

Part 3B: Critical Appraisal of Research- Best Practice based on my appraisal

According to Menegueti, et al (2019), the health care industry has been rapidly changing and more research have been done to advance the field. CAUTI is an infection that a patient can contract while in the hospital. About 75% of urinary tract infections are related to the use of indwelling catheters infection. Approximately 15-25 percent of hospitalized patients receive urinary catheters during their hospital stay. They can develop CAUTI due to prolonged use of the urinary catheter. These kinds of CAUTIs price the particular private hospitals in the USA around 400.00 zillions US dollars annually. (McNeill, 2017). The main objective of this discussion is to provide the best evidence-based practices from the previously reviewed research concerning the reduction of CAUTI in hospitalized patients.

The best evidence-based practices for reducing CAUTI infections among hospital patients with a urinary catheter is HWCs training and implementation of a daily checklist for reviewing the indication of indwelling urinary catheters. It has been determined that satisfactory catheter care and attention in addition to managing can certainly help reduce chances regarding CAUTIs. (Gesmundo, 2016, l. 38). These evidence-based practices provide a long-term positive impact on reduction of CAUTI rates in the general ICU (Menegueti, et al, 2019).

Menegueti, et al (2019) also suggests that early removal of indwelling catheters is the best approach to prevent CAUTI. Training health caregivers to control infections by observing hand hygiene will go a long way in preventing CAUTI incidences for patients admitted in the ICU. The WHO-modified EBHR formulation containing 0.5% glycerol will enhance skin tolerance than the initial formulation. Besides, it offers the best balance between skin tolerance and antimicrobial efficacy. Constant nurse training will increase their knowledge on how to prevent CAUTI incidences. They can also learn the best practices to prevent CAUTI and mentor other health caregivers.

References

Ferguson, A. (2018). Implementing a CAUTI Prevention Program in an Acute Care Hospital Setting. Urologic Nursing, 38(6), 273–302. https://doi.org.ezp.waldenulibr ary.org/10.7257/105 3- 816X.2018.38.6.27 3.

Gesmundo, Meters. (2016) Improving nurses’ understanding upon catheter-associated urinary: system contamination (CAUTI) avoidance. Kai Tiaki Medical Study, 7(1), 32-40.

McNeill, M. (2017). Back in principles: precisely how evidence-based nursing jobs training can easily stop catheter-associated urinary: system attacks. Urological Nursing jobs, 37(4), 204-206. doi: 15. 7257/1052- 816X. 2017. thirtyseven. 5. 204

Menegueti, M. G., Ciol, M. A., Bellissimo-Rodrigues, F., Auxiliadora-Martins, M., Gaspar, G. G., Canini, S. R. M. da S., Bakir., M. (2019). Long-term prevention of catheter-associated urinary tract infections among critically ill patients through the study. Medicine, 98(8). https://doi.org.ezp.waldenulibrary.org/10.109 7/MD.0000000000014417implementation of an educational program and a daily checklist for maintenance of indwelling urinary catheters: A quasi-experimental.

Parker, V., Giles, M., Graham, L., Suthers, B., Watts, W., O’Brien, T., & Searles, A. (2017). Avoiding inappropriate urinary catheter use and catheter-associated urinary tract infection (CAUTI): a pre-post control intervention study. BMC Health Services Research, 17, 1–9. https://doi.org.ezp.waldenulibrary.org /10.1186/s12913-017- 2268-2.

Scanlon, K. A. (2017). Saving Lives and Reducing Harm: A CAUTI Reduction Program. Nursing Economic$, 35(3), 134– 141. Retrieved from https://search-ebscohost.com.ezp.waldenulibrary. org/login.aspx? direct=true&db=rzh&AN =123428995&site=ehost.live&scope=sit.

Critical Appraisal Tool Worksheet Template

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