1-Evidence-based practice is what keeps the health care system up-to-date with technology and best-practices; these practices help improve patient outcomes. The first article that I read was research about improving the procedures for collecting and testing urine specimens. In the study, they observed how the collection method was carried out and how long it took for the specimen to reach the laboratory for testing. It was determined that not only were the collection methods flawed but the specimens were sitting too long at room temperature; both influenced the test results. Having contaminated specimens were producing unreliable test results and people were getting a wrong diagnosis with a wrong treatment plan. This study helped identify the major problems along with creating solutions to those problems: mid-stream clean catch, using straight-catheters, proper way to get a specimen from an indwelling-catheter, and appropriate time for the specimen to sit at room temperature. This research article helped improve patient outcomes because it increased the accuracy of the test results which yielded a more specific diagnosis; appropriate treatments increased patient outcomes. In our facility when we collect a urine specimen we keep the specimen in the refrigerator and call the labs for a stat pick-up.
The second article that I read was on improves patient outcome fall prevention in 65+ adults. A prevalent safety issue is injuries that occur from Falls. Elderly and frail have a higher risk of falls that can lead into hip-fractures or even death. Accidental falls can result from an unsafe environment or environmental risk factors for example low blood pressure, dehydration, impaired mobility, unstable gait to name a few. To prevent/reduce the risk for falls staff need to maintain awareness of the environmental safety. I work in an Assisted living facility we have Fall-Risk Assessment tool that we use for each of our residents. But our main intervention is communication with staff and residents. We ensure that there is no trip hazard, we lower the bed to the lowest position when they are in bed, check their rooms and facility for potential safety issues, have mats on the floors next to their bed.
2-Two areas of nursing practice that have been under scrutiny in my facility involve Catheter Associated Urinary Tract Infections (CAUTIs) and Standard precautions. Both seem like basic concepts, but in nursing, sometimes the “basics” get swept to the back of your mind when you are focusing on other issues involved in patient care. Both of these concepts are integral parts of patient safety, which is and should be our number one priority.
In the healthcare setting, the use of an indwelling catheter can be a necessity on many occasions. As nurses, it is imperative that we assess the need carefully for catheter placement, as well as continuously assess the need for the catheter to remain in place. According to a study put forth by BMC Health Services Research, “Urinary tract infection (UTI) as the most common healthcare-associated infection accounts for up to 36% of all healthcare-associated infections. Catheter-associated urinary tract infection (CAUTI) accounts for up to 80% of these” (Vicki, Michelle, & Andrew, 2017). According to this study, the aims of reducing CAUTIs is multifaceted. First and foremost, reduce inappropriate urinary catheterization and duration of catheterization (Vicki et al., 2017). Secondary is that when the use of an indwelling catheter is needed, ensure hand hygiene is performed, sterile technique is maintained and proper perineal care is performed regularly. It is also imperative that the medical staff caring for this patient is continually assessing the need for the catheter to remain in place and that it is removed as soon as possible (Vicki et al., 2017). In my facility, our protocol calls for perineal care to be performed at least once a shift and as necessary when soiled, as well as assessing the continuation of need at least once per shift. The goal in our facility is to have indwelling catheters removed within three days of placement.
The second area of nursing practice that is being stressed by my facility is adherence to standard precautions. We are all aware of what standard precautions are and how important they can be to protect not only ourselves, but our patients as well. “Health workers are exposed to diverse types of agents in the work environment, such as viruses, bacteria, fungi, protozoa, and ectoparasites. Occupational exposure might be caused by accidents with sharps, splashes of blood in mucous membranes, inhalation of aerosols, or larger particles” (Barsalobres, Vieira, Fleck, da Silva Canini, Malaguti-Toffano, & Gir, 2016). In this study that was put out by Brazilian Health Care Programs, the reasoning many healthcare professionals did not exercise proper use of personal protective equipment include “including low risk perception, perception of a poor safety climate at the work environment, conflict between providing the patient with the best care service or protecting themselves from exposure, and the belief that precautions are unnecessary in some situations” (Barsalobres et al., 2016). Another reason mentioned in the study was the understanding of the risk of contamination. In my facility, it is mandatory to utilize standard precautions such as hand washing or the use of antibacterial hand scrub before and after touching a patient as well as when soiled. It is mandatory for us to use gloves, gowns, masks, goggles and face shields on high risk patients. This has changed my practice by making me more aware of the “bad habits” that one can get into. In my facility, we have signs outside of each patient room that state “foam in, foam out” as a reminder to wash our hands and be more mindful of standard precautions in general.
Vicki P, Michelle G, Andrew S, et al. Avoiding inappropriate urinary catheter use and catheter-associated urinary tract infection (CAUTI): a pre-post control intervention study. BMC Health Services Research, Vol 17, Iss 1, Pp 1-9 (2017) [serial online]. 2017;(1):1. Available from: Directory of Open Access Journals, Ipswich, MA. Accessed August 30, 2018.
Barsalobres Bottaro, B., Vieira Pereira, F. M., Fleck Reinato, L. A., da Silva Canini, S. M., Malaguti-Toffano, S. E., & Gir, E. (2016). ADHERENCE TO STANDARD PRECAUTIONS BY NURSING PROFESSIONALS: A LITERATURE REVIEW. Journal Of Nursing UFPE / Revista De Enfermagem UFPE, 10(3), 1137-1142. doi:10.5205/reuol.8702-76273-4-SM.1003201625
3-The ability to utilize evidence-based practices is key to improving patient outcomes on every level. This is as true now as it was at the beginning of our industry. Many practices that we take for granted today and assume to be merely common sense originally were developed from intensive research. For instance, hand hygiene while commonly dismissed as obvious can have critical importance in a health care setting. A study done in Saudi Arabia from October 2006 to December 2011, proved this after improving hand hygiene compliance from a baseline of 38% to 85% and realizing the rate of Staphylococcus aureusdecreased from 0.42 in 2006 to 0.08 in 2011 (Al-Tawfig, Abed, Al-Yami, & Birrer, 2013). This was just one of the sicknesses that was prevented in many patients. There were many others. With information like this easily available it is astounding that any nurse would fail to meet compliance standards today.
Another instance of an evidence-based practice improving patient outcome is the practice of rooming-in. This is when a newborn baby and mother stay together in the same room during their stay rather than utilizing a separate nursery. Once again this seems trivial enough to be obvious, but it is a fairly recent trend in mother-baby healthcare that has numerous benefits. These benefits include encourage breastfeeding, giving the mother ample opportunity to ask providers about proper care techniques, and allowing the mother to develop a better understanding of their newborn’s behavior (Shrivastava, Shrivastava, & Ramasamy, 2013). While the industry movement towards rooming-in is still ongoing, it is gaining traction. As a mother-baby nurse, I intend to advocate for this change.
Al-Tawfiq, J. A., Abed, M. S., Al-Yami, N., & Birrer, R. B. (2013). Promoting and sustaining a hospital-wide, multifaceted hand hygiene program resulted in significant reduction in health care-associated infections. American Journal of Infection Control, 41(6), 482-486. doi:10.1016/j.ajic.2012.08.009
Shrivastava, S. R., Shrivastava, P. S., & Ramasamy, J. (2013). Fostering the practice of rooming-in in newborn care. Journal of Health Sciences, 3(2), 177. doi:10.17532/jhsci.2013.85