Assignment 2/Developing the Evidence Matrix/PICO Essay

Catheter associated urinary f old transmittals (CAUTI) ar the to the highest degree familiar of all nosocomial contagions inflicted upon patients while infirmaryized. Approximately 30% of all hospital reported infections are of the urinary folder (Joint commission New twelvemonth will demo in newborn CAUTI ginmill requiremants, 2011). The Joint management estimates the annual cost of CAUTI guardianship is in excess of $400 meg furthermore, CAUTI heraldic bearing is targeted by Medicaid and Medicare services as a non-reimbursable infection.For years, operative urinary catheter utilisation has been contested regarding the appropriate criteria required for its application, maintenance, and discontinuation. patient ofs hospitalized for short term operative care, specifically, orthopedical patients, are a good deal catheterized due to their limited immobility. The goal of therapy with surgical orthopedic procedures is to improve mobility, not render the patient immobil e. Urinary catheters are often viewed as cumbersome, inconvenient instruments of immobility by the patient. Conversely, nursemaids take away often viewed urinary catheters as an instrument of convenience and criterion of care for hospitalized patients. The ingestion of short term urinary catheter practice session, whether internal or intermittent, in orthopedic patients has been surveyed by multiple studies, resulting in ontogenesisary sorts in the standard of care of operative orthopedic patients.The contrastsin patient outcomes utilizing indwelling catheterization, intermittent direct catheterization, and non-use of catheterization will be freshened.PICOIn postoperative orthopedic patients, how does the discontinuation of an indwelling urinary catheter compare to non-catheterization in relation to the barroom of urinary parcel infection?INDWELLING URINARY CATHETERS AND THE POSTOPERATIVE orthopedic affected role cosmos Postoperative orthopedic patientsIntervention Di scontinuation of an indwelling catheterComparison Non-catheterization of postoperative orthopedic patients Outcome The patient will not exhibit whatever symptomology of a urinary tract infection demonstrate Based recital ModelsThe Johns Hopkins Nursing Evidence Based work Conceptual Model (JHNEBPCM) evoke be utilized in this area of focus as it comprises the foundations of care for practice, education, and re depend. There are three phases to this model known as the kiss process Practice question, Evidence, and Translation. The practice question identifies a problem with a flowing practice. Evidentiary support to answer the practice question is produced through the utilization and evaluation of research and non-research evidence. The outcome of the implemented research is past translated into practice variety, the measurement of those outcomes, and the dissemination the new research (Buchko & Robinson, 2012).The Iowa Model of Evidenced Based Practice (IMEBP) is appropriate for use in this area of focus. It allows for the consummate healthcare system to be utilized in determining the bespeak for change in the delivery of care. Employing this model allows the researcher to elect to take on mingled with a current problem and new research as the basis for change in patient care. Once the trigger has been substantiated as a priority, a squad is put in place to assemble, critique, and sic if generous research has been presented to pilot a change in current practices. If there is sufficient evidence for change and the pilotprogram is successful, a change in practice will occur. Once a change has been made, the data obtained from the practice change can be further actual utilizing this model and continuing the evolutionary cycle of improving standard of care practices.INDWELLING URINARY CATHETERS AND THE POSTOPERATIVE orthopedic PATIENTOtherwise, if there is not enough evidence, further research may be conducted to provide enough of a base to continue toward obtaining a practice change (Dontje, 2007). The diversitys between the JHNEBPCM and the IMEBP are minor. They both provide a common goal to change current practices by employing evidenced based research to foster the evolution of healthcare practices. Both models use a question or a trigger to initiate a change in practice. The minor difference between the JHNEBPCM and the IMEBP is the JHNEBPCM validates its change of practice question with the application of non-research data in addition to its research data. In this way, the JHNEBPCM can consider patient taste as an indicator to surmount practices.Determining the QuestionThe National Patient preventive Guidelines, as determined by the Joint Commission, include the prevention of indwelling CAUTI, emphasizing the trigger removal of these instruments and the observation for subsequent infection (Joint commission New year will usher in new CAUTI prevention requiremants, 2011). The initial question was, In admitted orthoped ic surgical patients, does prompt removal of an indwelling Foley catheter within 48 hours of performance reduce the incidence of catheter associated urinary tract infection? In order to have a broader result list in searching for articles, the PICO parameters were refined. The population parameter was lessen to postoperative orthopedic patients. The intervention parameter was refined to discontinuation of an indwelling catheter. This removed the time constraint from the initial PICO question. Using non-catheterization, employed the simile tool to serve as the basis for improved practice. The outcome parameter, prevention of urinarytract infection alignsINDWELLING URINARY CATHETERS AND THE POSTOPERATIVE ORTHOPEDIC PATIENTwith the Joint Commissions National Patient resort Guidelines to preventing CAUTI, ensuring cave in patient care by eliminating infections.Search of EvidencePubMed was the initial database searched for postoperative urinary catheter indications and subsequent i nfections. The bring out terms, indwelling urinary catheter AND urinary tract infection AND surgery, were entered into the search bar, yielding 320 results. Accordingly, a second search using the anchor terms, orthopedic surgery AND catheter associated urinary tract infection, resulted in eight articles. Of those eight, ii articles were chosen for review due to their specificity to joint surgery and urinary catheterization.The Cumulated Index of Nursing and Allied Health (CINAH) database was the second database searched. The key terms, surgical patients and urinary tract infection, produced 14 articles, of which two backward cohort studies were chosen for review based on the PICO criteria of urinary catheter use in the postoperative period. Additionally, a search for the key terms, orthopedic surgery and catheter associated urinary tract infection resulted in zero hits. The third database searched was Science Direct. The key terms searched for in this database were, surgical pa tients, indwelling catheter, sterile field, and urinary tract infection. This search resulted in 845 articles in which they were further limited to, infection tick, which yielded 27 articles. Of those 27 articles, two were chosen for further review a future observational study with descriptive and comparative design and a randomize control trial with cost-effectiveness analysis.INDWELLING URINARY CATHETERS AND THE POSTOPERATIVE ORTHOPEDIC PATIENTEvidence ReviewThe first, and oldest, article reviewed was discouraging. Knight and Pellegrinis (1996) randomize control trial determined utilization of indwelling catheters for urinary memory in postoperative total hip arthroplasty (THA) or total knee arthroplasty (TKA) procedures was upright for the patient. It was also determined urinary tract infections were not a return of indwelling catheter usage. The level of evidence met level one criteria, yet the check off of good word was D due to the weak recommendations with alternative approaches likely to better suit a different group of patients, those requiring urinary catheterization for urinary retention.The attached study, a retrospective cohort study, sampled 35,904 patients who underwent major cardiac, vascular, orthopedic, or gastrointestinal surgery. A urinary catheter was placed intraoperatively, resulting in the development of a urinary tract infection if left in for more than two days these patients were twice as likely to develop a urinary tract infection compared to patients whose catheters were removed within 48 hours of surgery (Wald, Allen, Bratzler, & Kramer, 2008). That same year, another retrospective cohort study by two of the previous authors along with two additional researchers, concluded postoperative patients admitted to skilled nursing facilities where their indwelling urinary catheters were maintained over the course of their care were associated with poorer outcomes. This study was restricted to the patients in skilled nursing faci lities where direct patient care was limited and current surveillance was minimal (Wald, Epstein, Radcliff, & Kramer, 2008). Both of these studies level of evidence met two-b criteria, grade of recommendation A and B respectively the first study could apply to most patients in most circumstances, while the second study could apply to most circumstances.INDWELLING URINARY CATHETERS AND THE POSTOPERATIVE ORTHOPEDIC PATIENTThe final review of Nyman, et.al, (2013), resulted in a one-a level ofevidence with an A for grade of recommendation. This randomized control trial concluded the employment of indwelling catheters and intermittent serial catheterization during the postoperative period for hip surgery patients had both benefits and disadvantages, yet non-catheterization was best for postoperative patient outcomes. This study was the most recent on go into and aligned with the Joint Commissions National Patient Safety Guidelines.SummaryEvidence based practices have become the corner stone for the standard of care in healthcare facilities. Over the course of the past 20 years, healthcare providers have provided the research necessary to remove indwelling urinary catheters as the standard of care in postoperative orthopedic patients from advocating of their use for urinary retention in the late 1990s to limiting their utilization today.The higher incidence of CAUTI has provided Medicaid and Medicare programs support in rejecting reimbursement measures to facilities for these types of nosocomial infections. New nurse directed protocols supported by evidenced based research have decreased the incidence of CAUTI, although, if these practices are to continue to be successful, a doc culture change must(prenominal) be embraced. The entire healthcare team must continue to participate in an active role to top unnecessary and preventable infections, specifically CAUTIs. To appropriately act on the behalf of the patient, clinicians must ensure best practices not only for the well-being of the patient, but for the monetary survival of a healthcare facility.INDWELLING URINARY CATHETERS AND THE POSTOPERATIVE ORTHOPEDIC PATIENTReferencesBuchko, B., & Robinson, L. (2012). An evidenced-based approach to decrease early postoperative urinary retention following urogynecologic surgery. Urology Nursing, 32(5), 260-264.Dontje, K. (2007). Evidence-based practiceUnderstanding the process. Topics in Advanced Practice Nursing e ledger, 7(4).Joint commission New year will usher in new CAUTI prevention requiremants.(2011). AIDS ALERT, 26(11), 1-2.Knight, R., & Pellegrini, V. (1996). Bladder management afterwards total joint arthoplasty. The Journal of Arthroplasty, 11(8), 882-888.Nyman, M., Gustafsson, M., Langius-Eklof, A., Johansson, J.-E., Norlin, R., & Hagberg, L. (2013). Intermittent versus indwelling urinary catheterisation in hip surgery patients A randomised controlled trial with cost-effectiveness analysis. International Journal of Nursing Studies, 50, 1 589-1598. doi10.1016/j.ijnurstu.2013.05.007 Wald, H., Allen, M., Bratzler, D., & Kramer, A. (2008). Indwelling urinary catheter use in the postoperative period Analysis of teh national surgical infection prevention cast data FREE. Arch Surg, 143(6), 551-557. doi10.1001/archsurg.143.6.551 Wald, H., Epstein, A., Radcliff, T., & Kramer, A. (2008). Extended use of urianry catheters in older surgical patients A patient safety issue? Infevtion Control and infirmary Epidemiology, 29(2), 116-124. doi10.1086/526433