The Use of an Indwelling Catheter Protocol to Reduce Rates of Postoperative Urinary Tract Infections.

BACKGROUND: Catheter-associated urinary tract infections (CAUTI) have been associated with increases in morbidity and mortality as well as increased costs of hospitalization. At our institution, we implemented a protocol for indwelling catheter use, maintenance, and removal based on Center for Medicare and Medicaid Services (CMS) guidelines, in efforts to reduce CAUTI rates. METHODS: A hospital committee of quality stewards focused on several measures which included staff education, modification of existing systems to ensure compliance, and auditing of patient care areas for catheter utilization before implementation of the protocol. Pre- and postintervention postoperative cohorts were then identified through American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) for prevalence of CAUTI. Data were collected through chart review and postdischarge patient interviews. RESULTS: A total of 3873 patients were identified between September 2007 and December 2010. Thirty-six patients (2.6%) were diagnosed with a CAUTI in the preintervention group (N = 1404) compared to 38 (1.5%) patients who were diagnosed with a CAUTI in the postintervention group (N = 2469). There was a 1.1% decrease in CAUTI rate after protocol implementation (P < .028). This reduction in rates resulted in annual estimated savings of $81,840 to $320,540 annually. CONCLUSION: A simple, multifaceted approach consisting of staff education and changing existing processes to reflect best care practices has the potential to significantly reduce the incidence of postoperative CAUTI.

Incidence and Risk Factors for Postoperative Urinary Retention: A Retrospective, Observational Study with a Literature Review of Preventive Strategies.

OBJECTIVE: To determine the incidence of postoperative urinary retention (POUR) in our surgical patients and review house staff practices in management. METHODS: A chart review of patients with POUR, identified through billing codes, was performed. In addition, a house staff survey was conducted to assess whether straight catheterization (SC) or indwelling urinary catheter (IUC) was preferred at different bladder volumes. RESULTS: The incidence of POUR was 2.2% (n = 43). This resulted in eight urology consults, seven discharges with an IUC, and three readmissions. There were significant disparities between the house staff survey results and actual practices. The mean volume for IUC insertion on the house staff survey was 365 cc compared to 739 cc from our patient cohort. Twenty percent of respondents chose to use SC at bladder volumes in excess of 700 cc. CONCLUSION: Management of POUR remains highly variable. Best practice guidelines are required to standardize our management of this complication.

Stress resiliency, psychological empowerment and conflict management styles among baccalaureate nursing students.

AIMS: This article is a report of a Neuman Systems Model-guided correlational study of the relations of stress resiliency, psychological empowerment, selected demographic characteristics (age, ethnicity, semester in school) and conflict management styles. BACKGROUND: Emerging evidence suggests that stress resiliency and psychological empowerment can strengthen student nurses in academic achievement and coping with stress. Little is known about conflict management styles of students and the relationship to empowerment, resiliency and the implications for managing workplace conflict. METHODS: A correlational study was conducted in Spring 2010 with 166 baccalaureate students. Most participants were female, single, Hispanic and 25 years old. The data collection instruments included the Stress Resiliency Profile, the Psychological Empowerment Instrument, the Conflict Mode Instrument and a demographic inventory. Descriptive and inferential correlational statistics were used to analyse the data. RESULTS: Students scored in the high range for focusing on their deficiencies in conflict situations; they scored above the 60th percentile for avoiding and accommodating behaviours and were less likely to use competing or collaborating strategies to manage conflict. Empowerment scores were significantly correlated with stress resiliency scores. Students with high scores on empowerment had high scores on the skill recognition subscale of the Stress Resiliency Profile suggesting more resilience; high scores on empowerment were related to high necessitating subscale scores of the Stress Resiliency Profile suggesting a predisposition to stress. CONCLUSIONS: Neuman Systems Model may provide guidance for educators to strengthen student nurses' management of stressors in the workplace.

Enhanced recovery after cardiac surgery protocol reduces perioperative opioid use.

Objective: Enhanced Recovery After Surgery protocols are relatively new in cardiac surgery. Enhanced Recovery After Surgery addresses perioperative analgesia by implementing multimodal pain control regimens that include both opioid and nonopioid components. We investigated the effects of an Enhanced Recovery After Surgery protocol at our institution on postoperative outcomes with particular focus on analgesia. Methods: Single-center retrospective study comparing perioperative opioid use before and after implementation of an Enhanced Recovery After Surgery protocol at our institution. Subjects were divided into 2 cohorts: Enhanced Recovery After Surgery (study group from year 2020) and pre-Enhanced Recovery After Surgery (control group from year 2018). Baseline and perioperative variables including total opioid use from the day of surgery to postoperative day 5 were collected. Opioid use was calculated as morphine milligram equivalents and compared between the 2 cohorts. Results: A total of 466 patients were included: 250 in the Enhanced Recovery After Surgery group and 216 in the pre-Enhanced Recovery After Surgery group. Both groups had similar baseline characteristics, but the Enhanced Recovery After Surgery group had significantly more subjects with intravenous drug use history (P < .0001), endocarditis (P < .0001), and liver disease (P = .007) compared with the pre-Enhanced Recovery After Surgery group. Every day from the day of surgery to postoperative day 5, the Enhanced Recovery After Surgery group had significant reduction (57%) in opioid use compared with the pre-Enhanced Recovery After Surgery group. Total opioid use for the entire length of stay was 259 morphine milligram equivalents in the Enhanced Recovery After Surgery group versus 452 morphine milligram equivalents in the pre-Enhanced Recovery After Surgery group (P < .0001). Subgroup analysis of subjects with intravenous drug use history did not demonstrate a significant reduction in opioid use. Conclusions: Enhanced Recovery After Surgery protocols with an emphasis on multimodal pain management throughout perioperative care are associated with a significant reduction in the postoperative use of opioid analgesics.

A family history intervention: enhancing cardiovascular risk assessment.

This article describes the effect of individualized counseling using family history data and objective cardiovascular risk factors on intent to change and actual exercise behavior in a diverse sample of working adults. Using a longitudinal, quasi-experimental, crossover design, objective data (blood lipids, glucose, blood pressure, and body mass index) and subjective data (awareness of heart disease risk, depression, spirituality, and knowledge of family history) were collected from 91 (mostly female and with a mean age of 45 years) primary and secondary teachers in a southwestern city. The Transtheoretical Model of Change guided the study and measured intent to exercise. Objective risks in this sample mirrored national indices of risk for obesity and abnormal lipids. Although some participants increased their exercise, no significant differences were found between the groups in exercise behavior at 6 and 12 months. Using knowledge of family history to raise awareness and encourage lifestyle changes related to cardiovascular risk warrants further study.

An exploratory study of cardiac health in college athletes.

A common assumption is that college athletes are healthy based on their age and level of physical activity. This study used a descriptive correlational design to explore relationships and predictors of physical fitness levels among an ethnically diverse sample of 135 college athletes from a National College Athletic Association Division II university. Both subjective and objective indices of cardiac health and physical fitness level (blood pressure [BP], body mass index [BMI], waist-to-hip ratio, waist circumference, hip circumference, blood lipids, glucose, and VO(2max)) were collected. Minimal research exists with this population or with such an array of subjective and objective measures. More than one fourth of the athletes had a BMI in the overweight range, one fifth was prehypertensive, and one fourth had lower-than-recommended high-density lipoprotein (HDL) cholesterol levels. Waist circumference accounted for 21% of the variance in systolic BP level. These factors may predispose the college athletes to cardiac risk in the future when exercise regimens are reduced. Gender differences were found in all physical size variables and in physical fitness levels, with physical fitness level alone predicting gender correctly 98.5% of the time. Differences support the need to account for gender and fitness levels in cardiac risk assessment of young populations.

A Novel Approach to Electronic Nursing Documentation Education: Ambassador of Learning Program.

Health care is rapidly evolving to meet the changing needs of our increasing complex patients. Nursing practice must keep pace with these changes. Emerging information technologies such as electronic health records (EHRs) challenge nursing practice to redesign workflow. Providing nurses with effective education on how to incorporate EHR documentation is essential for safe patient care. This article describes the development of an education program that promotes accurate and more efficient nursing EHR documentation practices.

Enhancing resilience, empowerment, and conflict management among baccalaureate students: outcomes of a pilot study.

To manage interpersonal conflict, nursing students need evidence-based interventions to strengthen stress resiliency, psychological empowerment, and conflict management skills. A pilot 1-group, pre-post-design, 2-semester intervention used simulated experiences to enhance these skills with 60 undergraduate nursing students. Findings suggest that integration of conflict resolution skills throughout the curriculum, with repeated opportunities to practice using a variety of styles of conflict management in relation to situational factors, may be beneficial to prepare students for the challenges of today's healthcare environment.

Thirty-day outcomes support implementation of a surgical safety checklist.

BACKGROUND: Thirty-day postoperative complications from unintended harm adversely affect patients and their families and increase institutional health care costs. A surgical checklist is an inexpensive tool that will facilitate effective communication and teamwork. Surgical team training has demonstrated the opportunity for stakeholders to professionally engage one another through leveling of the authority gradient to prevent patient harm. The American College of Surgeons National Surgical Quality Improvement Program database is an outcomes reporting tool capable of validating the use of surgical checklists. STUDY DESIGN: Three 60-minute team training sessions were conducted and participants were oriented to the use of a comprehensive surgical checklist. The surgical team used the checklist for high-risk procedures selected from those analyzed for the American College of Surgeons National Surgical Quality Improvement Program. Trained observers assessed the checklist completion and collected data about perioperative communication and safety-compromising events. RESULTS: Data from the American College of Surgeons National Surgical Quality Improvement Program were compared for 2,079 historical control cases, 246 cases without checklist use, and 73 cases with checklist use. Overall completion of the checklist sections was 97.26%. Comparison of 30-day morbidity demonstrated a statistically significant (p = 0.000) reduction in overall adverse event rates from 23.60% for historical control cases and 15.90% in cases with only team training, to 8.20% in cases with checklist use. CONCLUSIONS: Use of a comprehensive surgical safety checklist and implementation of a structured team training curriculum produced a statistically significant decrease in 30-day morbidity. Adoption of a comprehensive checklist is feasible with team training intervention and can produce measurable improvements in patient outcomes.