Rounding and Quick Access Education to Reduce Catheter-Associated Urinary Tract Infections.

PURPOSE/OBJECTIVES: The acute care division of a tertiary medical center experienced a 167% increase in catheter-associated urinary tract infections, with 2 inpatient surgical units accounting for 67% of infections. A quality improvement project was implemented to address the infection rates on the 2 inpatient surgical units. The aim was to reduce catheter-associated urinary tract infection rates by 75% in the acute care inpatient surgical units. DESCRIPTION OF THE PROJECT/PROGRAM: A survey identified educational needs of staff, with response data informing the development of a quick response code containing resources for prevention of catheter-associated urinary tract infections. Champions rounded on patients and audited maintenance bundle adherence. Educational handouts were disseminated to increase compliance with bundle interventions. Outcome and process measures were tracked on a monthly basis. OUTCOME: Infection rates decreased from 1.29 to 0.64 per 1000 indwelling urinary catheter days, catheter utilization increased 14%, and maintenance bundle compliance was 67%. CONCLUSION: The project enhanced quality care through the standardization of preventive practices and education. The data reflect a positive effect on catheter-associated urinary tract infection rates from increased awareness of the nurse's role in the prevention process.

Clinical Nurse Specialist Practice: Impact on Improving Sedation Practice in Critical Care.

PURPOSE/OBJECTIVES: Prolonged mechanical ventilation results from deeper levels of sedation. This may lead to impaired respiratory muscle functioning that develops into pneumonia, increases antibiotic use, increases delirium risk, and increases length of hospitalization. A trauma and surgical intensive care unit interdisciplinary team conducted a quality improvement project to lighten sedation levels and shorten mechanical ventilation time. DESCRIPTION OF THE PROJECT: The project included multimodal elements to improve sedation practice. Standardizing the spontaneous awakening trial algorithm, creation of electronic health record tools, integration of sedation practices into daily rounds, and focused education for nursing were implemented in April 2021 through October 2021. OUTCOME: A reduction of median hours spent on mechanical ventilation was achieved. Mechanical ventilation hours decreased from 77 to 70. Richmond Agitation Sedation Scale levels improved from a median of -2 to -1, and daily spontaneous awakening trials increased from 10% to 27% completed. CONCLUSION: The quality improvement project demonstrated that, with increased daily spontaneous awakening trials and lighter sedation levels, the time patients spent on mechanical ventilation was shortened. There was no increase to self-extubation with lighter sedations levels. Shorter time on mechanical ventilation can reduce patient harm risks.

Dashboard Design to Identify and Balance Competing Risk of Multiple Hospital-Acquired Conditions.

BACKGROUND: Hospital-acquired conditions (HACs) are common, costly, and national patient safety priority. Catheter-associated urinary tract infections (CAUTIs), hospital-acquired pressure injury (HAPI), and falls are common HACs. Clinicians assess each HAC risk independent of other conditions. Prevention strategies often focus on the reduction of a single HAC rather than considering how actions to prevent one condition could have unintended consequences for another HAC. OBJECTIVES: The objective of this study is to design an empirical framework to identify, assess, and quantify the risks of multiple HACs (MHACs) related to competing single-HAC interventions. METHODS: This study was an Institutional Review Board approved, and the proof of concept study evaluated MHAC Competing Risk Dashboard to enhance clinicians' management combining the risks of CAUTI, HAPI, and falls. The empirical model informing this study focused on the removal of an indwelling urinary catheter to reduce CAUTI, which may impact HAPI and falls. A multisite database was developed to understand and quantify competing risks of HACs; a predictive model dashboard was designed and clinical utility of a high-fidelity dashboard was qualitatively tested. Five hospital systems provided data for the predictive model prototype; three served as sites for testing and feedback on the dashboard design and usefulness. The participatory study design involved think-aloud methods as the clinician explored the dashboard. Individual interviews provided an understanding of clinician's perspective regarding ease of use and utility. RESULTS: Twenty-five clinicians were interviewed. Clinicians favored a dashboard gauge design composed of green, yellow, and red segments to depict MHAC risk associated with the removal of an indwelling urinary catheter to reduce CAUTI and possible adverse effects on HAPI and falls. CONCLUSION: Participants endorsed the utility of a visual dashboard guiding clinical decisions for MHAC risks preferring common stoplight color understanding. Clinicians did not want mandatory alerts for tool integration into the electronic health record. More research is needed to understand MHAC and tools to guide clinician decisions.

Developing the Graduate Nurse Residency: An Oral History With Dr. Colleen Goode and Dr. Mary Krugman.

Health care organizations face the challenge of needing newly licensed nurses to fill positions and facilitate competent care for patients. Wide variation in graduate nurse orientation programs, a growing complexity of care, and high graduate nurse turnover rates led to the development of nurse residency programs. The historical perspectives of two nursing pioneers involved in the development of a national model for nurse residency programs provide context to the importance of creating a vision, providing leadership, and applying an evidence-based rationale to structure a series of learning and work experiences designed to support graduate nurses as they transition into their first professional nursing position. [J Contin Educ Nurs. 2022;53(4):171-177.].

Using Evidence to Prevent Risk Associated With Perioperative Pressure Injuries.

Pressure injuries (PI) are a significant concern for surgical patients due to prolonged immobility and potential exposure to other risk factors associated with procedures. PI prevention strategies should begin early in the patient's surgical encounter starting with preoperative assessment. Much literature has been published to discuss PI risk factors, assessment tools, and evidence-based prevention measures. The purpose of this article is to critically review current best evidence to holistically assess patient risk for Hospital Acquired Pressure Injuries (HAPI) and review current tools used for risk assessment, interventions to combat skin injuries, and discuss implications for practice in perioperative nursing.

The lived experiences of graduate nurses transitioning to professional practice during a pandemic.

BACKGROUND: Graduate nurses face challenges during their transition to professional practice. Understanding these experiences during a pandemic has not been explored. PURPOSE: The purpose of this study is to describe the lived experiences of graduate nurses transitioning to practice during a pandemic. METHODS: Using a hermeneutic phenomenological approach, focus groups were conducted with fifteen nurses who were at three different stages of transition and participating in a 12-month Graduate Nurse Residency Program. FINDINGS: Seven themes emerged: 1) being new is overwhelming, even more so during COVID-19, 2) need to be flexible, 3) pandemic knowledge and practice disconnect, 4) communication barriers worsened with masks, 5) being a "COVID nurse," 6) no self-care, and 7) gratitude: still glad to be a nurse. DISCUSSION: Findings emphasize the important focus on graduate nurse support and educational foundation for role transition into professional practice, especially during a pandemic. Participants expressed lack of preparedness for practice but remain excited about being a nurse.

Nursing Considerations for Patients With HIV in Critical Care Settings.

Infection with HIV is a chronic condition that requires daily medication to suppress viral replication. With appropriate treatment, people living with HIV have a life expectancy approaching that of the general population. However, they are at increased risk for comorbidities including cardiovascular disease, renal disease, type 2 diabetes, neurologic conditions, and cancers, often with worse outcomes than in patients without HIV. When they are admitted to critical care settings, care considerations, particularly regarding antiretroviral therapy, must be addressed. Antiretroviral therapy is critical for successful management of HIV infection and should be continued when possible during intensive care unit stays. However, many antiretroviral regimens result in drug-drug interactions, adverse drug-related events, and secondary complications such as insulin resistance and prolonged QT intervals. Critical care nurses have unique opportunities to provide safe, unbiased, and compassionate care that promotes health for a population of people who have a history of being stigmatized.

Design and Evaluation of Low-Fidelity Visual Display Prototypes for Multiple Hospital-Acquired Conditions.

Hospital-acquired conditions such as catheter-associated urinary tract infection, stage 3 or 4 hospital-acquired pressure injury, and falls with injury are common, costly, and largely preventable. This study used participatory design methods to design and evaluate low-fidelity prototypes of clinical dashboards to inform high-fidelity prototype designs to visualize integrated risks based on patient profiles. Five low-fidelity prototypes were developed through literature review and by engaging nurses, nurse managers, and providers as participants (N = 23) from two hospitals in different healthcare systems using focus groups and interviews. Five themes were identified from participatory design sessions: Need for Integrated Hospital-Acquired Condition Risk Tool, Information Needs, Sources of Information, Trustworthiness of Information, and Performance Tracking Perspectives. Participants preferred visual displays that represented patient comparative risks for hospital-acquired conditions using the familiar design metaphor of a gauge and green, yellow, and red "traffic light" colors scheme. Findings from this study were used to design a high-fidelity prototype to be tested in the next phase of the project. Visual displays of hospital-acquired conditions that are familiar in display and simplify complex information such as the green, yellow, and red dashboard are needed to assist clinicians in fast-paced clinical environments and be designed to prevent alert fatigue.