NURS 380

Team
Application
Project #2
Presented by: Amanda Russi,
Natalie Springborn, Madeline
Tapia, and Amanda Truong
Let’s Take A Mindful Moment
 Presentation Objectives

01 02 03
Define related Discuss Case Study Discuss CAUTI and
terms and Background/ Introduce Project
Significance

04 05
Review PDSA and Summary and
Connect INP Reflection

Healthcare Acquired
Infections (HAI)
Catheter-Associated Urinary
Tract Infection (CAUTI)
The Four Phases of a QI
Project
Run Chart
Common Variation
Special Cause Variation
Useful Definitions
Nosocomial acquired infections that are typically not present or
might be incubating at time of admission1
An infection of the urinary system including the urethra, bladder,
ureters, and kidney caused by an indwelling urinary catheter2
1. Innovation – coming up with new ideas for changes3
2. Pilot – testing a change of a small scale3
3. Implementation – making the change the new standard process
in one defined setting3
4. Spread – implementing the change in several settings3
Graph of data over time3
Random causes of variation inherent to the system3
Non-random causes of variation due to irregular or unnatural
influences on the system3
 Summary of Case Study
● Whitney, a sophomore in college,
came in postoperative after an
appendectomy4
● Nurse not using gloves and not
washing hands to remove the
adhesive from IV line
● No correct documentation of vital
signs and rash were recorded
● Doctors didn’t take precautions with
following up with decreased BP and
increased temperature
● Whitney ended up in ICU with MRSA
infection in her bloodstream and
passed away due to improper
hygiene, quick spread of infection,
and ineffective communication
 Background and Significance
● Healthcare acquired infections are a chronic issue within the healthcare system.
● UTIs account for 36% of HAIs and CAUTIs account for 80% of those5
● Among UTIs acquired in the hospital, approx. 75% are associated with a urinary
catheter. Between 15-25% of hospitalized patients receive urinary catheters during
their hospital stay2
● Patients trust healthcare providers that the proper preventative measures are being
taken to decrease healthcare acquired infections.
● We want to know how daily periurethral cleansing with sterile water will decrease
catheter associated urinary tract infections.
 Synthesis of Literature
❏ Following protocols
❏ Decreases rate of CAUTI6,7,8
❏ Sets a standard for when indwelling catheters are needed
vs not needed5,6,7
❏ Proper hygiene
❏ Decreases rate of CAUTI5,7
❏ Importance of hand washing5,8
❏ Daily client care8
❏ Communication
❏ Limits the number of days with indwelling catheter5,6,7,8
❏ Makes sure everyone involved in care is on the same
page5,6,7
❏ Continuing education5,6.7,8
 Making the Connection
● To Err is Human Documentary9
● Review orders before doing anything else to ensure
proper administration and handling is provided to the
patient
● All errors affect not only the patient, but the family as
well
● Errors in hygiene can cause death
○ Prevention is the first step
● Errors can have emotional, physical, and mental
effects on the patients and their families
Concept Map & IN
Applications
Patient-Centered Concept Map4
 Patient & Informatics
Complex Adaptive Systems (CAS)
❏ A “Systems within Systems”
❏ Poor interoperability leads
approach is various consumer
to missing or incomplete
and healthcare information
tasks that need to be
technology to enhance the
performed in order to
delivery of healthcare10
❏ Data can be verified
provide safety for the
between one system and patient10
another and the patient ❏ Decrease quality of
confirms
❏ This gives the healthcare care
team a more holistic view ❏ Cause potential
of the patient
safety concern
 Identify Health Care Issues
Safety and quality issues: ● Our selected safety
○ Doctors and nurses at risk for issue:
ineffective communication causing
potential error
○ Ineffective
○ Family members being a possible communication
safety concern ○ Increase cost of
care
Integrative Nursing Principles10:
○ Proper technique
○ Interdisciplinary being used
teams: Principle #1
○ Safety culture: ○ Evidenced-based
Principle #6 practices
How to Improve with the Model
for Improvement (MFI)
 Model for Improvement (MFI) Overview12

What are we accomplishing? Decrease the number of CAUTI.

We will look at the “S” portion of our

PDSA cycle to see if our change has been It is good change?
effective.

Ensure that periurethral care is

What changes did we make? done during each shift.
 Reducing CAUTI
in ICU Patients
Our Question: How will implementing
periurethral cleaning at each shift affect the
rate of CAUTIs in ICU patients?
Qualitative: How do the nurses implementing
this process describe their experience and were
there any facilitators or barrier encountered in
this implementation?
Quantitative: Would regular periurethral
cleansing done once a shift with sterile water
aid in preventing catheter associated urinary
tract infections?
 PDSA – Plan the Test of Change
Our Test: Will periurethral cleaning Barriers & Recommendations:
performed with sterile water once Barriers we foresee will be
per shift decrease CAUTIs? unwillingness from the staff to
implement this new procedure. We
Who will collect?: A quality recommend increasing the number of
improvement nurse and a HA participants for future studies.
infections nurse specialist.
Expectations: We expect to see a
Where will this take place? We reduction in CAUTIs on the ICU
will be looking at these changes floor.
made on the 2nd floor ICU of the
Wildcat Hospital beginning on
October 11th and running until
November 4th.
PDSA – Plan the Test of Change Data Collection Plan
Our Goal: To decrease the number of catheter acquired urinary tract infections.

Qualitative: Look at how this new implementation will be accepted by the

medical staff.

Quantitatively: Measure the reduction of CAUTIs in the ICU after the new
periurethral care plan has been implemented.

When, Where, How?: Our data collection will occur on the 2nd floor ICU at
the Wildcat Hospital. This study will begin on October 11th and will end on
November 4th. We will obtain data on how many CAUTIs have occurred
during this time and compare it to the previous number of CAUTIs.

Who?: Data will be collected and analyzed by quality improvement nurses and
HA infections nurse specialist. Our data that is collected will be present to ICU
and hospital management.
 PDSA – Do
● Theoretically, we would expect the number of CAUTI infections to
decrease after implementing one periurethral cleansing per shift as
well as education on the importance of this change.
● Based on our theoretical run chart, we expect for the mean number of
HAIs from CAUTI infections to decrease by greater than 10 in about 3
weeks, or 21 days.
● We would also expect for the understanding that patients have about
the importance cleansing catheters would increase, which would also
decrease the number of CAUTIs.
CREDITS: This presentation template was created by
Slidesgo, including icons by Flaticon, and infographics
& images by Freepik.
Run Chart
 Run Chart Analysis
Run Chart What that component Absent or Present in our run
Component tells us chart (if present, how many?)

Shift(s) There are no consecutive data 6

points that fall below median
line

Trend(s) There are no sequential data 0

all going up or down

Number of Run(s) Data line crosses the median 0

(if any, indicate too twice for a total of 1 run each,
which is too few for 10 data
many or too few points
status)

Astronomical point(s) There are no data points 0

starting from the
implementation date that stand
out from the others

● Change is occurring but very inconsistently. As The run chart goes down, it still moves
up to the median line twice, meaning the data is going up and down frequently. Not
frequently enough for any runs or trends.
 PDSA – Study
Our prediction was that be instilling
a requirement of one periurethral
change per shift, we would see a
significant decrease in the number of
HAIs contracted from
Catheter-Associated Urinary Tract
Infections. Compared to our
theoretical findings, we saw a
decrease n the number of CAUTIs
but not as consistent of a change as
we thought it would be within our
run cycle.
Our proposed change will likely
lead to an improvement by
decreasing the infections being
contracted in this way. Although
we did not see as consistent of a
change as we may have liked to, I
think that because of the overall
decrease in number of CAUTIs
over this 24 day period, if we do
this run cycle again for longer, we
will see an improvement.
 PDSA - Act
In our next PDSA run cycle, I would expect that…

● We would need to implement a longer run time so that we would have

more information/date to assess a more long term effect of the

implementation of the periurethral cleansing per shift.

● We would also need to assess the educational aspects of the teaching

provided and the encouragement of participation from patients by

surveying patients on what they now understand about acquiring CAUTIs.

Summary, Questions to
Class,
Reflections, and Pearls
 Summary
Process:

● Understanding basic course content

● Project idea was easy to understand
● IHI provided extra support

IN Principles:

● To improve communication between doctors and

nurses to decrease the amount of HAI.
● Future improvement:
○ Well being of patient
○ Well being of providers and nurses
 Questions to the Class
Question 2: How does
Question 1: What educating the patients
ways can we teach on cleaning and HAIs
patients to from CAUTIs relate to
effectively cleanse the integrative nursing
indwelling principle that human
catheters so that beings have the innate
infection is actually capacity for health
being prevented? and wellbeing?
 Reflection

Facilitators Barriers
Being that this was our second Finding time to meet
project, we had better that worked with
knowledge of what we wanted everyone’s busy
to contribute in group schedules as clinical and
meetings. simulations began.
 Pearls of Wisdom

Communication
is key

Utilize the
tools in your
toolbox
Closing Mindful Moment
 References
Monegro, A. F., Muppidi, V. & Regunath, H. (2021). Hospital acquired infections. StatPearls
[Internet]. https://www.ncbi.nlm.nih.gov/books/NBK441857/
Centers for Disease Control and Prevention (n.d). Healthcare-associated infections:
Catheter-
associated urinary tract infections (CAUTI). https://www.cdc.gov/hai/ca_uti/uti.html
Institute for Healthcare Improvement. (n.d.). Interpreting data: Run charts, control charts,
and other measurement tools.
https://education.ihi.org/topclass/topclass.do?expand-New_CourseHome-id=198768103-acti
vitytype=28-learningPage=TrainingHistory#view_New_CourseContents-tab-link

YouTube. (2012). Partnering To Heal. YouTube. Retrieved October 24, 2021, from
https://www.youtube.com/watch?v=pVOVPl9S9jk

Parker, V., Giles, M., Graham, L., et al. (2017). Avoiding inappropriate urinary catheter use
and catheter-associated urinary tract infection (CAUTI): A pre-post control intervention
study. BMC Health Services Research, 17(314). https://doi.org/10.1186/s12913-017-2268-2
 References Continued
DePuccio, M. J., Gaughan, A. A., Sova, L. N., MacEwan, S. R., et al. (2020). An examination of the barriers to and
facilitators of implementing nurse-driven protocols to remove indwelling urinary catheters in acute care hospitals. Joint
Commission Journal on Quality & Patient Safety, 46(12), 691–698.
https://doi-org.ezproxy3.library.arizona.edu/10.1016/j.jcjq.2020.08.015
Halperin, J. J., Moran, S., Prasek, D., Richards, A., Ruggiero, C., & Maund, C. (2016). Reducing hospital-acquired
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Rahimi, M., Farhadi, K., Babaei, H., & Soleymani, F. (2019). Prevention and management catheter-associated urinary tract
infection in intensive care unit. Journal of Nursing & Midwifery Sciences, 6(2), 98–103.
https://doi-org.ezproxy4.library.arizona.edu/10.4103/JNMS.JNMS_47_18
Eisenberg, M. (Director). (2019). To err is human: A patient safety documentary. [Film]. Gravitas Ventures.
Kreitzer, M. J., Koithan, M., & Oxford University Press. (2019). Integrative nursing (Second edition.) DOI:
10.1093/med/9780190851040.001.0001
Institute for Healthcare Improvement (n.d). How to improve.
http://www.ihi.org/resources/Pages/HowtoImprove/default.aspx
YouTube. (2016). 2 Minute Re-Centering Mindfulness Meditation for De-stressing.
YouTube. Retrieved October 24, 2021, from https://www.youtube.com/watch?v=Jholcb8Gz0M
 Images Used
● Slide 2, https://www.headspace.com/meditation/10-minute-meditation
● Slide 27,
https://www.vectorstock.com/royalty-free-vector/group-of-people-talk-to-each-other-with-speec
h-vector-23790661
● Slide 28,
https://www.wallpaperflare.com/rocks-stones-stacked-sunset-beach-hd-nature-wallpaper-mhzqu
● Slide 28, https://www.digitaldealer.com/latest-news/work-smarter-not-harder/