NRS 493 After discussion with your preceptor, name one financial aspect, one quality aspect, and one clinical aspect that need to be taken into account for developing the evidence-based change proposal

NRS 493 After discussion with your preceptor, name one financial aspect, one quality aspect, and one clinical aspect that need to be taken into account for developing the evidence-based change proposal

NRS 493 After discussion with your preceptor, name one financial aspect, one quality aspect, and one clinical aspect that need to be taken into account for developing the evidence-based change proposal

Over the last 2 decades there has been an undeniable rise in health care costs which has caused a shift in focus toward measuring care quality. Studies have shown that improved quality of care has been associated with lower health care costs through decreased complications and length of stay (Agarwal, Youngerman, Kaakaji, Smith, McGregor, Et. Al, 2021). In efforts to improve care quality, providers use clinical practice guidelines, which are statements that include recommendations, informed by systematic reviews of evidence, intended to optimize patient care. CAUTI caused by improper testing of urine can have financial ramifications. A urine culture can cost $80 or more. Antibiotic treatment for a UTI cost from $3 to over $300. In addition, drug-resistant infections (caused by improper treatment with antibiotics) add costs for extended lengths of stay, expensive medicines, and nursing care (ABIM Foundation, 2014).

 

After discussion with my preceptor, a urine culture stewardship initiative will reduce costs associated with improper testing and the treatment. Implementation of this initiative will affect clinical practice by decreasing the total number of urine cultures ordered and reducing the number of inappropriate treatments. Regarding quality, a urine culture stewardship will help identify areas where routine ordering and inappropriate practices increase costs and affect patient outcomes, as well as used to reduce excessive ordering, lower contamination rates, and decrease unnecessary antibiotic prescribing (Sinawe, Casadesus, 2022).

 

References

Agarwal, N., Youngerman, B., Kaakaji, W., Smith, G., McGregor, J. M., Powers, C. J., Guthikonda, B., Menger, R., Schirmer, C. M., Rosenow, J. M., Cozzens, J., & Kimmell, K. T. (2021). Optimizing Medical Care Via Practice Guidelines and Quality Improvement Initiatives. World Neurosurgery151, 375–379. https://doi-org.lopes.idm.oclc.org/10.1016/j.wneu.2021.02.013

 

American Board of Internal Medicine Foundation. (2014). Tests & treatments for urinary tract infections (UTIs) in older people When you need them—and when you don’t. https://www.choosingwisely.org/wp-content/uploads/2014/09/ChoosingWiselyUTIAGSAMDA-ER.pdf

 

Sinawe H, Casadesus D. Urine Culture. (2022). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557569

Your capstone proposal regarding a urine culture stewardship initiative is an excellent idea to improve healthcare

NRS 493 After discussion with your preceptor, name one financial aspect
NRS 493 After discussion with your preceptor, name one financial aspect

costs. Our facility adopted a policy to reduce the laboratory cost of urine cultures last year. Our facility must have a signed “ticket to ride” by the nurse and charge nurse that checks a list of qualifications for the patient before a specimen can be sent for culture. The checklist helps to reduce over-testing. An article from the International Journal of Urology highlighted a study that discusses the overuse of prescriptions for ASB (asymptomatic bacteriemia) due to over-testing of UCx (urine cultures). The authors stated that “another impetus to avoid UCx testing is to decrease the likelihood of treatment for ASB. Unnecessary antibiotic treatment of ASB is common, occurring in up to 83% of patients which undermines patient safety initiatives due to increased risk of development of resistant organisms” (Richards et al., 2018).

Since the implementation of our facility’s urine culture checklist, AKA ticket to ride, I have found that we continually have to educate physicians who order urine cultures when in fact the patient may not qualify for urine culture testing based on the new protocol guidelines. It will be of great financial benefit and positive health outcomes for patients should continued reduction in urine cultures be achieved.

Reference

Richards, K. A., Cesario, S., Best, S. L., Deeren, S. M., Bushman, W., & Safdar, N. (2018). Reflex urine culture testing in an ambulatory urology clinic: Implications for antibiotic stewardship in urology. International Journal of Urology, 26(1), 69–74. https://doi.org/10.1111/iju.13803

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The urine culture stewardship program included monthly 1-hour discussions with ICU house staff emphasizing avoidance of “pan-culture” for sepsis workup and obtaining urine culture only if a urinary source of sepsis is suspected. The urine culture utilization rate metric (UCUR; i.e., no. urine cultures/catheter days ×100) was utilized to measure the effect. AN INTERACTIVE QUALITY DASHBOARD REPORTED monthly UCUR, catheter utilization ratio (CUR), and CAUTI rate. Catheterized ICU patients (2015-2016) were evaluated for 30-day readmission for UTIs to ensure safety. Time-series data and relationships were analyzed using Spearman correlation coefficients and regression analysis. The urine culture stewardship program was effective and safe in reducing UC overutilization and was correlated with a decrease in CAUTIs. The addition of urine-culture stewardship to standard best practices could reduce CAUTI in ICUs.

Reference

Al-Bizri LA, Vahia AT, Rizvi K, Bardossy AC, Robinson PK, Shelters RT, Klotz S, Starr PM, Reyes KQ, Suleyman G, Alangaden GJ.(2021 ) Effect of a urine culture stewardship initiative on urine culture utilization and catheter-associated urinary tract infections in intensive care units. Infect Control Hosp Epidemiol. 2021 Jul 8:1-4. DOI: 10.1017/ice.2021.273. Epub ahead of print. PMID: 34236024.

After speaking with my preceptor there are different financial aspects, quality aspects, and clinical aspects when developing the evidence-based change proposal. The capstone project change proposal is on fall interventions and the use of bed alarms and the benefits of hourly rounding. The use of bed alarms can cause a mistrust among staff and of the patients in our care. Patients can feel mistrusted and confined to their beds with the use of these alarms. As nurses we can take on that leadership role to help our facilities strive away from the use of alarms and implement the use of hourly rounding. We able to improve the dignity of our patients and their well faire. We can help to get us the education that we need to understand how to properly hourly round on our patients. By doing this, we are building upon that trusting relationship with our patients. Ensuring that we are providing our patients with quality care is vital to their success in their health. Ensuring quality care is being provided is always a concern. There are rising concerns that poor quality care often results in harm to patients, but also an increase in healthcare costs (Agarwal et al. 2021). This is where focusing on the quality of care being provided is of great importance. Improving the care being given has been related to the lowering of health care and has been shown to decrease complications and the decrease in patient stay (Agarwal et al. 2021). By building upon a trusting relationship with our patients and ensuring that we are providing patient centered care, we can provide our patients with quality care. Increasing patient satisfaction with their care is how quality care can be given. By hourly rounding and increasing patient centered care, is how falls can be prevented. Falls lead to an increase in patient complications and increase in patient stay. This prolongs patients need for hospital care and increases healthcare costs. Patients are at risk for infections and further negative aspects the longer they are in the hospital. This is a financial aspect of care as patient falls leads to an increase in costs. By implementing hourly rounding, we can decrease the financial aspects of the healthcare system. We are able to prevent further injuries to our patients as well and improve patient care. Ensuring that patients are safety is how quality care can be ensured as well. A clinical aspect of the evidence-based practice can be due to staffing. As staffing in the healthcare system is short, being able to implement this intervention can be tough. As many are left short staffing, doubling up on patients is often occurring. At my place of work, this often occurs in order to meet the needs of the patients. Being able to purposefully hourly round can be a challenge in order to meet and care for all of the patients. As short staffing makes it difficult to meet the needs of the patients in a purposeful way. But the implementation of this intervention is crucial in the care and needs of the patients.

 

Agarwal, N., Youngerman, B., Kaakaji, W., Smith, G., McGregor, J. M., Powers, C. J., Guthikonda, B., Menger, R., Schirmer, C. M., Rosenow, J. M., Cozzens, J., & Kimmell, K. T. (2021). Optimizing Medical Care Via Practice Guidelines and Quality Improvement Initiatives. World Neurosurgery151, 375–379. https://doi-org.lopes.idm.oclc.org/10.1016/j.wneu.2021.02.013

Moncada, L., & Mire, L. G. (2017). Preventing Falls in Older Persons. American Family Physician96(4), 240–247. https://www.aafp.org/afp/2017/0815/p240.html