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Initiating Smart Goals

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Initiating Smart Goals
Jennifer Clay
Chamberlain School of Nursing
Mary Thomas
NR 447 Collaborative Health Care

Introduction
Smart goal #1; nursing will assess for appropriate use of indwelling catheters every shift in order to prevent CAUTI, nursing will obtain an order for discontinuation if no longer needed, this will be audited weekly in order to reach the goal of zero UTI’s on a monthly basis. This smart goal was developed to insure nursing is doing everything possible to prevent CAUTI. The goal steers toward patient safety and because Medicare and Medicaid do not reimburse for UTI’s acquired while hospitalized any longer. Smart goal #2; there will be 100% compliance in doing CVAD assessments, dressing changes, and the use of 70% isopropyl alcohol caps (CURO’s) in order to decrease the rate of CLABSI’s in the Medical-Surgical unit. This goal is to insure nursing is doing proper assessments, dressing changes, proper hand hygiene, using CURO’s caps and handling techniques in order to prevent contaminating the line.
Goal 1: Preventing CAUTI Prevention of Hospital-acquired UTI’s should be a goal for every acute care setting to prevent the high cost of treatment, each episode of symptomatic CAUTI cost at least $600. It is not surprisingly the most common of health care associated infections accounting for about 40% of HAI’s. (Saint Et.al) This goal is to develop a way for nursing to assess the use of indwelling catheters and discontinue them if not needed to prevent CAUTI.
Peer Reviewed Article Translating Health Care- Associated Urinary Tract Infection Prevention Research into Practice via the Bladder Bundle, an article from the US National Library of Medicine National Institutes of Health focuses on preventing CAUTI by continual assessment and removal of catheter as soon as possible, especially if the use of it is not clearly indicated. This article also indicates per studies that most hospital-acquired UTI’s are caused by an indwelling catheter and evaluating the indications for the use of the catheter is pertinent to prevention of UTI’s because it is consistently found that about half are appropriate.
Credible Website The Centers for Disease Control and Prevention is a credible website that can be used in order to find the appropriate guidelines for catheter use and prevention of CAUTI. What the core strategies are for prevention of CAUTI, like using only for appropriate indications, and removal as soon as possible. The site is also a good reference for governmental guidelines, to remain up-to-date on any changes that may come about.
Informational Expert The infection control nurse Deborah Norris RN, BSN was interviewed on the topic of CAUTI, from SRMC. Her recommendations for prevention of CAUTI on the Medical-Surgical floor was to implement a nurse-initiated Foley removal protocol, in addition to the computerized reminder in the daily assessment we already have in place. The reminder only reminds the nurse to obtain an order to discontinue its use, then the nurse gets busy with other tasks and for gets. If there’s a nurse-initiated removal protocol, the nurse can discontinue the catheter at the time of the assessment when fresh on their minds.
Goal 2: CLABSI Prevention Nursing in the Medical-Surgical unit will have decreased reports of central-line bloodstream infections reported on a monthly basis to the infection control nurse for SRMC. The charge nurses will audit daily for accuracy in the assessment for CVAD use, dressing change, ultra-sites in use, and Curos alcohol impregnated caps are being used to prevent contamination of the device. According to studies, consistent use of 70% isopropyl alcohol caps on the end of the device does influence the CLABSI rates. (Ramirez et.al)
Peer-Reviewed Article Central Venous Catheter Protective Connector Caps Reduce Intraluminal Catheter-Related Infection an article from The Journal of the Association for Vascular Access, tells about a study done in an ICU to decrease the incidence of CLABSI in their unit. They implemented the use of Curo’s caps, and improved hand hygiene and this decreased there rated from 4 CLABSI’s in 2010 to only 1 in 2011. They kept the caps readily available for nurses and respiratory therapist to at the bedside and on strips on the IV poles at bedside in order to keep their compliance rate up. (Ramirez et.al)
Credible Website The Centers for Disease Control and Prevention’s website gives guideline on prevention, toolkits, and monitoring CLABSI’s. The website also provides resources for the patient and the healthcare provider to educate on the use of and proper handling of the device to reduce the risk of contamination. Whether in the healthcare setting or in the outpatient setting.
Informational Expert
The infection control nurse, Deborah Norris RN, BSN, was interviewed on the topic of CLABSI in the Medical-Surgical unit. Her recommendations for decreasing our rate of CLABSI’s for the next year is to improve hand hygiene and compliance with the use of Curo’s green caps on the end of any needless ports attached to the device, or directly to the end of the device itself. She also recommended and audit tool to insure these things were being done on a daily basis.
Summary
In summary, these two articles and the websites both indicate proper assessment for the use of an indwelling catheter or CVAD, can decrease the incidence of HAI for both. The nurse, also has to follow through with the findings of their assessment in order for it to benefit the patient. Also, proper assessing of these devices can decrease extra costs to the facilities if these HAI’s are prevented dramatically.

References
Ramirez, C., Lee, A. M., & Welch, K. (2012). Central Venous Catheter Protective Connector Caps Reduce Intraluminal Catheter-Related Infection. Journal Of The Association For Vascular Access, 17(4), 210-213. doi:10.1016/j.java.2012.10.002
Saint, S., Olmstead, RN., Fakih, G., Kowalski, CP., Watson, SR., Sales, AE., Krein, SL., Translating Health Care- Associated Urinary Tract Infection Prevention Research into Practice via the Bladder Bundle. Joint Commission Journal Quality Patient Saf, September 2009; 35(9): 449-455
http://www.cdc.gov

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