Using statistical process control charts to measure changes from a nurse-driven protocol to remove urinary catheters.
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BackgroundImplementing a nurse-driven protocol (NDP) to remove indwelling urinary catheters is a strategy to reduce catheter-associated urinary tract infections (CAUTI). The purpose of this project was to implement a comprehensive NDP to reduce indwelling urinary catheter utilization and CAUTI rates at a large academic health system.
MethodsStatistical process control charts, a quality improvement method, was used to identify special cause variation. A formal protocol was developed to provide guidance for nurses to remove indwelling urinary catheters when no longer indicated. Changes were also made within the electronic health record.
ResultsSignals of improvement were not noted on the Statistical process control charts for urinary catheter utilization or CAUTI rates. The frequency with which the NDP was documented (process measure) was assessed, showing it is used approximately 600 times each month. Of those catheters removed by the NDP, an average of 6% were reinserted within 48 hours (balancing measure).
DiscussionOur findings differed from other literature as we did not see a reduction in urinary catheter utilization after implementing a NDP. However, our project adds to the literature as we also evaluated process and balancing measures.
ConclusionsA NDP for urinary catheter removal provides nurses with the autonomy to remove catheters when no longer indicated; however, other interventions should be added to a comprehensive CAUTI-prevention program.
Published Version (Please cite this version)
Reynolds, Staci S, Halie Lozano, Monique Fleurant and Kalpana Bhandari (2022). Using statistical process control charts to measure changes from a nurse-driven protocol to remove urinary catheters. American journal of infection control, 50(12). pp. 1355–1359. 10.1016/j.ajic.2022.03.005 Retrieved from https://hdl.handle.net/10161/26914.
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Dr. Staci Reynolds joined Duke in January 2016, with a joint position between Duke University School of Nursing and Duke University Hospital (DUH). At DUSON, Dr. Reynolds teaches in the ABSN Program (neuroscience nursing) and DNP program (healthcare quality improvement methods). Clinically, she served as a neuroscience Clinical Nurse Specialist (CNS) for the inpatient neuro units at DUH from 2016 - 2019 and for the Infection Prevention and Hospital Epidemiology department from 2019 - 2023. Dr. Reynolds coordinated the Duke Advancement of Nursing, Center of Excellence (DANCE) academic-practice partnership from 2016 - 2023, and was the faculty lead for the post-DNP Quality Implementation Scholars Program from 2019 - 2022. In January 2023, Dr. Reynolds was appointed the Editor-in-Chief of the Journal of Nursing Care Quality. Before coming to DUSON, she was a neuro critical care nurse and a neuroscience Clinical Nurse Specialist at Indiana University Health Methodist Hospital.
Dr. Reynolds received a baccalaureate degree in nursing science from Indiana University (IU) in Indianapolis, Indiana. She earned a Master’s degree as a Clinical Nurse Specialist at IU in 2011, and completed her PhD at IU in May 2016. Dr. Reynolds’ dissertation focused on implementation of clinical practice guidelines, and her current research interests includes evidence-based practice implementation and quality improvement.
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