Interventions and Care for Patients

Evidence-Base practice (EBP) is defined as: “based on problem identified from the practitioner’s area of practice; a combining of best evidence and professional expertise and an integration of this into current practice; about ensuring patients receive quality care, being part of quality improvement processes; about collaboration and requiring a team approach” (French, 1999). Scott and Mcsherry (2008) supported the French’s assertion, proposing the key elements of EBP are that it is a theory-driven process, which involves the use, evaluation and application of research; identification of best evidence; evaluation of care; problem solving; decision-making; clinical expertise; and requires patient involvement. Evidence-based practice is made of evidence, clinical expertise, patient preference, the context of care (Barker, 2013). In brief, evidence-based practice is the parameter in the nursing practice that it requires that the nurses gather and use clinical evidence to make decision for the patients so that in the nursing process they can deliver the quality of care for the patients (Ellis, 2013). In the other words, in the nursing practice all the nursing procedures performed by the clinical evidence supported.

Evidence based practice is an integral part of nursing care. According to the Academy of Medical-Surgical Nurses, evidence based practice is defined as, “the conscientious use of current best evidence in making decisions about patient care.” (AMSN) The use of evidence based practice has drastically improved patient outcomes, increased quality and safety of healthcare, and reduced costs for facilities. (Melnyk, 2016) In this paper I will provide the history of evidence based practice, how it has already been incorporated and impacted healthcare, and why it is important to nursing and healthcare as a whole.

Catheter related bloodstream infections are not only responsible for prolonged hospital stays and increased hospital costs, it is also responsible for increased mortality of the hospitalized patients. According to Centers for Disease Control and Prevention (2017), an estimate of 30,100 central line-associated bloodstream infections (CLABSI) occur in intensive care units and wards of U.S. acute care facilities each year. CLABSI is a serious hospital-acquired infection that occurs when bacteria enters the bloodstream through central venous catheters. CLABSI is preventable as long as health-care personnel practice aseptic techniques when working with the catheter. A blood culture swabbed from the tip of the catheter is needed to confirm the

Getting an infection from improper care during or after insertion of a central line is the last thing you want to get while in the hospital. This paper will discuss Kaiser Permanente’s policy on central venous catheter, also known as a central line, care and dressing change, and whether it follows the current evidence-based practice on preventing bloodstream infection in patients who have them inserted. I will explain about what a central line is, why evidence-based practice is important in the clinical setting, what Kaiser Permanente’s policy about central line care and dressing change is, if Kaiser is currently following evidence-based practice based on current articles about preventing central line associated bloodstream infections (CLABSIs), and what my role in using evidence-based practice is as a future registered nurse.

The purpose of my essay is to identify a quality or service problem which requires improvement at my place of work. The essay will then identify a range of interventions that can be used; albeit choose the most effective approach required to ameliorate the situation. This will be followed by critical analysis using evidence based literature on policies underpinning the service improvement. The author will further use the Plan Do Study Act (PDSA) cycle as stated by Langley et al (2009) and Kerridge (2012) to illustrate the effectiveness of the chosen interventions. The essay will also discuss the leadership style used, stakeholders involved including issues that impact on the implementation of service improvement. A conclusion will then be

Usage of indwelling urinary catheters in critically ill patients can seem to be a permanent fixture in intensive care units. Most critical care nurse expect their patients to have an indwelling urinary catheter (IUC) in place without much regard to the risk of catheter associated urinary tract infections (CAUTI) or the ability to implement IUC alternatives. Critical care patients may require IUC usage due to diagnosis, need for accurate hourly intake and output measurements, or other specified documented reasons. The risk of acquiring a catheter associated urinary tract infections is a result of IUC usage. The Centers for Disease Control and Prevention’s Guideline for Prevention of Catheter-associated

Itroduction: Evidence-based practice is an approach to medicine that uses scientific evidence to determine the best practice (Beyea & Slattery, 2006). As nurses perform their daily tasks they must continually ask themselves, “What is the evidence for this intervention?”. Nurses are well positioned to question current nursing practices and use evidence to make care more effective. In order to improve patients’ outcomes it is the responsibility of the nurse to transition evidence-based practice into the norm, through application of daily practice (Flynn Makic, Rauen, Watson & Will Poteet, 2014). Continual evaluation of current practice must be performed to ensure the use of evidence-based practice opposed to practice based upon tradition. The implementation of evidence-based practice standardizes healthcare practices and diminishes groundless variations within care. These variations lead to the production of uncertain health outcomes (Stevens, 2013).

There have been several policy-level measures to address the environment of the health care system and how it contributes to health disparities. First, as seen in Figure 3, the uninsured rate in the United States has declined by 43% following the implementation of the Affordable Care Act (ACA. According to National Health Interview Survey data, the increases in insurance coverage under the ACA were substantial across all races and ethnicities [11], increasing access to care for minorities which is an essential step in eliminating disparities. More notably, the ACA has also designated funding towards the diversification of the workforce. These measures took form in the U.S. Department of Health and Human Services Disparities Action

Over the course of decades medical treatment has advanced causing an increase in the wellness of patient clinical outcomes. A large portion of the improvement is due to the vital role nurses play in the delivery of safe and quality care to their patients. For many years different methods of treating patients have evolved due to the continued research for the best practice. Nurses, researchers and people with questions have always tried to find better and efficient solutions to treat their patients detailing the best possible evidence-based practice. Evidence-based practice is an important tool to use for clinical decision making however one must understand it first. Interpreting Evidence-based practice allows nurses to comprehend the steps to determine if new evidence is needed and realize there are some benefits to utilizing up to date research and obstacles that may impeded the research into practice. .

This link describes the importance of clinicians to provide culturally and sensitive services to diverse populations

P in the PICOT is patients with Foley catheter inserted at admission causing patients catheter-associated urinary tract infections (CAUTI). The aim is to build a nurse-driven protocol to remove Foley catheters early on will help reduce additional days of having the use of an unnecessary indwelling urinary catheter. For every extra day, a Foley catheter increases the risk to develop hospital-acquired catheter-associated infections in our patients ("AACN Competencies and Curricular Expectations for CNL Education & Practice,"

How good it would be for you as dentist, for your dental practice as a business, and for the dental health and well-being of your patients, if you could offer more than just verbal reassurance about the state of your patients dental health?

The Quality Improvement nursing process that I have chosen to research is patient safety. I have chosen to focus specifically on the topic of catheter associated urinary tract infections (CAUTI’s) during hospitalization and their preventions. It is estimated that 15-25% of hospitalized patients receive a urinary catheter throughout their stay, whether or not they need it. A large 80% of all patients diagnosed with a urinary tract infection (UTI) can be attributed to a catheter (Bernard, Hunter, and Moore, 2012). The bacteria may gain entry into the bladder during insertion of the catheter, during manipulation of the catheter or drainage system, around the catheter, and after removal.

In searching for a topic pertaining to my area of nursing specialty, I began my search in Google and searched “trends in I.V. therapy”. This topic is of interest to me because as a high tech infusion home care nurse, I currently have been seeing an increase in peripheral intravenous (PIV) infections. Due to insurance cut backs and their refusals to pay for hospital admissions patients are being discharged home to receive their IV antibiotic therapy or other peripheral medications. As a high tech IV infusion nurse myself, I am responsible for instructing and educating my patients on proper hand hygiene prior to any contact of their PIV and medication. Infection control is so important when dealing with peripheral intravenous lines, hand hygiene, aseptic technique and cleansing the area prior to placement are top priorities (Hadaway & Millam, 2007). This practice personally shocks me that patients are expected to learn, in only one or two visits, how to calculate IV drip factor rates and properly flush their PIV’s with saline prior and after medication administration.

The use of intravenous therapy in the hospitals is now considered a routine therapy. In 2016, DeVries and Valentine stated that 70% to 80% of hospital patients have peripheral intravenous lines at some time during their stay. A peripheral intravenous (PIV) line is a small hollow tube (catheter) that is inserted into a vein and can be connected to special tubing. PIV line is commonly used to administer medications or fluids directly into the vein. The article “Intravenous Therapy: A Review of Complications and Economic Considerations of Peripheral Access,” states that the history of intravenous (IV) therapy dates back to the Middle Ages. Dr. Thomas Latta pioneered the use of IV saline infusion during the cholera epidemic and in the 20th century, two world wars established a role for IV therapy as routine medical practice (Dychter, Gold, Carson, & Haller, 2012).