After verifying the physician’s order to discontinue a nasogastric tube, according to the Fundamentals of Nursing, next the nurse should auscultate the abdomen to note baseline bowel sounds (Hall, Perry, Potter, Stockert, 2013). This assessment serves as a means of reference. Once the nurse performs patient identification, he or she should explain to the patient that discontinuation of the nasogastric tube is less discomforting than the insertion process (Hall, Perry, Potter, Stockert, 2013). As explained by The Fundamentals of Nursing, providing patient education will help decrease anxiety as well as aiding in cooperation from the patient (Hall, Perry, Potter, Stockert 2013). The current policy does not discuss removing the tube from the drainage collection device or turning off suction prior to discontinuation. As soon as the nurse places a chux or towel on the chest of the patient, next he or she should power the suction off, (if suction was indicated) and disconnect the nasogastric tube from the drainage collection device (Hall, Perry, Potter, Stockert, 2013). Upon completion of discontinuing the nasogastric tube, the nurse must discard gloves and ensure adequate hand hygiene (Hall, Perry, Potter, Stockert, 2013). These steps discussed should be added for best practice, as they are not currently within Adena’s policy. …show more content…
By implementing these recommendations the policy will be up to date. The safety, quality, and outcomes of patient care will improve. Recommendations for evidence based practice
However, there are additional guidelines in terms of assessing the patient for prolonged catheter use. There should be frequent assessment and evaluation of the patient’s need for continued use. It is important to note that in addition to determining the patient’s need for catheterization, prior to insertion the nurse should also complete the following:
For nurses, (P) on 2 South caring for patients with urinary catheters, will education, on the importance and proper use of a nurse -driven indwelling catheter removal protocol (I), change knowledge on the use of the nurse driven protocol, as compared to knowledge before receiving an education, (C), as evidenced by (O), change in knowledge in the use of the nurse -driven indwelling catheter removal protocol, and CAUTI rates as evidenced by, pre and posttest scores and CAUTI audits after three months? The project will utilize a
Promptness is very important when monitoring feeding tubes. If a tube is clogged and it is not reached quickly, the patient is going without nutrients they need. A clogged tube basically starves the person because no formula is permitted to flow through the tube.
Once an area of evidence-based practice has been chosen for investigation, the reviewer must locate current evidence sources and, using a structured approach, assess each for applicability to the issue being investigated. The aim of this paper is to use a Rapid Critical Appraisal Checklist (Melnyk and Fineout-Overholt, 2011) to support these sources of evidence into a review that discusses the importance of daily, high-level, multidisciplinary communication and patient safety. The summaries of these evaluations will be provided as an appraisal of each study.
4) Significance: This research shows that there is a gap in the evidence, but that the primary concern for nursing staff is to ensure that catheters are removed as soon as it is possible to do so.
Only when it is absolutely necessary should a catheter be inserted into a patient. Every patient is assessed for the need for a Foley catheter. If the Foley is inserted, assessments are also then done daily to see if the need is still valid. If the reason is not justifiable the catheter must be removed from the patient (Joint Commission releases new NPSG for CAUTI, 2011). Nurses must follow guidelines while inserting indwelling catheters as well. Aseptic technique is critical to maintain during this process. The use of sterile equipment and a sterile procedure helps to reduce the risk of CAUTI. If in any way the catheter becomes contaminated during the process of insertion, the nurse should discard of the entire catheter and start with a new, sterile kit. Proper hand hygiene is very important before and after contact with indwelling catheters to decrease risk of infection. Maintenance of a close drainage is system is also important that way bacteria are not able to get in and cause infection (Revello & Gallo, 2013). Decreasing the number of times Foleys are inserted and how long they stay in for can help reduce the risk of CAUTI since the longer a Foley stays in, the higher the risk of infection becomes. Nurses must keep the catheter line patent, with no kinks to allow urine to flow freely through into the collection bag. When a urine sample must be obtained it must be done in a sterile
A nurse-driven protocol is the recommended tool to be used by the nurse to remove catheters without orders following set CDC guidelines and prevent CAUTI
The majority of nurses are still auscultating air insufflation over the abdomen to check the placement of nasogastric tubes, since it was the method that was taught for many years. It is an easy and less expensive way to check the placement, but research has shown that it is not reliable. Research showed that sounds can be transmitted to the epigastrium no matter where the nasogastric tube is placed. It does not matter if it is in the lungs, esophagus, or stomach, it can still be heard through the stethoscope (De Boer, J., Smit, B., Mainous, R., 2009).
The nurse driven protocol was tested in 4 intensive care units. It included evidence-based orders for discontinuing, handling, and properly managing the catheters. One of the most important factors was the removal of the catheters in a timely manner. The data pre
The World Health Organization recommends the standardized communication process, called SBAR, an acronym which simplifies a patient’s situation and background and the patient care provider’s assessment and recommendations (Wacogne & Diwakar, 2010). The situation, background, assessment, and recommendation (SBAR) protocol is a technique that provides structure for
Evidence-based practice is an approach used by health care professionals to continually use current best evidence-based research to make ethical and reliable decisions regarding patient care. “Research to promote evidence-based practice is becoming more and more a part of the regular work of health care leaders” (Grand Canyon University, 2015, p. 1). However, it is important to determine the difference between solid research and flawed research that provides unreliable inferences. Evidence-based research includes focusing on a clinical question; and includes the review and incorporation of several studies to strengthen the results of the new study (Grand Canyon University, 2015). Roddy et al. and Ganz et al. articles will be assessed to determine if the recommended changes were backed by solid research that warrants changes in a hospital.
The evidence based interventions we learn can improve patient’s outcomes, help provide quality care, reduce cost and eliminate practices that have become obsolete.
The only intervention identified within the scope of nursing practice is to use sterile technique. Central line insertion, intubation, and prescription are functions of the physician.
Until recently it was not uncommon for patients admitted to an acute care facility to have an indwelling catheter anchored for unnecessary reasons. Patients that came in thru the emergency department typically were sent to the units with unnecessary indwelling catheters in place and it was not unusual for a surgery patient to have an indwelling catheter anchored before or during a procedure. Once a patient was admitted and was transported to the units nursing would also anchor indwelling catheters for multiple unnecessary reasons. These Catheters could be
Evidence Based Practice is a principle that is centered on the improvement of patient care and outcomes, by introducing and researching current based evidence when making decisions for that patient. According to Johnston (2016), “Health-care practitioners are increasingly being encouraged to implement research evidence into practice in order to ensure optimal patient outcomes and provide safe, high-quality care”. Throughout the course of this class, whether it be from researching about Evidence Based Practice, or the implementation of nursing care delivery models, patient care and the way we treat our patients is at the forefront of change. We know that change is necessary, now it is just a matter of how to implement that change into the healthcare