NURSING ECONOMIC$/November-December 2015/Vol. 33/No. 6320
C
ATHETER-ASSOCIATED urinary
tract infections (CAUTI)
continue to challenge com-
munity hospitals. Hospital-
acquired urinary tract infections
account for 40% of hospital-ac quir -
ed infections, with 80% of those in -
fections related to use of a urinary,
or Foley, catheter (Gokula, Smolen,
Gaspar, Hensley, Benninghoff, &
Smith, 2012; Hanchett, 2012).
Given the rising cost of treating
CAUTI, the Centers for Medicare
& Medicaid Services (CMS) identi-
fied hospital-acquired CAUTI as
one of eight conditions for which
hospitals would no longer receive
reimbursement as of October 1,
2008 (Milstein, 2009). Community
hospitals, therefore, are charged
with implementing innovative
strategies that will reduce the inci-
dence of hospital-acquired CAUTI.
A variety of strategies have
been explored in nursing and other
scientific literature for decreasing
the incidence of CAUTI. Practical
suggestions, such as stickers on pa -
tients’ medical records or comput-
er-generated reminders, along with
implementation of evidence-bas -
ed guidelines for Foley cathe ter
maintenance, have been offer ed as
potential solutions (Bruminhent,
Keegan, Lakhani, Roberts &
Passalacqua, 2010; Gokula et al.,
2012; Wilson et al., 2009). The
majority of literature, however,
has been focused on tertiary or
academic medical centers and
long-term care facilities
White Plains Hospital is a
301-bed non-academic communi-
ty hospital in the suburbs of New
York City that has implemented a
nurse-driven process that reduced
the incidence of CAUTI 50%
within 1 year of implementation.
The incidence of CAUTI contin-
ues to decline to date with the goal
of eventually having zero hospital-
acquired CAUTI events. Further,
with the decline in the incidence
of CAUTI, costs decreased sub-
stantially. White Plains Hospital’s
nurse-driven, cost-effective pro -
cess for reducing CAUTI is des -
cribed. The ideas and steps taken
to implement and sustain the
process are outlined, along with
suggestions for how nurse leaders
in similar clinical settings can
replicate the process.
Background
In 2007, White Plains Hospital
experienced a transition in its sen-
ior nursing leadership that reor-
ganized the roles and responsibil-
ities of the directors of nursing.
The incoming chief nursing offi-
cer launched the nursing division
on its Magnet® journey and creat-
ed an innovative role for the
organization: the director of nurs-
ing quality. This senior nursing
EXECUTIVE SUMMARY
Due to treatment costs and lack
of reimbursement, community
hospitals are charged with imple-
menting innovative strategies that
will reduce the incidence of hos-
pital-acquired catheter-associated
urinary tract infections (CAUTI).
A nurse-driven system for
decreasing the number of hospi-
tal-acquired CAUTI is effective
and useful for a community hos-
pital.
One nurse with accountability for
implementing a simple evidence-
based protocol can dramatically
decrease the t ...
Quality health improvement initiativeOne of the recent quality hjanekahananbw
Quality health improvement initiative
One of the recent quality health improvement initiatives is having a systematic and data-driven approach that reduces the length of stay but improves treatment efficiency—Gulfport memorial hospital. The main reason why the health facility started the initiative is that the revenue was so low, and the costs of operations escalated because of Medicare and Medicaid settlements (Griffiths, 2018). The management had to derive a way that would allow service providers and at the same time reduce or maintain the standard rates so that they did not burden the children's families. The approach also involves improving care conditions by improving and lowering the length of stay.
Similarly, the patient is also prevented from hospital-acquired conditions. For instance, during the Covid 19 pandemic, patients can easily contract the virus because of its spread. The surfaces and contact with other patients make them more vulnerable to contracting Covid 19. Other conditions spread in the hospital may include pneumonia, urinary tract infections, and bloodstream infections. The initiative looks to provide the best services and ensure that the facilities discharge patients sooner unless family members cannot manage the condition outside the facility. Only critical conditions are admitted into the medical facilities. For instance, patients in ICU can stay in the hospital until they are medically cleared to leave the facility. The rest of the conditions are treated with the best care, and if need be, the patient can pop in for a checkup at agreed intervals. Therefore, those who are treated and allowed to go home become less vulnerable to getting other infections, and the quality of their lives improves.
The nurses' role in the initiative was to help the doctors to monitor patients and keep the records that are used to determine which of the patients should be admitted and which ones can be discharged. They also help to advise the patients why they should opt for a shorter stay and how it makes them less vulnerable to contracting hospital acquired infections. Since the medical facility uses data driven approach, the nurses can also take part in decision making because they interact more with the patients and can analyze the reports and record the patients' progress (Schmitt et al., 2019). The doctors will use these records to determine which patients can be allowed to go home and which situations require them to stay longer in the facility.
The outcome of the initiative was reduced costs of keeping the patient in the medical facilities. In so doing, the health center lowers maintenance costs and financial burden on the patient. Gulfport memorial hospital also adopted a systematic data-driven approach that keeps records and showing the initiative's progress. The results showed that the facility saved $2 million in one year because the medical facility needed fewer supplies. Coordination care also improved, and an increase ...
Optimising the Model of Care for Patient Management at The Tweed Cancer Care ...Cancer Institute NSW
The document describes the implementation of a morning handover process utilizing the MOSAIQ electronic medical record (EMR) system at the Tweed Cancer Care and Haematology Unit. An evaluation found the EMR handover process improved staff satisfaction, coordination of patient care, and reduced incidents. It was concluded the handover process meets national standards and could benefit other ambulatory care units utilizing EMRs.
The document proposes strategies to reduce hospital readmission rates by 50% in 12 months. It recommends that the pharmacy department educate patients on medications to contribute a 30% reduction. The transportation department will offer rides to follow-up appointments to contribute a 10% reduction. The IT department will call patients after discharge to check on medications and needs, also contributing a 10% reduction. Department heads will submit monthly reports on readmissions which will be quantified and incentives tied to goals. A study will assess if the strategies ("Educate and Follow up initiative") reduced readmissions compared to previous rates.
CAUTI is a hospital-acquired urinary tract infection that results from an extended use of a urinary catheter. Around 75% of hospital-acquired urinary tract infections are associated with a urinary catheter. The hospital has implemented interventions like educating medical staff on the CAUTI bundle, nurse-driven timely removal of catheters, and proper catheter care during placement to reduce CAUTI rates and improve patient outcomes and safety.
This document discusses an evidence-based quality improvement project aimed at evaluating the effectiveness of an educational intervention for nurses on reducing catheter-associated urinary tract infection (CAUTI) rates. The project would employ a pretest-posttest design to assess the impact of education on nurses' knowledge and facility CAUTI rates. Permission is being requested to conduct the project at a hospital where CAUTI rates are currently higher than the national benchmark according to published data. Potential benefits include cost savings from a reduction in CAUTI treatment and reimbursement risks, while there are no anticipated risks to patients. Nurses may have to work longer hours to care for patients with CAUTIs.
DASHBOARD BENCHMARK
Miatta Teasley
Capella University
Running Head: DASHBOARD BENCHMARK
DASHBOARD BENCHMARK
April 19,2022
DASHBOARD BENCHMARK
Second Quarter Hypertension Intervention Compliance at Med for adults presenting with Diabetes
Intervention
Needed
Completed
Compliance Percentage
Initial Lactate within 3 hours
30
30
100%
Blood cultures were drawn before antibiotics
22
17
77%
Antibiotics administered within 3 hours
22
20
91%
Fluid resuscitation if in septic shock within 2hours
19
12
63%
Vasopressors if hypertension persists after fluid or lactate >4mmoL/L within 6 hours
12
7
58%
Overall
105
86
82%
Second Quarter Dialysis Intervention
Compliance and Inpatient Mortality
Patient ID
Number of Interventions needed
Number of Interventions completed
Inpatient Mortality
2000
4
2
0
2014
3
3
1
2098
2
1
0
2134
5
4
0
2156
3
4
1
2245
4
2
0
2345
3
3
1
2567
5
4
1
2676
4
1
1
2935
3
2
0
Note: The Staffing benchmark for the nurse staffing unit is 3 patients per nurse. The average monthly staffing for the unit is 3 nurse workloads. The average number of patients in the unit per month in the third quarter was 5.75.
The data above is a review regarding the compliance of Dialysis measures and interventions compliance and the sample of the second quarter inpatient mortality. The information below entails evaluating the data, which indicates that various departments need to be improved, and a proposal for a specific area and target for improvement.
Evaluation of Dashboard Metrics
There are several inefficiencies in regards to dialysis measures at Med. From the dashboard concerning the compliance of executing the arranged measures and procedures, the two stand out at the 77% compliance rate on drawing blood cultures before running antibiotics and 58% compliance rate on administering vasopressors for those patients that require them. As per Medicare.Gov (n.d), the national average for meeting dialysis guidelines is 72%, and the state of Minnesota is 60% which indicates that Med is performing at 82% overall testing. Higher percentages are required to ensure the advanced quality of life for residents of the healthcare institution (Morfín et al., 2018).
Failure to complete blood draws for cultures before running broad-spectrum antibiotics; there will be an incapability to authorize contamination and the responsible pathogen. This can result in an inefficient or ineffective intervention for aiding a patient. Moreover, by failing to confirm infection from the start, unnecessary and wasteful care interventions could be performed or ordered for patients (Morfín et al., 2018). As per the failure to administer vasopressors, the institution is gambling with the patient's life. As the reinforcement for the dialysis unit states, vasopressor therapy is needed to sustain and uphold perfusion in the wake of life-threatening hypertension. The needed nature of compliance concerning administering this intervention can be seen in the samp.
This document summarizes a clinical project reviewing practices for managing indwelling urinary catheters and preventing catheter-associated urinary tract infections (CAUTI) at Lutheran General Hospital. The author conducted research on patients with catheters in the medical cardiac intensive care unit (MCICU) and examined differences in catheter systems used in the emergency department versus the MCICU. The research aims to determine if changing emergency department catheters to sealed systems with urine meters could decrease CAUTI risk by avoiding breaks in the sterile field when transferring patients. A literature review found guidelines recommending appropriate catheter indications and aseptic insertion/maintenance to minimize infection risk.
This document discusses processes that have been implemented at a rural hospital with 1200 births per year to improve obstetric patient safety and outcomes. Some of the key processes discussed include establishing a team approach involving all hospital personnel, conducting regular simulations to improve communication and adherence to protocols, implementing mentorship programs for nurses and managers, standardizing communication using SBAR, leveraging electronic medical records and data to monitor quality and outcomes, and promoting a culture of accountability and professionalism. The goal of these initiatives is to reduce errors, minimize harm, and improve outcomes through multidisciplinary collaboration and a systems-based approach. While changing healthcare culture and achieving measurable outcomes can be challenging, continuous monitoring and refinement of processes may help advance safety and quality of
Quality health improvement initiativeOne of the recent quality hjanekahananbw
Quality health improvement initiative
One of the recent quality health improvement initiatives is having a systematic and data-driven approach that reduces the length of stay but improves treatment efficiency—Gulfport memorial hospital. The main reason why the health facility started the initiative is that the revenue was so low, and the costs of operations escalated because of Medicare and Medicaid settlements (Griffiths, 2018). The management had to derive a way that would allow service providers and at the same time reduce or maintain the standard rates so that they did not burden the children's families. The approach also involves improving care conditions by improving and lowering the length of stay.
Similarly, the patient is also prevented from hospital-acquired conditions. For instance, during the Covid 19 pandemic, patients can easily contract the virus because of its spread. The surfaces and contact with other patients make them more vulnerable to contracting Covid 19. Other conditions spread in the hospital may include pneumonia, urinary tract infections, and bloodstream infections. The initiative looks to provide the best services and ensure that the facilities discharge patients sooner unless family members cannot manage the condition outside the facility. Only critical conditions are admitted into the medical facilities. For instance, patients in ICU can stay in the hospital until they are medically cleared to leave the facility. The rest of the conditions are treated with the best care, and if need be, the patient can pop in for a checkup at agreed intervals. Therefore, those who are treated and allowed to go home become less vulnerable to getting other infections, and the quality of their lives improves.
The nurses' role in the initiative was to help the doctors to monitor patients and keep the records that are used to determine which of the patients should be admitted and which ones can be discharged. They also help to advise the patients why they should opt for a shorter stay and how it makes them less vulnerable to contracting hospital acquired infections. Since the medical facility uses data driven approach, the nurses can also take part in decision making because they interact more with the patients and can analyze the reports and record the patients' progress (Schmitt et al., 2019). The doctors will use these records to determine which patients can be allowed to go home and which situations require them to stay longer in the facility.
The outcome of the initiative was reduced costs of keeping the patient in the medical facilities. In so doing, the health center lowers maintenance costs and financial burden on the patient. Gulfport memorial hospital also adopted a systematic data-driven approach that keeps records and showing the initiative's progress. The results showed that the facility saved $2 million in one year because the medical facility needed fewer supplies. Coordination care also improved, and an increase ...
Optimising the Model of Care for Patient Management at The Tweed Cancer Care ...Cancer Institute NSW
The document describes the implementation of a morning handover process utilizing the MOSAIQ electronic medical record (EMR) system at the Tweed Cancer Care and Haematology Unit. An evaluation found the EMR handover process improved staff satisfaction, coordination of patient care, and reduced incidents. It was concluded the handover process meets national standards and could benefit other ambulatory care units utilizing EMRs.
The document proposes strategies to reduce hospital readmission rates by 50% in 12 months. It recommends that the pharmacy department educate patients on medications to contribute a 30% reduction. The transportation department will offer rides to follow-up appointments to contribute a 10% reduction. The IT department will call patients after discharge to check on medications and needs, also contributing a 10% reduction. Department heads will submit monthly reports on readmissions which will be quantified and incentives tied to goals. A study will assess if the strategies ("Educate and Follow up initiative") reduced readmissions compared to previous rates.
CAUTI is a hospital-acquired urinary tract infection that results from an extended use of a urinary catheter. Around 75% of hospital-acquired urinary tract infections are associated with a urinary catheter. The hospital has implemented interventions like educating medical staff on the CAUTI bundle, nurse-driven timely removal of catheters, and proper catheter care during placement to reduce CAUTI rates and improve patient outcomes and safety.
This document discusses an evidence-based quality improvement project aimed at evaluating the effectiveness of an educational intervention for nurses on reducing catheter-associated urinary tract infection (CAUTI) rates. The project would employ a pretest-posttest design to assess the impact of education on nurses' knowledge and facility CAUTI rates. Permission is being requested to conduct the project at a hospital where CAUTI rates are currently higher than the national benchmark according to published data. Potential benefits include cost savings from a reduction in CAUTI treatment and reimbursement risks, while there are no anticipated risks to patients. Nurses may have to work longer hours to care for patients with CAUTIs.
DASHBOARD BENCHMARK
Miatta Teasley
Capella University
Running Head: DASHBOARD BENCHMARK
DASHBOARD BENCHMARK
April 19,2022
DASHBOARD BENCHMARK
Second Quarter Hypertension Intervention Compliance at Med for adults presenting with Diabetes
Intervention
Needed
Completed
Compliance Percentage
Initial Lactate within 3 hours
30
30
100%
Blood cultures were drawn before antibiotics
22
17
77%
Antibiotics administered within 3 hours
22
20
91%
Fluid resuscitation if in septic shock within 2hours
19
12
63%
Vasopressors if hypertension persists after fluid or lactate >4mmoL/L within 6 hours
12
7
58%
Overall
105
86
82%
Second Quarter Dialysis Intervention
Compliance and Inpatient Mortality
Patient ID
Number of Interventions needed
Number of Interventions completed
Inpatient Mortality
2000
4
2
0
2014
3
3
1
2098
2
1
0
2134
5
4
0
2156
3
4
1
2245
4
2
0
2345
3
3
1
2567
5
4
1
2676
4
1
1
2935
3
2
0
Note: The Staffing benchmark for the nurse staffing unit is 3 patients per nurse. The average monthly staffing for the unit is 3 nurse workloads. The average number of patients in the unit per month in the third quarter was 5.75.
The data above is a review regarding the compliance of Dialysis measures and interventions compliance and the sample of the second quarter inpatient mortality. The information below entails evaluating the data, which indicates that various departments need to be improved, and a proposal for a specific area and target for improvement.
Evaluation of Dashboard Metrics
There are several inefficiencies in regards to dialysis measures at Med. From the dashboard concerning the compliance of executing the arranged measures and procedures, the two stand out at the 77% compliance rate on drawing blood cultures before running antibiotics and 58% compliance rate on administering vasopressors for those patients that require them. As per Medicare.Gov (n.d), the national average for meeting dialysis guidelines is 72%, and the state of Minnesota is 60% which indicates that Med is performing at 82% overall testing. Higher percentages are required to ensure the advanced quality of life for residents of the healthcare institution (Morfín et al., 2018).
Failure to complete blood draws for cultures before running broad-spectrum antibiotics; there will be an incapability to authorize contamination and the responsible pathogen. This can result in an inefficient or ineffective intervention for aiding a patient. Moreover, by failing to confirm infection from the start, unnecessary and wasteful care interventions could be performed or ordered for patients (Morfín et al., 2018). As per the failure to administer vasopressors, the institution is gambling with the patient's life. As the reinforcement for the dialysis unit states, vasopressor therapy is needed to sustain and uphold perfusion in the wake of life-threatening hypertension. The needed nature of compliance concerning administering this intervention can be seen in the samp.
This document summarizes a clinical project reviewing practices for managing indwelling urinary catheters and preventing catheter-associated urinary tract infections (CAUTI) at Lutheran General Hospital. The author conducted research on patients with catheters in the medical cardiac intensive care unit (MCICU) and examined differences in catheter systems used in the emergency department versus the MCICU. The research aims to determine if changing emergency department catheters to sealed systems with urine meters could decrease CAUTI risk by avoiding breaks in the sterile field when transferring patients. A literature review found guidelines recommending appropriate catheter indications and aseptic insertion/maintenance to minimize infection risk.
This document discusses processes that have been implemented at a rural hospital with 1200 births per year to improve obstetric patient safety and outcomes. Some of the key processes discussed include establishing a team approach involving all hospital personnel, conducting regular simulations to improve communication and adherence to protocols, implementing mentorship programs for nurses and managers, standardizing communication using SBAR, leveraging electronic medical records and data to monitor quality and outcomes, and promoting a culture of accountability and professionalism. The goal of these initiatives is to reduce errors, minimize harm, and improve outcomes through multidisciplinary collaboration and a systems-based approach. While changing healthcare culture and achieving measurable outcomes can be challenging, continuous monitoring and refinement of processes may help advance safety and quality of
12
Capstone Project
Olivia Timmons
Department of Nursing. St. Johns River State College
NUR 4949: Nursing Capstone
Dr. C. Z. Velasco
November 14, 2021
Capstone Project
There is a saying that states one can only learn through doing it, practically and physically. It is the explanation as to why it is very important to implement the skills acquired in theory into practice to ascertain one’s competence. This is even more crucial in the medical field as they have no choice but just to be perfect at what they are doing, the only secret is through practice. Practicums connect the two worlds of theory and classwork, thus breaking the monotony alongside connecting what was taught in class with what happens in the field. They are important as apart from sharpening the student’s skills, they also open a window of opportunity and build up connections that will come in handy for the student later on. They will feel the experience and the pressure that comes with it thus preparing themselves accordingly.
Statement of the Problem
Timing is essential in the nursing field and the Emergency Room is notorious for its long wait times. The goal of a clinical laboratory is to deliver medically useful results for patients on a timely basis. This goal can be hindered by the new paradigm of the modern laboratory – “do more with less" (Lopez, 2020). When implementing new care models for patients, the patient perspective is critical. The objective of this study was to describe and develop an understanding of the information needs of patients in the ED waiting room concerning ED wait time notification (Calder, 2021). As a patient arrives at the ER waiting area, it's critical to have lab results for the provider to evaluate. I can give you an example of a patient that waited in the waiting room for over 3 hours, no labs were completed because they were waiting for the patient to go back into a room. The patient was suffering from a heart attack and his troponins were elevated and no one knew until 3 hours later. If POC labs were done on all patients as soon as they arrived, mistakes like these can be avoided. Completed POC blood can cut the wait times in half and the laboratory also won't be backed up on resulting lab specimens.
PICOT Question
Question: Is there a significant decrease in Emergency Department patient length of stay (LOS) for those whose blood was analyzed using POC testing versus those whose blood was analyzed using laboratory testing?
· P-Population= emergency room patients
· I-Intervention or Exposure= POC testing of blood specimens
· C-Comparison= Laboratory blood specimens
· O-Outcome= Decrease patient stay in the emergency room
· T-Time = N/A
History of the Issue
The length of patient stay in the emergency department (ED) is an issue that not only increases the severity of illnesses but also reduces the quality of patient care. Serious health conditions including diabetes and hypertension can worsen while patients are ...
12
Capstone Project
Olivia Timmons
Department of Nursing. St. Johns River State College
NUR 4949: Nursing Capstone
Dr. C. Z. Velasco
November 14, 2021
Capstone Project
There is a saying that states one can only learn through doing it, practically and physically. It is the explanation as to why it is very important to implement the skills acquired in theory into practice to ascertain one’s competence. This is even more crucial in the medical field as they have no choice but just to be perfect at what they are doing, the only secret is through practice. Practicums connect the two worlds of theory and classwork, thus breaking the monotony alongside connecting what was taught in class with what happens in the field. They are important as apart from sharpening the student’s skills, they also open a window of opportunity and build up connections that will come in handy for the student later on. They will feel the experience and the pressure that comes with it thus preparing themselves accordingly.
Statement of the Problem
Timing is essential in the nursing field and the Emergency Room is notorious for its long wait times. The goal of a clinical laboratory is to deliver medically useful results for patients on a timely basis. This goal can be hindered by the new paradigm of the modern laboratory – “do more with less" (Lopez, 2020). When implementing new care models for patients, the patient perspective is critical. The objective of this study was to describe and develop an understanding of the information needs of patients in the ED waiting room concerning ED wait time notification (Calder, 2021). As a patient arrives at the ER waiting area, it's critical to have lab results for the provider to evaluate. I can give you an example of a patient that waited in the waiting room for over 3 hours, no labs were completed because they were waiting for the patient to go back into a room. The patient was suffering from a heart attack and his troponins were elevated and no one knew until 3 hours later. If POC labs were done on all patients as soon as they arrived, mistakes like these can be avoided. Completed POC blood can cut the wait times in half and the laboratory also won't be backed up on resulting lab specimens.
PICOT Question
Question: Is there a significant decrease in Emergency Department patient length of stay (LOS) for those whose blood was analyzed using POC testing versus those whose blood was analyzed using laboratory testing?
· P-Population= emergency room patients
· I-Intervention or Exposure= POC testing of blood specimens
· C-Comparison= Laboratory blood specimens
· O-Outcome= Decrease patient stay in the emergency room
· T-Time = N/A
History of the Issue
The length of patient stay in the emergency department (ED) is an issue that not only increases the severity of illnesses but also reduces the quality of patient care. Serious health conditions including diabetes and hypertension can worsen while patients are ...
How does your facility incorporate EBP in a clinical setting to prom.docxfideladallimore
How does your facility incorporate EBP in a clinical setting to promote patient outcomes? Do you have recommendations on how your facility can improve its use of EBP?
My facility incorporates evidence-based practice in the clinical setting in a resourceful manner in order to promote patient outcomes. The institution integrates clinical expertise, the best research evidence and patient values in the decision making process to foster the implementation of evidence based practice. In this endeavor, the facility also encourages patients to bring their personal preferences, unique concerns, values and expectations in order to ensure that the clinicians have a heighted understanding of their pertinent medical issues and provide patient-centered care that meets the distinct needs of the patients.
According to
Polit & Beck (2011),
through the practice of EBP, the healthcare facility can be in a better position to ascertain the effects of therapy, the prognosis of diseases, the utility of diagnostic tests as well as the etiology of disorders. It is worth mentioning that my facility follows various steps in implementing the EBP practices. These steps include assessing the patient, asking clinical questions derived from the patient’s case, acquiring the evidence through searching appropriate resources and then appraising the evidence for its applicability and validity. The other steps usually include integrating the evidence with patient preferences, clinical expertise and applying it to practice. The institution also encourages all practitioners to evaluate their performance with the patient as a yardstick for determining the effectiveness of the EBP process.
Although the facility has registered notable success in its EBP initiatives, various recommendations can help it to improve on these processes. One of such proposals is to aim at creating and sustaining strong nurse-client relationships
(Majid, Foo, & Luyt, 2011)
. This can enable the practitioners to have a better understanding of the patient’s unique values and preferences, all of which are fundamental components of EBP practice. The leaders of the facility should also serve as positive role models through advocating, embracing and communicating the benefits of EBP to other employees in the organization. Ultimately, this will help to create a culture that supports the adoption and implementation of evidence-based practice across the entire healthcare establishment
(Polit & Beck, 2011)
.
References
Majid, S., Foo, S., & Luyt, B. (2011). Adopting evidence-based practice in clinical decision making: nurses' perceptions, knowledge, and barriers.
Journal of the Medical Library Association, 99
(3), 229–236. Retrieved June 10, 2015, from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3133901/
Polit, D., & Beck, C. (2011).
Nursing Research: Generating and Assessing Evidence for Nursing Practice
(9 ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Discussion Question 2
Ho.
Scheduling Of Nursing Staff in Hospitals - A Case Studyinventionjournals
This document summarizes a study that developed a goal programming algorithm to schedule 11 nurses across a two-week period at a hospital. The goals were to satisfy each nurse's contracted time, ensure minimum nurse requirements by role each day, give full-time nurses a weekend off while avoiding more than two consecutive days off, and honor nurses' weekend preference when possible. The algorithm solved the 154-variable, 120-constraint scheduling problem in under 30 seconds. The results showed schedules that met goals for minimum nurse levels each day and individual nurses' two-week schedules.
The document discusses a PICOT statement regarding use of a CAUTI bundle to reduce catheter-associated urinary tract infections (CAUTI) in hospital patients. It then summarizes two research articles that support the PICOT statement. Krein et al. (2013) found that while CAUTI bundles reduced infections, barriers like lack of buy-in from nurses and doctors limited their effectiveness. Oman et al. (2012) found that a nurse-led intervention including CAUTI bundles did not reduce infection rates but did reduce catheter duration, thus lowering CAUTI risk. Both studies support the use of CAUTI bundles and guidelines to reduce CAUTI incidence.
The document proposes developing an occupational therapy outreach service for elderly patients being discharged from medical assessment wards. Research shows elderly patients are often unprepared for discharge and lack communication between health services. The outreach program aims to facilitate smooth transitions, reduce readmissions, and relieve hospital bed pressures through home-based rehabilitation and empowering patients. Outcomes would be measured through tools like the Barthel Index to evaluate the program's effectiveness.
Reply1
Re: Topic 1 DQ 2
Topic 1 DQ 2
The inclusion of evidence-based practice provides nurses with the scientific research and experience to make a comprehensive decision. The practice enables the nurses to re-evaluate the risks and only adopt the best mechanism to ensure an improved patient outcome. Patients are also able to receive the best available outcomes. It is very advisable to move the nursing practice to be evidence-based to ensure that there is patient-centered care that is safe, inclusive, and effective. However, there have been barriers towards this progress since only 15% of U.S practice is evidence-based. One of the barriers which have led to lagging behind in adopting evidence-based practice is nurse shortage. Evidence-based practice requires massive documentation and research together with increased testing and experience. This requires a large human resource which is not available due to nurse shortage across the united states (Stavor et al., 2017). This has acted as a barrier towards the goal of moving practice to evidence-based. The government should employ more nurses and also dedicate some of the workforces specifically to matters to do with shifting traditional caregiving to EBP.
The second barrier is unsupportive administration. Research indicates that over 70% of nurses know about evidence-based practice, but the barriers to the practice in a clinical setting make it hard for them to adopt it. To move practice to EBP requires active collaboration from all stakeholders and more so from the administration of the healthcare setting. However, most administrations have been termed as unsupportive for the move due to the challenges of resources involved in the move. EPB presents a huge cost in the beginning due to its data requirements. However, it is able to reduce the cost of healthcare by 35% after its implementation. Lack of support from the management makes it hard to move nursing practice to EBP in a clinical setting since it’s a collaborative activity that requires dedicated and goal-oriented leadership (Duncombe, 2018). Policies and regulations should be created which force the push to enable the administration of various healthcare to have no otherwise but to comply in the shift.
References
Stavor, D. C., Zedreck-Gonzalez, J., & Hoffmann, R. L. (2017). Improving the use of evidence-based practice and research utilization through the identification of barriers to implementation in a critical access hospital.
JONA: The Journal of Nursing Administration
,
47
(1), 56-61.
Duncombe, D. C. (2018). A multi‐institutional study of the perceived barriers and facilitators to implementing evidence‐based practice.
Journal of Clinical Nursing
,
27
(5-6), 1216-1226.
Reply 2
aur
1 posts
Re: Topic 1 DQ 2
As unprecedented development in the diagnosis, treatment, and long-term management of disease bring Americans closer than ever to the promise of personalized health care, we are faced with similarly unprecedented c.
Hospitals Hospeal cinical cace teacs requite acces to patients' vital.docxIsaac9LjWelchq
Hospitals Hospeal cinical cace teacs requite acces to patients' vital sigre in real time at the peint of care ts support ewidence-based medical good as the qualty of the eaptured data. A lack of full system adcptioe leads to a hypridization of clinical workfows that result in poos: quality care and process ineficiencies. These types of bamiers to continuous quality impoyoumerit ICOQ, in turn, lead to inconsistent quality outcomes and unrealized process synerges. Health case eminagens muat undedstand and elminate these barriers that prevent geod clinical decision making and adeption of CQl best peactices. Case Report tehabitiation in firockilyn as part of the Now York City Health and Heapitals Comporation, the moat extersive municipal health tyathm in the nation Health care erganuations auch in Kings County Hospinat inplament COl progams to impreve the ouccemes of a health intervention or teeatment. Incresuing patent actess to medical prefesticnals or redating expowure to bospitif based infections can promote early or temely dicharget from the hotpial (Vaidya, 20180. For exartple, Kings County Hospial bagght to reduce patient wait bimes for ah appeintment from 2 di days to 4 digst farnan, 2016. Care team membes are essential for care continuify and quaify outoomes in hospitals, phystioan champions mutt ipostar and lead CQI initiatives to umpower the implementation procass (Crentan, 2013 . At Kings County Hospital ut deehelders began implementing the CGI initiative by streamlining the EHR computerised physitian orden: entyy teepplades for charting clinical documentation as well as for Ghing appointreent or intde time slots for standard heikh secvices deliery Closing the gap between inpatient and outpatient heuth outcomes became the foundarion for al system.wide improvenent projecte itimami, 2051 is Conclusion The adoption ef CHR vystems can facilitate the delvery of CQI. However, the data colestad by wuch systams must be reilable and walid and support how the orgacitation uses in to enhance CQl pogamis, A notable stiength of the CCi tooks is that the system is buit upon the feundaticn of exising standards and protocol, such as insereperablity and Health Level 7 language that hospital it atatf memben heve been using for mary years. A limation of the COI tool is ther falure to address specific barriens to mplementation, tuch in fraveial constrains of how the tod can unify or suppert the kealth care organiraton based on the dymamics of the local ensipenenent. Kings County Hospats wecesiful CQl inicabve created a bresithrough that led to inpropements in qualty care delvery and induction comergente of eaterval events wich as changing cave models based on CQt outcomes and EhR techrology adoption wall continue to presusure hospitals to evolve irto leareing health tystement. Questions 1. Why are CCI initiatives important for hospials and heath irstems? preveneable advene incidenat. 3. What rele do hospitals heve in advaneng CQi heolth outeomes and mode.
1
Quantitative Synopsis and Appraisal
Studentfirstname Studentlastname, Studentfirstname Studentlastname, Studentfirstname
Studentlastname, Studentfirstname Studentlastname
College of Nursing, Resurrection University
NUR4440: Research in Nursing
Professor Carina Piccinini
February 14, 2020
2
Quantitative Appraisal and Synopsis
The purpose of this paper is to summarize and appraise a research study testing the use of
disinfectant caps on intravenous (IV lines) to reduce the rate of hospital associated bloodstream
infections (BSI). The Centers for Disease Control and Prevention (CDC, 2019) reports that
central line associated bloodstream infections (CLABSI) remain a major concern in hospital
settings causing fatalities, increased length of stay, and increased costs. The CDC (2019)
recommends proper maintenance of intravenous lines to reduce the risk of infection. Current
research is still looking to define what proper maintenance should be, including whether
disinfectant caps influence rates of infection for intravenous (IV) lines.
Summary of the Study
The CDC recommends that healthcare workers disinfect all needleless connectors for
peripheral and central IVs prior to connection to reduce the risk of CLABSIs without further
recommendation on the type or length of disinfections. The authors of this study note other
studies have tested disinfecting caps and sought to confirm those results.
Merrill et al. (2014) conducted a quasi-experimental study to identify if disinfectant caps
reduce CLABSI incidence and the relationship between nursing compliance with the caps and
CLABSI rates. This study was held in a single Trauma 1 hospital with 430 beds in the United
States.
The researchers obtained their sample through nonrandom convenience sampling by
including all patients meeting inclusion criteria at the hospital starting January 2012. Participants
were included if they had a central or peripheral intravenous line, of any age, and were admitted
to 13 specific hospital floors. Subjects were excluded if they were on the following floors:
emergency department; labor, delivery or post-partum; ambulatory care, surgical services; and
3
well-baby nursery. The study did not report any demographic information about participants, the
number of participants, or attrition or loss to follow up.
The intervention involved applying a Curos brand disinfectant cap to all ports on
peripheral lines, central lines, and IV tubing when not in use on patients. The nurses on the
involved units were trained on the use of the disinfectant caps with a 1:1 follow up by the
researchers. Nurses were then responsible for placing caps. The researchers intermittently
observing nurses for compliance to the intervention and reporting compliance to nursing
departments twice a week.
CLABSIs were defined as a positive blood culture drawn within 48 hours symptom onset,
and C ...
The document summarizes a study that tested the use of disinfectant caps on intravenous (IV) lines to reduce the rate of hospital-associated bloodstream infections (BSIs). The study found that using disinfectant caps on IV ports decreased the mean rate of central line-associated BSIs from 1.5 infections per month before the intervention to 0.88 infections after. However, the study had limitations such as lack of statistical significance testing for the pre-post infection rates and not accounting for other infection prevention practices. Therefore, more research is needed to fully understand the impact of disinfectant caps on reducing BSIs.
Do you ever wonder whynurses engage in practicesthat areDustiBuckner14
D
o you ever wonder why
nurses engage in practices
that aren’t supported by
evidence, while not implementing
practices substantiated by a lot
of evidence? In the past, nurses
changed hospitalized patients’ IV
dressings daily, even though no
solid evidence supported this prac-
tice. When clinical trials finally
explored how often to change IV
dressings, results indicated that
daily changes led to higher rates
of phlebitis than did less frequent
changes.1 In many hospital EDs
across the country, children with
asthma are treated with albuterol
delivered with a nebulizer, even
though substantial evidence shows
that when albuterol is delivered
with a metered-dose inhaler plus
a spacer, children spend less time
in the ED and have fewer adverse
effects.2 Nurses even disrupt
patients’ sleep, which is important
for restorative healing, to docu-
ment blood pressure and pulse
rate because it’s hospital policy to
take vital signs every two or four
hours, even though no evidence
supports that doing so improves
the identification of potential
complications. In fact, clinicians
often follow outdated policies and
procedures without questioning
their current relevance or accu-
racy, or the evidence for them.
When a spirit of inquiry—an
ongoing curiosity about the best
evidence to guide clinical decision
making—and a culture that sup-
ports it are lacking, clinicians are
unlikely to embrace evidence-based
practice (EBP). Every day, nurses
across the care continuum perform
a multitude of interventions (for
example, administering medica-
tion, positioning, suctioning)
that should stimulate questions
about the evidence supporting
their use. When a nurse possesses
a spirit of inquiry within a sup-
portive EBP culture, she or he
can routinely ask questions about
clinical practice while care is being
delivered. For example, in patients
with endotracheal tubes, how
does use of saline with suctioning
compared with suctioning without
saline affect oxygen saturation?
[email protected] AJN � November 2009 � Vol. 109, No. 11 49
By Bernadette Mazurek Melnyk, PhD,
RN, CPNP/PMHNP, FNAP, FAAN,
Ellen Fineout-Overholt, PhD, RN,
FNAP, FAAN, Susan B. Stillwell, DNP,
RN, CNE, and Kathleen M.
Williamson, PhD, RN
Igniting a Spirit of Inquiry: An Essential Foundation for
Evidence-Based Practice
How nurses can build the knowledge and skills they need to
implement EBP.
Every day, nurses perform interventions (for
example, administering medication, positioning,
suctioning) that should stimulate questions
about the evidence supporting their use.
This is the first article in a new series from the Arizona State University College of Nursing and Health Innovation’s
Center for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving approach
to the delivery of health care that integrates the best evidence from studies and patient care data with clinician
expertise and patient preferences and values. When delivered in a context of caring a ...
The document discusses how health systems can achieve standardized patient-centric care through clinician-led transformation. It highlights the success of Trinity Health in saving $20,000 per day and improving outcomes by empowering clinicians to lead collaborative efforts to develop and implement evidence-based standardized care protocols and monitor their impact. Key aspects that contributed to Trinity Health's success include creating an open forum for clinicians to develop solutions, proving rather than just stating that clinicians are decision-makers, using data to prioritize opportunities, and establishing rigorous project management and measurement of results.
Introduction of the NZ Health IT Plan enables better gout management - Reflections of an early adopter. Presented by Peter Gow, Counties Manukau DHB, at HINZ 2014, 12 November 2014, 11.37am, Plenary Room
This document summarizes a quality improvement project conducted at King Abdulaziz Medical City in Riyadh, Saudi Arabia that aimed to reduce rates of ventilator-associated pneumonia (VAP) in intensive care units. A multidisciplinary team implemented a bundle of evidence-based practices shown to reduce VAP, including head of bed elevation, daily sedation vacations, oral care with chlorhexidine, and others. Through multiple tests of changes using the model for improvement methodology over one year, compliance with the bundle increased from 83% to 97% and the VAP rate decreased from 4.0 to 0.8 per 1,000 ventilator days. This translated to a reduction in the number of annual VAP
EVIDENCE- BASED PRACTICE PROPOSAL SECTION A2EVIDENCE- BASED PR.docxSANSKAR20
EVIDENCE- BASED PRACTICE PROPOSAL SECTION A:2
EVIDENCE- BASED PRACTICE PROPOSAL SECTION A:7
Running head: EVIDENCE- BASED PRACTICE PROPOSAL SECTION A:1
Evidence- Based Practice Proposal- Section A: Organizational Culture and Readiness Assessment
Evidence based practice (EBP) should be fundamental in every healthcare setting in the sense that it ensures decisions based on the best evidence integrated with clinical experience and the various expectations of patients within the healthcare setting (Gale & Schaffer, 2009). The main objective and aim in evidence-based practice protocols are to integrate the clinical expertise with the patient’s perspective and the scientific evidence in a bid to provide efficient and high quality healthcare services which are based on the needs, values, interests and culture of the patients served by the healthcare organization in question. It should be noted that evidence- based practice is essential as it does integrate the perspective of the patient, including values and culture in providing higher quality healthcare supported by research and scientific evidence (Gale & Schaffer, 2009). In essence it ensures the provision of quality and reliability of the healthcare services provided within the healthcare setting.
In regards to the healthcare organization I am currently employed by, and would opt for the implementation of EBP in, the organization is ready for the implementation of EBP in the sense that all stakeholders are in support of implementation of EBP protocols in the various units. Considering the fact that my organization is a very small critical access hospital in rural Georgia, with very limited resources, the organization is ready to fully adopt EBP. All stakeholders believe that such implementation is critical and vital for ensuring quality, and reliable healthcare service that is comprehensive and not only meets but exceeds the needs and expectations of our clients.
According to the survey, some respondents were in full support of the implantation of EBP, while others were not. It should be noted that the category scores for the survey varied due to the fact that respondents had a varied degree of preference when it comes to the implementation of EBP, and changes to practice within the facility. Most respondents responded higher in areas pertaining to changes in providing educational strategies according to EBP guidelines (Melnyk & Fineout-Overholt, 2015). Incorporating EBP within the facility basically requires all the organizational stakeholders to develop a culture of openness and inquiry since such implementation provides very clear parameters for quality and efficient care (Melnyk & Fineout-Overholt, 2015). Some of the notable barriers to the full implementation of EBP include lack of managerial commitment to the full implementation, lack of resources due to the size and financial situation of the facility. Above all lack of interest of upper management to assist staff in ...
This monograph provides an assessment of the current hospital-physician landscape and outlines an innovative vehicle for advancing hospital-physician relationships that has the potential to improve care delivery and coordination, clinical quality, and patient cost. Our findings and recommendations address:• Changes in the market place.• The concept of an integrated medical staff model.• The role of operational clinical integration, enabled by an Electronic Medical• Record, toward creating virtual medical staffs.• Benefits to the hospital, physicians, patients and community.• What boards and senior management can do to move toward the model.
This study examined how characteristics of medical group practices influence rates of inappropriate emergency department visits and avoidable hospital admissions among Medicare patients. The researchers found that practices owned by physicians and those using electronic health records had lower rates of non-emergent ED visits and emergent but primary care treatable visits. Larger practices and those with more non-physician providers per doctor had higher rates of avoidable hospital admissions. The findings suggest that care coordination declines as practices grow in size and complexity.
RESEARCH-BASED LITERATURE SUPPORT FOR CAUTI 2.docxaudeleypearl
RESEARCH-BASED LITERATURE SUPPORT FOR CAUTI 2
Research-Based Literature Support for CAUTI
Kamila Julian
Chamberlain College of Nursing
NR 505: Advanced Research Methods: Evidenced Based Practice
July 2019
Running head: RESEARCH-BASED LITERATURE SUPPORT FOR CAUTI 1
RESEARCH-BASED LITERATURE SUPPORT FOR CAUTI 8
Research-Based Literature Support for CAUTI
Preventing inappropriate use of a urinary catheter and the risk of patient harm associated with the use of indwelling catheters remains a significant challenge for healthcare facilities. The purpose of this paper is to provide research-based literature support from 10 (ten) different research-based references, on the prevention of CAUTI, evaluating interventions that support the use of nurse-driven protocols to reduce the incidence of CAUTI.
The following is the proposed PICO question: “How does the use nurse-driven protocol for evaluating the appropriateness and prevalence of catheter use or removal, compared with no protocol affect the CAUTI rates?”
The literature review from Fakih, Krein, Edson, Watson, Battles, and Saint (2014) aimed to engage healthcare workers to prevent CAUTI and prevent patient harm. A quantitative approach and a quasi-experimental design were used to assess the impact of guidelines for CAUTI prevention and reduce CAUTI rates in the state of Michigan through the use of a bladder bundle, promoting a daily evaluation of catheter indication (Fakih et al., 2014). The ability of the selected design to generate a cause and effect relationship collaborated in spreading educational insights and guidance to various stakeholders. A disadvantage of such design is the lack of control group, as internal validity is not easy to control once a probability of a stakeholder not following all the necessary steps of the protocol to generate true findings, for example nurses not consistent with their rounds to evaluate daily necessity of indwelling catheter, which are important in order to identify gaps and make appropriate and necessary modifications based on new evidence. Target population here are hospitalized patients from 163 units including ER, ICU, Surgical, and operating room from 71 acute care hospitals in the state of Michigan, with an equal probability of being selected resulting in random sampling and confidentiality (Fakih et al., 2014).
The aim of the study by Shehab (2017) is to analyze the impact of the protocol of care, from nurse’s knowledge, of patients that requires a urinary catheter. A quasi-experiment design was used to test assumptions of effective changes in nurse’s knowledge after caring out the protocol of care on patients with the urinary catheter by using a structured interview questionnaire and a nurse’s knowledge assessment tool (Shehab, 2017). An advantage of this study is to evaluate nurse’s readiness to follow protocols and to update their knowledge on how to provide the best EBP care for patients with a Foley catheter. ...
1. Primary sources2. Secondary sources3. La Malinche4. Bacon’s.docxvannagoforth
1. Primary sources
2. Secondary sources
3. La Malinche
4. Bacon’s rebellion
5. Robert Carter III
6. Mesoamerica
7. Middle Passage
8. Indentured servitude
9. The Jefferson-Hemings Controversy
10. Triangular trade
11. Saint Dominique Revolt
12. Syncretism
13. Olaudah Equiano
14. Christopher Columbus
15. Columbian Moment
16. Hernan Cortes
17. Florentine Codex
18. Master Narrative of American History
19. Reconquista
20. The Paradox of Slavery
21. Indian Removal Act 1830
22. Trail of Tears
23. Treaty of Guadalupe Hidalgo
24. Niños Heroes (Heroic Children)
25. Antonio López de Santa Anna y Pérez de Lebrón
26. The Royal Africa Company
27. John Locke
28. St. Patrick’s Battalion
29. Chilam Balam
30. Popol Vuh
31. El requerimiento (The Requirement)
32. Manifest Destiny
33. Moses and Stephen F. Austin
34. Colonialism
35. Colonial Legacy
.
1. Prepare an outline, an introduction, and a summary.docxvannagoforth
The document instructs the reader to prepare a 4 page double spaced report on an attached article, including an outline, introduction, and summary, and to prepare 4 PowerPoint slides summarizing the report.
More Related Content
Similar to NURSING ECONOMIC$November-December 2015Vol. 33No. 6320C.docx
12
Capstone Project
Olivia Timmons
Department of Nursing. St. Johns River State College
NUR 4949: Nursing Capstone
Dr. C. Z. Velasco
November 14, 2021
Capstone Project
There is a saying that states one can only learn through doing it, practically and physically. It is the explanation as to why it is very important to implement the skills acquired in theory into practice to ascertain one’s competence. This is even more crucial in the medical field as they have no choice but just to be perfect at what they are doing, the only secret is through practice. Practicums connect the two worlds of theory and classwork, thus breaking the monotony alongside connecting what was taught in class with what happens in the field. They are important as apart from sharpening the student’s skills, they also open a window of opportunity and build up connections that will come in handy for the student later on. They will feel the experience and the pressure that comes with it thus preparing themselves accordingly.
Statement of the Problem
Timing is essential in the nursing field and the Emergency Room is notorious for its long wait times. The goal of a clinical laboratory is to deliver medically useful results for patients on a timely basis. This goal can be hindered by the new paradigm of the modern laboratory – “do more with less" (Lopez, 2020). When implementing new care models for patients, the patient perspective is critical. The objective of this study was to describe and develop an understanding of the information needs of patients in the ED waiting room concerning ED wait time notification (Calder, 2021). As a patient arrives at the ER waiting area, it's critical to have lab results for the provider to evaluate. I can give you an example of a patient that waited in the waiting room for over 3 hours, no labs were completed because they were waiting for the patient to go back into a room. The patient was suffering from a heart attack and his troponins were elevated and no one knew until 3 hours later. If POC labs were done on all patients as soon as they arrived, mistakes like these can be avoided. Completed POC blood can cut the wait times in half and the laboratory also won't be backed up on resulting lab specimens.
PICOT Question
Question: Is there a significant decrease in Emergency Department patient length of stay (LOS) for those whose blood was analyzed using POC testing versus those whose blood was analyzed using laboratory testing?
· P-Population= emergency room patients
· I-Intervention or Exposure= POC testing of blood specimens
· C-Comparison= Laboratory blood specimens
· O-Outcome= Decrease patient stay in the emergency room
· T-Time = N/A
History of the Issue
The length of patient stay in the emergency department (ED) is an issue that not only increases the severity of illnesses but also reduces the quality of patient care. Serious health conditions including diabetes and hypertension can worsen while patients are ...
12
Capstone Project
Olivia Timmons
Department of Nursing. St. Johns River State College
NUR 4949: Nursing Capstone
Dr. C. Z. Velasco
November 14, 2021
Capstone Project
There is a saying that states one can only learn through doing it, practically and physically. It is the explanation as to why it is very important to implement the skills acquired in theory into practice to ascertain one’s competence. This is even more crucial in the medical field as they have no choice but just to be perfect at what they are doing, the only secret is through practice. Practicums connect the two worlds of theory and classwork, thus breaking the monotony alongside connecting what was taught in class with what happens in the field. They are important as apart from sharpening the student’s skills, they also open a window of opportunity and build up connections that will come in handy for the student later on. They will feel the experience and the pressure that comes with it thus preparing themselves accordingly.
Statement of the Problem
Timing is essential in the nursing field and the Emergency Room is notorious for its long wait times. The goal of a clinical laboratory is to deliver medically useful results for patients on a timely basis. This goal can be hindered by the new paradigm of the modern laboratory – “do more with less" (Lopez, 2020). When implementing new care models for patients, the patient perspective is critical. The objective of this study was to describe and develop an understanding of the information needs of patients in the ED waiting room concerning ED wait time notification (Calder, 2021). As a patient arrives at the ER waiting area, it's critical to have lab results for the provider to evaluate. I can give you an example of a patient that waited in the waiting room for over 3 hours, no labs were completed because they were waiting for the patient to go back into a room. The patient was suffering from a heart attack and his troponins were elevated and no one knew until 3 hours later. If POC labs were done on all patients as soon as they arrived, mistakes like these can be avoided. Completed POC blood can cut the wait times in half and the laboratory also won't be backed up on resulting lab specimens.
PICOT Question
Question: Is there a significant decrease in Emergency Department patient length of stay (LOS) for those whose blood was analyzed using POC testing versus those whose blood was analyzed using laboratory testing?
· P-Population= emergency room patients
· I-Intervention or Exposure= POC testing of blood specimens
· C-Comparison= Laboratory blood specimens
· O-Outcome= Decrease patient stay in the emergency room
· T-Time = N/A
History of the Issue
The length of patient stay in the emergency department (ED) is an issue that not only increases the severity of illnesses but also reduces the quality of patient care. Serious health conditions including diabetes and hypertension can worsen while patients are ...
How does your facility incorporate EBP in a clinical setting to prom.docxfideladallimore
How does your facility incorporate EBP in a clinical setting to promote patient outcomes? Do you have recommendations on how your facility can improve its use of EBP?
My facility incorporates evidence-based practice in the clinical setting in a resourceful manner in order to promote patient outcomes. The institution integrates clinical expertise, the best research evidence and patient values in the decision making process to foster the implementation of evidence based practice. In this endeavor, the facility also encourages patients to bring their personal preferences, unique concerns, values and expectations in order to ensure that the clinicians have a heighted understanding of their pertinent medical issues and provide patient-centered care that meets the distinct needs of the patients.
According to
Polit & Beck (2011),
through the practice of EBP, the healthcare facility can be in a better position to ascertain the effects of therapy, the prognosis of diseases, the utility of diagnostic tests as well as the etiology of disorders. It is worth mentioning that my facility follows various steps in implementing the EBP practices. These steps include assessing the patient, asking clinical questions derived from the patient’s case, acquiring the evidence through searching appropriate resources and then appraising the evidence for its applicability and validity. The other steps usually include integrating the evidence with patient preferences, clinical expertise and applying it to practice. The institution also encourages all practitioners to evaluate their performance with the patient as a yardstick for determining the effectiveness of the EBP process.
Although the facility has registered notable success in its EBP initiatives, various recommendations can help it to improve on these processes. One of such proposals is to aim at creating and sustaining strong nurse-client relationships
(Majid, Foo, & Luyt, 2011)
. This can enable the practitioners to have a better understanding of the patient’s unique values and preferences, all of which are fundamental components of EBP practice. The leaders of the facility should also serve as positive role models through advocating, embracing and communicating the benefits of EBP to other employees in the organization. Ultimately, this will help to create a culture that supports the adoption and implementation of evidence-based practice across the entire healthcare establishment
(Polit & Beck, 2011)
.
References
Majid, S., Foo, S., & Luyt, B. (2011). Adopting evidence-based practice in clinical decision making: nurses' perceptions, knowledge, and barriers.
Journal of the Medical Library Association, 99
(3), 229–236. Retrieved June 10, 2015, from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3133901/
Polit, D., & Beck, C. (2011).
Nursing Research: Generating and Assessing Evidence for Nursing Practice
(9 ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Discussion Question 2
Ho.
Scheduling Of Nursing Staff in Hospitals - A Case Studyinventionjournals
This document summarizes a study that developed a goal programming algorithm to schedule 11 nurses across a two-week period at a hospital. The goals were to satisfy each nurse's contracted time, ensure minimum nurse requirements by role each day, give full-time nurses a weekend off while avoiding more than two consecutive days off, and honor nurses' weekend preference when possible. The algorithm solved the 154-variable, 120-constraint scheduling problem in under 30 seconds. The results showed schedules that met goals for minimum nurse levels each day and individual nurses' two-week schedules.
The document discusses a PICOT statement regarding use of a CAUTI bundle to reduce catheter-associated urinary tract infections (CAUTI) in hospital patients. It then summarizes two research articles that support the PICOT statement. Krein et al. (2013) found that while CAUTI bundles reduced infections, barriers like lack of buy-in from nurses and doctors limited their effectiveness. Oman et al. (2012) found that a nurse-led intervention including CAUTI bundles did not reduce infection rates but did reduce catheter duration, thus lowering CAUTI risk. Both studies support the use of CAUTI bundles and guidelines to reduce CAUTI incidence.
The document proposes developing an occupational therapy outreach service for elderly patients being discharged from medical assessment wards. Research shows elderly patients are often unprepared for discharge and lack communication between health services. The outreach program aims to facilitate smooth transitions, reduce readmissions, and relieve hospital bed pressures through home-based rehabilitation and empowering patients. Outcomes would be measured through tools like the Barthel Index to evaluate the program's effectiveness.
Reply1
Re: Topic 1 DQ 2
Topic 1 DQ 2
The inclusion of evidence-based practice provides nurses with the scientific research and experience to make a comprehensive decision. The practice enables the nurses to re-evaluate the risks and only adopt the best mechanism to ensure an improved patient outcome. Patients are also able to receive the best available outcomes. It is very advisable to move the nursing practice to be evidence-based to ensure that there is patient-centered care that is safe, inclusive, and effective. However, there have been barriers towards this progress since only 15% of U.S practice is evidence-based. One of the barriers which have led to lagging behind in adopting evidence-based practice is nurse shortage. Evidence-based practice requires massive documentation and research together with increased testing and experience. This requires a large human resource which is not available due to nurse shortage across the united states (Stavor et al., 2017). This has acted as a barrier towards the goal of moving practice to evidence-based. The government should employ more nurses and also dedicate some of the workforces specifically to matters to do with shifting traditional caregiving to EBP.
The second barrier is unsupportive administration. Research indicates that over 70% of nurses know about evidence-based practice, but the barriers to the practice in a clinical setting make it hard for them to adopt it. To move practice to EBP requires active collaboration from all stakeholders and more so from the administration of the healthcare setting. However, most administrations have been termed as unsupportive for the move due to the challenges of resources involved in the move. EPB presents a huge cost in the beginning due to its data requirements. However, it is able to reduce the cost of healthcare by 35% after its implementation. Lack of support from the management makes it hard to move nursing practice to EBP in a clinical setting since it’s a collaborative activity that requires dedicated and goal-oriented leadership (Duncombe, 2018). Policies and regulations should be created which force the push to enable the administration of various healthcare to have no otherwise but to comply in the shift.
References
Stavor, D. C., Zedreck-Gonzalez, J., & Hoffmann, R. L. (2017). Improving the use of evidence-based practice and research utilization through the identification of barriers to implementation in a critical access hospital.
JONA: The Journal of Nursing Administration
,
47
(1), 56-61.
Duncombe, D. C. (2018). A multi‐institutional study of the perceived barriers and facilitators to implementing evidence‐based practice.
Journal of Clinical Nursing
,
27
(5-6), 1216-1226.
Reply 2
aur
1 posts
Re: Topic 1 DQ 2
As unprecedented development in the diagnosis, treatment, and long-term management of disease bring Americans closer than ever to the promise of personalized health care, we are faced with similarly unprecedented c.
Hospitals Hospeal cinical cace teacs requite acces to patients' vital.docxIsaac9LjWelchq
Hospitals Hospeal cinical cace teacs requite acces to patients' vital sigre in real time at the peint of care ts support ewidence-based medical good as the qualty of the eaptured data. A lack of full system adcptioe leads to a hypridization of clinical workfows that result in poos: quality care and process ineficiencies. These types of bamiers to continuous quality impoyoumerit ICOQ, in turn, lead to inconsistent quality outcomes and unrealized process synerges. Health case eminagens muat undedstand and elminate these barriers that prevent geod clinical decision making and adeption of CQl best peactices. Case Report tehabitiation in firockilyn as part of the Now York City Health and Heapitals Comporation, the moat extersive municipal health tyathm in the nation Health care erganuations auch in Kings County Hospinat inplament COl progams to impreve the ouccemes of a health intervention or teeatment. Incresuing patent actess to medical prefesticnals or redating expowure to bospitif based infections can promote early or temely dicharget from the hotpial (Vaidya, 20180. For exartple, Kings County Hospial bagght to reduce patient wait bimes for ah appeintment from 2 di days to 4 digst farnan, 2016. Care team membes are essential for care continuify and quaify outoomes in hospitals, phystioan champions mutt ipostar and lead CQI initiatives to umpower the implementation procass (Crentan, 2013 . At Kings County Hospital ut deehelders began implementing the CGI initiative by streamlining the EHR computerised physitian orden: entyy teepplades for charting clinical documentation as well as for Ghing appointreent or intde time slots for standard heikh secvices deliery Closing the gap between inpatient and outpatient heuth outcomes became the foundarion for al system.wide improvenent projecte itimami, 2051 is Conclusion The adoption ef CHR vystems can facilitate the delvery of CQI. However, the data colestad by wuch systams must be reilable and walid and support how the orgacitation uses in to enhance CQl pogamis, A notable stiength of the CCi tooks is that the system is buit upon the feundaticn of exising standards and protocol, such as insereperablity and Health Level 7 language that hospital it atatf memben heve been using for mary years. A limation of the COI tool is ther falure to address specific barriens to mplementation, tuch in fraveial constrains of how the tod can unify or suppert the kealth care organiraton based on the dymamics of the local ensipenenent. Kings County Hospats wecesiful CQl inicabve created a bresithrough that led to inpropements in qualty care delvery and induction comergente of eaterval events wich as changing cave models based on CQt outcomes and EhR techrology adoption wall continue to presusure hospitals to evolve irto leareing health tystement. Questions 1. Why are CCI initiatives important for hospials and heath irstems? preveneable advene incidenat. 3. What rele do hospitals heve in advaneng CQi heolth outeomes and mode.
1
Quantitative Synopsis and Appraisal
Studentfirstname Studentlastname, Studentfirstname Studentlastname, Studentfirstname
Studentlastname, Studentfirstname Studentlastname
College of Nursing, Resurrection University
NUR4440: Research in Nursing
Professor Carina Piccinini
February 14, 2020
2
Quantitative Appraisal and Synopsis
The purpose of this paper is to summarize and appraise a research study testing the use of
disinfectant caps on intravenous (IV lines) to reduce the rate of hospital associated bloodstream
infections (BSI). The Centers for Disease Control and Prevention (CDC, 2019) reports that
central line associated bloodstream infections (CLABSI) remain a major concern in hospital
settings causing fatalities, increased length of stay, and increased costs. The CDC (2019)
recommends proper maintenance of intravenous lines to reduce the risk of infection. Current
research is still looking to define what proper maintenance should be, including whether
disinfectant caps influence rates of infection for intravenous (IV) lines.
Summary of the Study
The CDC recommends that healthcare workers disinfect all needleless connectors for
peripheral and central IVs prior to connection to reduce the risk of CLABSIs without further
recommendation on the type or length of disinfections. The authors of this study note other
studies have tested disinfecting caps and sought to confirm those results.
Merrill et al. (2014) conducted a quasi-experimental study to identify if disinfectant caps
reduce CLABSI incidence and the relationship between nursing compliance with the caps and
CLABSI rates. This study was held in a single Trauma 1 hospital with 430 beds in the United
States.
The researchers obtained their sample through nonrandom convenience sampling by
including all patients meeting inclusion criteria at the hospital starting January 2012. Participants
were included if they had a central or peripheral intravenous line, of any age, and were admitted
to 13 specific hospital floors. Subjects were excluded if they were on the following floors:
emergency department; labor, delivery or post-partum; ambulatory care, surgical services; and
3
well-baby nursery. The study did not report any demographic information about participants, the
number of participants, or attrition or loss to follow up.
The intervention involved applying a Curos brand disinfectant cap to all ports on
peripheral lines, central lines, and IV tubing when not in use on patients. The nurses on the
involved units were trained on the use of the disinfectant caps with a 1:1 follow up by the
researchers. Nurses were then responsible for placing caps. The researchers intermittently
observing nurses for compliance to the intervention and reporting compliance to nursing
departments twice a week.
CLABSIs were defined as a positive blood culture drawn within 48 hours symptom onset,
and C ...
The document summarizes a study that tested the use of disinfectant caps on intravenous (IV) lines to reduce the rate of hospital-associated bloodstream infections (BSIs). The study found that using disinfectant caps on IV ports decreased the mean rate of central line-associated BSIs from 1.5 infections per month before the intervention to 0.88 infections after. However, the study had limitations such as lack of statistical significance testing for the pre-post infection rates and not accounting for other infection prevention practices. Therefore, more research is needed to fully understand the impact of disinfectant caps on reducing BSIs.
Do you ever wonder whynurses engage in practicesthat areDustiBuckner14
D
o you ever wonder why
nurses engage in practices
that aren’t supported by
evidence, while not implementing
practices substantiated by a lot
of evidence? In the past, nurses
changed hospitalized patients’ IV
dressings daily, even though no
solid evidence supported this prac-
tice. When clinical trials finally
explored how often to change IV
dressings, results indicated that
daily changes led to higher rates
of phlebitis than did less frequent
changes.1 In many hospital EDs
across the country, children with
asthma are treated with albuterol
delivered with a nebulizer, even
though substantial evidence shows
that when albuterol is delivered
with a metered-dose inhaler plus
a spacer, children spend less time
in the ED and have fewer adverse
effects.2 Nurses even disrupt
patients’ sleep, which is important
for restorative healing, to docu-
ment blood pressure and pulse
rate because it’s hospital policy to
take vital signs every two or four
hours, even though no evidence
supports that doing so improves
the identification of potential
complications. In fact, clinicians
often follow outdated policies and
procedures without questioning
their current relevance or accu-
racy, or the evidence for them.
When a spirit of inquiry—an
ongoing curiosity about the best
evidence to guide clinical decision
making—and a culture that sup-
ports it are lacking, clinicians are
unlikely to embrace evidence-based
practice (EBP). Every day, nurses
across the care continuum perform
a multitude of interventions (for
example, administering medica-
tion, positioning, suctioning)
that should stimulate questions
about the evidence supporting
their use. When a nurse possesses
a spirit of inquiry within a sup-
portive EBP culture, she or he
can routinely ask questions about
clinical practice while care is being
delivered. For example, in patients
with endotracheal tubes, how
does use of saline with suctioning
compared with suctioning without
saline affect oxygen saturation?
[email protected] AJN � November 2009 � Vol. 109, No. 11 49
By Bernadette Mazurek Melnyk, PhD,
RN, CPNP/PMHNP, FNAP, FAAN,
Ellen Fineout-Overholt, PhD, RN,
FNAP, FAAN, Susan B. Stillwell, DNP,
RN, CNE, and Kathleen M.
Williamson, PhD, RN
Igniting a Spirit of Inquiry: An Essential Foundation for
Evidence-Based Practice
How nurses can build the knowledge and skills they need to
implement EBP.
Every day, nurses perform interventions (for
example, administering medication, positioning,
suctioning) that should stimulate questions
about the evidence supporting their use.
This is the first article in a new series from the Arizona State University College of Nursing and Health Innovation’s
Center for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving approach
to the delivery of health care that integrates the best evidence from studies and patient care data with clinician
expertise and patient preferences and values. When delivered in a context of caring a ...
The document discusses how health systems can achieve standardized patient-centric care through clinician-led transformation. It highlights the success of Trinity Health in saving $20,000 per day and improving outcomes by empowering clinicians to lead collaborative efforts to develop and implement evidence-based standardized care protocols and monitor their impact. Key aspects that contributed to Trinity Health's success include creating an open forum for clinicians to develop solutions, proving rather than just stating that clinicians are decision-makers, using data to prioritize opportunities, and establishing rigorous project management and measurement of results.
Introduction of the NZ Health IT Plan enables better gout management - Reflections of an early adopter. Presented by Peter Gow, Counties Manukau DHB, at HINZ 2014, 12 November 2014, 11.37am, Plenary Room
This document summarizes a quality improvement project conducted at King Abdulaziz Medical City in Riyadh, Saudi Arabia that aimed to reduce rates of ventilator-associated pneumonia (VAP) in intensive care units. A multidisciplinary team implemented a bundle of evidence-based practices shown to reduce VAP, including head of bed elevation, daily sedation vacations, oral care with chlorhexidine, and others. Through multiple tests of changes using the model for improvement methodology over one year, compliance with the bundle increased from 83% to 97% and the VAP rate decreased from 4.0 to 0.8 per 1,000 ventilator days. This translated to a reduction in the number of annual VAP
EVIDENCE- BASED PRACTICE PROPOSAL SECTION A2EVIDENCE- BASED PR.docxSANSKAR20
EVIDENCE- BASED PRACTICE PROPOSAL SECTION A:2
EVIDENCE- BASED PRACTICE PROPOSAL SECTION A:7
Running head: EVIDENCE- BASED PRACTICE PROPOSAL SECTION A:1
Evidence- Based Practice Proposal- Section A: Organizational Culture and Readiness Assessment
Evidence based practice (EBP) should be fundamental in every healthcare setting in the sense that it ensures decisions based on the best evidence integrated with clinical experience and the various expectations of patients within the healthcare setting (Gale & Schaffer, 2009). The main objective and aim in evidence-based practice protocols are to integrate the clinical expertise with the patient’s perspective and the scientific evidence in a bid to provide efficient and high quality healthcare services which are based on the needs, values, interests and culture of the patients served by the healthcare organization in question. It should be noted that evidence- based practice is essential as it does integrate the perspective of the patient, including values and culture in providing higher quality healthcare supported by research and scientific evidence (Gale & Schaffer, 2009). In essence it ensures the provision of quality and reliability of the healthcare services provided within the healthcare setting.
In regards to the healthcare organization I am currently employed by, and would opt for the implementation of EBP in, the organization is ready for the implementation of EBP in the sense that all stakeholders are in support of implementation of EBP protocols in the various units. Considering the fact that my organization is a very small critical access hospital in rural Georgia, with very limited resources, the organization is ready to fully adopt EBP. All stakeholders believe that such implementation is critical and vital for ensuring quality, and reliable healthcare service that is comprehensive and not only meets but exceeds the needs and expectations of our clients.
According to the survey, some respondents were in full support of the implantation of EBP, while others were not. It should be noted that the category scores for the survey varied due to the fact that respondents had a varied degree of preference when it comes to the implementation of EBP, and changes to practice within the facility. Most respondents responded higher in areas pertaining to changes in providing educational strategies according to EBP guidelines (Melnyk & Fineout-Overholt, 2015). Incorporating EBP within the facility basically requires all the organizational stakeholders to develop a culture of openness and inquiry since such implementation provides very clear parameters for quality and efficient care (Melnyk & Fineout-Overholt, 2015). Some of the notable barriers to the full implementation of EBP include lack of managerial commitment to the full implementation, lack of resources due to the size and financial situation of the facility. Above all lack of interest of upper management to assist staff in ...
This monograph provides an assessment of the current hospital-physician landscape and outlines an innovative vehicle for advancing hospital-physician relationships that has the potential to improve care delivery and coordination, clinical quality, and patient cost. Our findings and recommendations address:• Changes in the market place.• The concept of an integrated medical staff model.• The role of operational clinical integration, enabled by an Electronic Medical• Record, toward creating virtual medical staffs.• Benefits to the hospital, physicians, patients and community.• What boards and senior management can do to move toward the model.
This study examined how characteristics of medical group practices influence rates of inappropriate emergency department visits and avoidable hospital admissions among Medicare patients. The researchers found that practices owned by physicians and those using electronic health records had lower rates of non-emergent ED visits and emergent but primary care treatable visits. Larger practices and those with more non-physician providers per doctor had higher rates of avoidable hospital admissions. The findings suggest that care coordination declines as practices grow in size and complexity.
RESEARCH-BASED LITERATURE SUPPORT FOR CAUTI 2.docxaudeleypearl
RESEARCH-BASED LITERATURE SUPPORT FOR CAUTI 2
Research-Based Literature Support for CAUTI
Kamila Julian
Chamberlain College of Nursing
NR 505: Advanced Research Methods: Evidenced Based Practice
July 2019
Running head: RESEARCH-BASED LITERATURE SUPPORT FOR CAUTI 1
RESEARCH-BASED LITERATURE SUPPORT FOR CAUTI 8
Research-Based Literature Support for CAUTI
Preventing inappropriate use of a urinary catheter and the risk of patient harm associated with the use of indwelling catheters remains a significant challenge for healthcare facilities. The purpose of this paper is to provide research-based literature support from 10 (ten) different research-based references, on the prevention of CAUTI, evaluating interventions that support the use of nurse-driven protocols to reduce the incidence of CAUTI.
The following is the proposed PICO question: “How does the use nurse-driven protocol for evaluating the appropriateness and prevalence of catheter use or removal, compared with no protocol affect the CAUTI rates?”
The literature review from Fakih, Krein, Edson, Watson, Battles, and Saint (2014) aimed to engage healthcare workers to prevent CAUTI and prevent patient harm. A quantitative approach and a quasi-experimental design were used to assess the impact of guidelines for CAUTI prevention and reduce CAUTI rates in the state of Michigan through the use of a bladder bundle, promoting a daily evaluation of catheter indication (Fakih et al., 2014). The ability of the selected design to generate a cause and effect relationship collaborated in spreading educational insights and guidance to various stakeholders. A disadvantage of such design is the lack of control group, as internal validity is not easy to control once a probability of a stakeholder not following all the necessary steps of the protocol to generate true findings, for example nurses not consistent with their rounds to evaluate daily necessity of indwelling catheter, which are important in order to identify gaps and make appropriate and necessary modifications based on new evidence. Target population here are hospitalized patients from 163 units including ER, ICU, Surgical, and operating room from 71 acute care hospitals in the state of Michigan, with an equal probability of being selected resulting in random sampling and confidentiality (Fakih et al., 2014).
The aim of the study by Shehab (2017) is to analyze the impact of the protocol of care, from nurse’s knowledge, of patients that requires a urinary catheter. A quasi-experiment design was used to test assumptions of effective changes in nurse’s knowledge after caring out the protocol of care on patients with the urinary catheter by using a structured interview questionnaire and a nurse’s knowledge assessment tool (Shehab, 2017). An advantage of this study is to evaluate nurse’s readiness to follow protocols and to update their knowledge on how to provide the best EBP care for patients with a Foley catheter. ...
Similar to NURSING ECONOMIC$November-December 2015Vol. 33No. 6320C.docx (20)
1. Primary sources2. Secondary sources3. La Malinche4. Bacon’s.docxvannagoforth
1. Primary sources
2. Secondary sources
3. La Malinche
4. Bacon’s rebellion
5. Robert Carter III
6. Mesoamerica
7. Middle Passage
8. Indentured servitude
9. The Jefferson-Hemings Controversy
10. Triangular trade
11. Saint Dominique Revolt
12. Syncretism
13. Olaudah Equiano
14. Christopher Columbus
15. Columbian Moment
16. Hernan Cortes
17. Florentine Codex
18. Master Narrative of American History
19. Reconquista
20. The Paradox of Slavery
21. Indian Removal Act 1830
22. Trail of Tears
23. Treaty of Guadalupe Hidalgo
24. Niños Heroes (Heroic Children)
25. Antonio López de Santa Anna y Pérez de Lebrón
26. The Royal Africa Company
27. John Locke
28. St. Patrick’s Battalion
29. Chilam Balam
30. Popol Vuh
31. El requerimiento (The Requirement)
32. Manifest Destiny
33. Moses and Stephen F. Austin
34. Colonialism
35. Colonial Legacy
.
1. Prepare an outline, an introduction, and a summary.docxvannagoforth
The document instructs the reader to prepare a 4 page double spaced report on an attached article, including an outline, introduction, and summary, and to prepare 4 PowerPoint slides summarizing the report.
1. Normative moral philosophy typically focuses on the determining t.docxvannagoforth
According to Aristotle, virtues are traits of character that are good for a person to have and that are developed through habitual actions over time. Acting virtuously leads to morally correct actions. The document discusses Aristotle's view of virtue ethics and how it differs from normative moral philosophy by focusing on the character of the moral agent rather than just determining the right action. It asks how virtue ethics would analyze two different medical ethical dilemmas.
1. Paper should be 5-pages min. + 1 page works cited2. Should have.docxvannagoforth
1. Paper should be 5-pages min. + 1 page works cited
2. Should have at least 10 annotated sources (copy article onto word, highlight main point, write a few sentences about how it'll help you in writing the paper at the bottom of page)
3
. Should have an INTRO, NARRATION, ARGUMENTS, REFUTATION, CONCUSION
4. Use in-text citations and have organized mla format works cited page
SAMPLE OUTLINE
Research Paper Outline
Title: Rebellious Libya
Thesis: The United States should not get involved with Libya’s conflicts.
I.
Introduction:
A.
Start with the question, what is war? Explain briefly.
B.
Talk about the wars of the United States.
C.
What were the outcomes of some of those wars?
II.
Narration:
A.
Give some background on Libya.
B.
Explain how Col. Muammar Gaddafi became the leader of Libya
C.
Talk about why the citizens of Libya want to overthrow Gaddafi.
D.
Explain why the people feel that the United States should get involved in Libya’s conflicts.
III.
Partition:
A.
Thesis: I believe that the United States should not get involve with Libya’s conflicts.
B.
Essay Map.
1.
Cost of war.
2.
Using money in other Departments other defense.
3.
Killing innocent civilians and soldiers.
4.
Helping unknown rebels
5.
Involvement of foreign wars
IV.
Arguments:
A.
The cost of war is rising by the minute. The Obama Administration proposed a budget of $553 billion dollars for the department.
B.
Instead of spending all that money on war, we should be investing that money on health care and education.
C.
This conflict has caused the lives of many innocent civilians. NATO openly admitted to have killed innocent civilians, due to misguidance.
D.
The rebels fighting against Gaddafi are in need of military supplies. I don’t think that it is a good idea to help unknown rebels. We helped the Afghanistan rebels when they were fighting Russia. After they were victorious, they later became the “Taliban” and used those weapons to attack the US.
E.
Getting involved in foreign wars is not a good idea. The US has been involved in many foreign wars lately. These wars have been in foreign countries where Islam is the prominent religion. Libya is one of these countries. The involvement of the US in these places, builds a bad reputation worldwide and among the Muslim community.
V.
Refutation:
A.
Gaddafi’s actions against the civilians of Libya are totally wrong. Killing your own people is bad and therefore, we should help the rebels overthrow him.
B.
Gaddafi has been in power for many years. In fact, he holds the record for most years in power in a single country. This type of power can potentially lead to corruption and mistreatment of civilians.
C.
The people of Libya deserve to have democracy. They should have the right to elect their own leader.
D.
If Al Qaeda is threatening NATO and Libyan mercenaries then we should help them fight terrorism.
VI.
Conclusion:
A.
Summarize my arguments.
B.
State why we should not get involve with Libya’s conf.
1. Name and describe the three steps of the looking-glass self.2.docxvannagoforth
1. Name and describe the three steps of the 'looking-glass self'.
2. List and describe the three stages in George Mead's model of human development.
3. Piaget developed a four-stage process to explain how children develop reasoning skills. List each and give an example of one of the stages.
4. Briefly summarize the three elements of Freud's theory of personality and explain why sociologist have negative reactions to his analysis.
5. How does the mass media reinforce society's expectations of gender?
.
1. Provide an example of a business or specific person(s) that effec.docxvannagoforth
1. Provide an example of a business or specific person(s) that effectively use social media. What tools does the business or person use? How do they apply the tools effectively? Describe areas of improvement.
This assignment has to be 4 pages long, then it needs a cover page and reference page however that can not be a part of the four pages. So it would be 6 pages if you count the cover page and reference page!
.
1. Mexico and Guatemala. Research the political and economic situati.docxvannagoforth
1. Mexico and Guatemala. Research the political and economic situation of these countries and write about their peculiar circumstances.
2. Honduras, El Salvador and Panama. Research the political and economic situation of these countries and write about their peculiar circumstances.
3. Costa Rica and Nicaragua. Research the ecological and political situation of these countries and write about their peculiar circumstances.
4. Colombia and Ecuador. Research about the truths and myths about this two countries and write about your impressions on these stereotypes.
.
1. Many scholars have set some standards to judge a system for taxat.docxvannagoforth
1. Many scholars have set some standards to judge a system for taxation for its validity. How can you decide if a tax is good or bad?
You can consider these five following principles for your Discussion. What do these issues mean? How do you think they matter?
Adequacy Equity Exportability Neutrality Simplicity
What other tax revenue systems could you consider? How do you think they would be better or worse?
2. What role do taxes play in political issues?
3. What is your opinion of a flat tax as some politicians have proposed?
.
1. List and (in 1-2 sentences) describe the 4 interlocking factors t.docxvannagoforth
1. List and (in 1-2 sentences) describe the 4 interlocking factors that led to the ourbreak of world war 1
2. Explain the difference between and authoritarian regime and a totalitarian regime.
3. List and (in 1-2 sentences) describe the 5 factors that led to the ourbreak of world war 2.
.
1. Please explain how the Constitution provides for a system of sepa.docxvannagoforth
1. Please explain how the Constitution provides for a system of separation of powers and checks and balances. Provide a fully developed essay of at least 500 words, and cite sources used.
2. Describe how a bill becomes a law at the national level, in a fully developed essay of at least 500 words. Support your work with cited sources, references to Lecture Notes, or URLs where you obtained your information.
.
1. Please watch the following The Diving Bell & The Butterfly, Amel.docxvannagoforth
1. Please watch the following: The Diving Bell & The Butterfly, Amelie, The Lookout, A Single Man, Her, Little Children, and An Education and
Please respond to the films. In particular, respond to how the film develops the identity of a single character for an audience, and which you responded to (either the characters themselves or the way the film constructed the character) the most, or the least please , 10 sentence min and no plagiariasm also it has to be
followowed exactly whats written here.
PS: please dont waste my time if you will do a messy assigment, just dont send me a msg.
.
1. Most sociologists interpret social life from one of the three maj.docxvannagoforth
1. Most sociologists interpret social life from one of the three major theoretical frameworks/perspectives (conflict theory, functionalism, symbolic interactionism). Describe the major points of each one. List at least one sociologist who has been identified with each of these three theories.
2. What is the difference between basic sociology and applied sociology?
3. List and describe the eight steps of the scientific research model.
4. Discuss the importance of ethics in social research. Define what is meant by ethics.
.
1. Members of one species cannot successfully interbreed and produc.docxvannagoforth
1. Members of one species cannot successfully interbreed and produce fertile offspring with members of other species. This idea is known as
a. reproductive success.
b. punctuated evolution.
c. adaptive radiation.
d. the biological species concept.
e. geographic isolation.
2. The origin of new species, the extinction of species, and the evolution of major new features of living things are all changes that result from
a. macroevolution.
b. fitness.
c. speciation.
d. the biological species concept.
e. convergent evolution.
3. Which is a barrier that can contribute to reproductive isolation?
a. timing
b. behavior
c. habitat
d. incompatible reproductive structures
e. all of the above
4. Which of the following statements is false?
a. Horses and donkeys are separate species.
b. Two mules can mate and produce fertile offspring.
c. A horse and a donkey can mate and produce offspring.
d. Two donkeys can mate and produce fertile offspring.
e. Two horses can mate and produce fertile offspring.
5. The evolution of the penguin’s wing from a wing suited for flying to a “flipper-wing” used for swimming is an example of
a. refinement of existing adaptations.
b. reproductive isolation.
c. adaptation of existing structures to new functions.
d. inheritance of acquired characteristics.
e. the biological species concept.
6. Which of the following have been preserved as fossils?
a. dinosaur footprints
b. insects preserved in amber
c. petrified plant remains
d. animal bones
e. all of the above
7. The mass extinctions that included the dinosaurs took place during which period?
a. Cambrian (543–510 million years ago)
b. Devonian (409–363 million years ago)
c. Carboniferous (363–290 million years ago)
d. Jurassic (206–144 million years ago)
e. Cretaceous (144–65 million years ago)
8. The development of the complex, camera-like eye of a mammal is an example of
a. refinement of existing adaptations.
b. reproductive isolation.
c. adaptation of existing structures to new functions.
d. inheritance of acquired characteristics.
e. the biological species concept.
9. Which of the following statements is true?
a. Carbon-14 dating is useful for studying the age of early dinosaur fossils.
b. Carbon-14 has a half-life of 5,730 years.
c. Uranium-238 has a very short half-life.
d. Uranium-238 is present in all organisms.
e. Carbon-12 is not found in living plants.
10. Which of the following provides the best explanation for why Australia has so many organisms unique to that continent?
a. punctuated equilibrium
b. the biological species concept
c. convergent evolution
d. continental drift
e. cladistics
11. Scientists think that a meteor that fell in ____________________ may have led to the extinction of the dinosaurs.
a. Australia
b. the Yucatán peninsula
c. The Galápagos Islands
d. Pangaea
e. India
12. The great diversit.
1. Of the three chemical bonds discussed in class, which of them is .docxvannagoforth
1. Of the three chemical bonds discussed in class, which of them is simultaneously the weakest and most important for life on this planet as we know it?
2.Carbohydrates are very important sources of energy for life. Plants and arthropods also use carbohydrates as components of structures that are very important for their existence. Provide the names of the two most important carbohydrate based structures (one for plants and one for arthropods) and the carbohydrate components that are used to form them.
3._____________ _____________ are joined by ______________ bonds to form proteins.
4.Proteins can be used for several functions. Provide examples of structural and metabolic functions of proteins.
5.Describe the phosholipid bilayer of the plasma membrane. Why is this bilayer important for the formation of cells and the sequestration of chemical reactions within the cell?
.
1. Look at your diagrams for hydrogen, lithium, and sodium. What do .docxvannagoforth
1. Look at your diagrams for hydrogen, lithium, and sodium. What do they all have in common? What group are these elements in on the periodic table?
2. Look at your diagrams for fluorine and chlorine. What do they have in common?
Picture is in the link. Put answers on the word document and re-submit
.
1. Name the following molecules2. Sketch the following molecules.docxvannagoforth
1. Name the following molecules:
2. Sketch the following molecules:
3-cyclohexenone
4-ethyl 2,2,5-trimethyl 3-hexanone
ethyl butyrate
pentanoic acid
2-chloro 4-methyl 2,5-heptadienal
3,4-dichloro 4-ethyl octanal
p-chloro phenol
3-bromo 2-chloro 4-methyl hexane
3-cyclopropyl 1,2-cyclopentanediol
methyl phenyl ether
3,5-dimethyl 2-heptene-4,5-diol
3. Give two different uses for ethanol.
4. Name two categories of organic compounds (alkanes, aldehydes…) that have very strong characteristic odours.
.
1. List the horizontal and vertical levels of systems that exist in .docxvannagoforth
1. List the horizontal and vertical levels of systems that exist in organizations.
2.
Describe at least five steps involved in systems integration
3.
What is the role of ERP systems in system integration?
4. Why do you think functional silos are not appropriate for today's organization? Discuss your answer from organizational and technical perspectives.
5. Pick an organization that you know of or where you are/were working and provide examples of logical and physical integration issues that were faced by the organization when they broke the functional silos and moved to integrated systems.
.
1. Kemal Ataturk carried out policies that distanced the new Turkish.docxvannagoforth
1. Kemal Ataturk carried out policies that distanced the new Turkish republic of the 1920s from the Ottoman past. Why? What specific policies did Ataturk pursue? 2. Why many Arabs felt betrayed by the British (and the French) after the First World War? 3. Discuss at least three features of patrimonial leadership. List three or more Middle Eastern states where such type of political leadership persists 4. Describe the key processes (both internal and external) that initiated political and economic disintegration of the Ottoman Empire in the nineteenth century. 5. European military superiority in the late eighteenth century prompted Ottoman rulers to respond with what specific political measures? 6. The Zionist political movement originated in Europe rather than in the Middle East. Explain why and how. 7. After the Second World War, several Arab countries went through the process of transition from constitutional monarchies to republics. Identify three such countries and describe the course of events that brought about this transition. 8. How is religious Zionism different from secular Zionism? What is the relevance of this difference for the creation of the state of Israel? Has the relative influence of the two remained stable since the creation of the Israeli state? 9. What was the principle source of political legitimacy of the Ottoman Empire? 10. While most Ottoman European provinces, riding the tide of the nineteenth century nationalism, sought and won independence from Istanbul, Ottoman Arab provinces maintained their political loyalty to the Ottomans. What explains this difference between Arab and European provinces? 11. Social and political forces in favor of a constitutional reform in Iran (1905-1911) were markedly different from the groups that promoted constitutional limitations on executive powers of the sultan in the Ottoman Empire prior to the First World War? Explain this difference. 12. What are some of the key features of Arab socialisms? Which Arab leaders adopted socialist ideology? Which Arab leaders were opposed to it? 13. After the First World War, the new Middle Eastern protectorates (e.g., Syria, Lebanon, Iraq) were expected to develop into modern secular states. What specific policies did France and Britain try to implement? How successful have theses policies been? 14. The 1967 war was a watershed event for all major actors in the Middle East. Explain the consequences of the war for domestic politics in Israel and Egypt respectively.
.
1. If we consider a gallon of gas as having 100 units of energy, and.docxvannagoforth
1. If we consider a gallon of gas as having 100 units of energy, and 25 of those units are used to move the car, what law of thermodynamics accounts for the other 75 units of energy? (Points : 2)
the first law
the second law
2. Which of these is not a component of a molecule of adenosine triphosphate (ATP)? (Points : 3)
adenosine
phosphate
deoxyribose sugar
ribose sugar
3. Glycolysis is a sequence of ______ chemical reactions. (Points : 3)
nine
six
five
ten
4. Exergonic reactions produce products with a ___ energy level than that of the initial reactants. (Points : 3)
lower
higher
the same
5. When chemical X is reduced, which of these expressions would be an accurate representation of its reduced state? (Points : 3)
XO
XH
X
HX
6. Most enzymes are which kind of organic compound? (Points : 3)
carbohydrates
lipids
proteins
none of the above
7. The area on an enzyme where the substrate attaches is called the: (Points : 3)
active site
allosteric site
anabolic site
inactive site
8. Which of the following creatures would not be an autotroph? (Points : 3)
cactus
cyanobacteria
fish
palm tree
9. The process by which most of the world's autotrophs make their food is known as: (Points : 3)
glycolysis
photosynthesis
chemosynthesis
herbivory
10. Plants are the only organisms that use ATP for the transfer and storage of energy. (Points : 2)
True
False
11. The colors of light in the visible range (from longest wavelength to shortest) are: (Points : 3)
ROYGBIV
VIBGYOR
GRBIYV
ROYROGERS
12. Chlorophyll is a green pigment because it absorbs only the green part of the visible light spectrum. (Points : 2)
True
False
13. The photosynthetic pigment that is essential for the process to occur is: (Points : 3)
chlorophyll a
chlorophyll b
beta carotene
xanthocyanin
14. A photosystem is: (Points : 3)
a collection of hydrogen-pumping proteins
a series of electron-accepting proteins arranged in the thylakoid membrane
a collection of photosynthetic pigments arranged in a thylakoid membrane
found only in prokaryotic organisms
15. Which of these molecules is NOT a product of the Electron Transport System? (Points : 3)
ATP
Water
Pyruvate
NAD+
16. The dark reactions require all of these chemicals to proceed except: (Points : 3)
ATP
NADPH
carbon dioxide
oxygen
17. The structural unit of photosynthesis, where the photosystems are located, are called: (Points : 3)
chlorophylls
eukaryotes
stroma
thylakoids
18. Which of the following does NOT occur during the light independent process? (Points : 3)
CO2 is used to form carbohydrates
NADPH converts to NADP
ADP converts to ATP
ATP converts to ADP
19. The production of ATP that occurs in the presence of oxygen is called: (Points : 3)
aerobic respiration
anaerobic respiration
chemiosmosis
photosynthesis
20. The first stable chemical formed by the Calvin Cycle is: (Points :.
1. In 200-250 words, analyze the basic issues of human biology as th.docxvannagoforth
1. In 200-250 words, analyze the basic issues of human biology as they relate to chronic conditions and describe the interaction between disability, disease, and behavior. Examine and discuss the impact of biological health or illness on social, psychological, and physical problems from the micro, mezzo, and macro perspectives. Choose a chronic condition from those provided in your text and consider how you might feel, think, and behave differently if the condition were affecting you versus if the condition were affecting a stranger. How might you think differently about this chronic condition if it were affecting someone close to you, your neighbor, or someone in your community? Please include at least two supporting scholarly resources.
2.Our stage of life, intellectual/cognitive abilities, and sociocultural position in life, affect our perspectives and resultant behaviors about a number of conditions including cancer. Consider the information provided in the
“Introduction to the Miller Family”
document. Both Ella and Elías have been diagnosed with cancer. Ella has been fighting cancer with complementary and alternative methods with some success for many years. Elías, her grandson, is 10 years old and has recently been diagnosed with leukemia but has not yet begun treatment. Putting yourself in either Ella or Elías’s place, what might your perspective on your cancer be? Integrate how the stage of life, cognitive abilities, and sociocultural position of your chosen person impacts her/his perspective on his/her individual disease.
.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
1. NURSING ECONOMIC$/November-December 2015/Vol.
33/No. 6320
C
ATHETER-ASSOCIATED urinary
tract infections (CAUTI)
continue to challenge com-
munity hospitals. Hospital-
acquired urinary tract infections
account for 40% of hospital-ac quir -
ed infections, with 80% of those in -
fections related to use of a urinary,
or Foley, catheter (Gokula, Smolen,
Gaspar, Hensley, Benninghoff, &
Smith, 2012; Hanchett, 2012).
Given the rising cost of treating
CAUTI, the Centers for Medicare
& Medicaid Services (CMS) identi-
fied hospital-acquired CAUTI as
one of eight conditions for which
hospitals would no longer receive
reimbursement as of October 1,
2008 (Milstein, 2009). Community
hospitals, therefore, are charged
with implementing innovative
strategies that will reduce the inci-
dence of hospital-acquired CAUTI.
A variety of strategies have
been explored in nursing and other
scientific literature for decreasing
2. the incidence of CAUTI. Practical
suggestions, such as stickers on pa -
tients’ medical records or comput-
er-generated reminders, along with
implementation of evidence-bas -
ed guidelines for Foley cathe ter
maintenance, have been offer ed as
potential solutions (Bruminhent,
Keegan, Lakhani, Roberts &
Passalacqua, 2010; Gokula et al.,
2012; Wilson et al., 2009). The
majority of literature, however,
has been focused on tertiary or
academic medical centers and
long-term care facilities
White Plains Hospital is a
301-bed non-academic communi-
ty hospital in the suburbs of New
York City that has implemented a
nurse-driven process that reduced
the incidence of CAUTI 50%
within 1 year of implementation.
The incidence of CAUTI contin-
ues to decline to date with the goal
of eventually having zero hospital-
acquired CAUTI events. Further,
with the decline in the incidence
of CAUTI, costs decreased sub-
stantially. White Plains Hospital’s
nurse-driven, cost-effective pro -
cess for reducing CAUTI is des -
cribed. The ideas and steps taken
to implement and sustain the
process are outlined, along with
3. suggestions for how nurse leaders
in similar clinical settings can
replicate the process.
Background
In 2007, White Plains Hospital
experienced a transition in its sen-
ior nursing leadership that reor-
ganized the roles and responsibil-
ities of the directors of nursing.
The incoming chief nursing offi-
cer launched the nursing division
on its Magnet® journey and creat-
ed an innovative role for the
organization: the director of nurs-
ing quality. This senior nursing
EXECUTIVE SUMMARY
Due to treatment costs and lack
of reimbursement, community
hospitals are charged with imple-
menting innovative strategies that
will reduce the incidence of hos-
pital-acquired catheter-associated
urinary tract infections (CAUTI).
A nurse-driven system for
decreasing the number of hospi-
tal-acquired CAUTI is effective
and useful for a community hos-
pital.
One nurse with accountability for
implementing a simple evidence-
based protocol can dramatically
4. decrease the total incidence of
hospital-acquired CAUTI.
The basis for the success of this
initiative relied heavily on the
ease of using the eight-point
Question the Foley criteria, the
availability of the electronic med-
ical record, interdisciplinary col-
laboration, and support from
nursing and physician administra-
tion.
With collaboration and support
from nursing leadership, the
goals for patient safety by reduc-
ing hospital-acquired CAUTI can
become a reality in a short period
of time.
Paul Quinn
Chasing Zero: A Nurse-Driven Process
For Catheter-Associated Urinary Tract
Infection Reduction in a Community Hospital
PAUL QUINN, PhD, CNM, RN-BC, NEA-
BC, CEN, CCRN, is Director of Nursing,
White Plains Hospital, White Plains, NY.
321NURSING ECONOMIC$/November-December 2015/Vol.
33/No. 6
5. leadership role had direct respon-
sibility for all nursing-sensitive
indicators, performance improve-
ment, nursing research, evidence-
based practice, and dissemination
of quality data within the nursing
division. Specifically, the director
of nursing quality was charged
with identifying trends in health
care that could affect the nursing
division, performing gap analyses,
and reporting the findings to the
chief nursing officer so that action
plans could be created and imple-
mented.
The author, in the role of direc-
tor of nursing quality, utilizing cod-
ing data and a retrospective chart
audit, found White Plains Hospital
had an astonishing 110 incidences
of CAUTI for the period of 2007
and the first two quarters of 2008.
Current estimates for an organiza-
tion to treat each incidence of hos-
pital-ac quired CAUTI range from
$1,200 to $2,400 (Palmer, Lee,
Dutta-Linn, Wroe, & Hartmann,
2013; Rebmann & Greene, 2010).
Since treating a hospital-acquired
CAUTI was costly, with the poten-
tial for those costs to increase over
time, the chief nursing officer
made reducing the incidence of
CAUTI a key initiative in her strate-
gic plan.
6. The Question the Foley pro -
cess (see Figure 1), an evidence-
based criteria that utilized existing
resources within the organization,
was implemented. Adopted from
a best practice described in a long-
term care setting in Illinois, the
criteria provided a framework for
nurses to use daily to assess the
need for continuing a Foley cath -
eter (Robinson et al., 2007). This
successful initiative, however,
relied on the usefulness of eight-
point criteria, physician support,
informatics collaboration, targeted
education, daily monitoring, and
dissemination of results through-
out the organization (see Table 1).
Question the Foley
To minimize the incidence of
hospital-acquired CAUTI, nurses
needed a way to evaluate which
Figure 1.
Question the Foley Criteria
Ask Daily if the Foley Catheter Is Being Used to:
1. Provide bladder irrigation and/or instill medication?
2. Provide relief from urinary tract obstruction not manageable
by other means?
3. Permit urine drainage in a patient with neurogenic bladder
dysfunction,
7. hydronephrosis, or urinary retention not manageable by other
means?
4. Obtain accurate intake and output in critically ill patients?
5. Aid in urologic surgery or other surgery in the contiguous
area (GYN or lower
GI surgery)?
6. Manage urinary issues or special purposes/circumstances
such as a difficult
insertion per the urologist?
7. Manage urinary incontinence in patients with Stage III or
Stage IV pressure
ulcers?
8. Provide comfort care in terminally ill or hospice patients?
If the patient meets NONE of the above criteria, the RN will
contact the physician
and discuss the possibility of catheter removal.
Table 1.
Tactics for CAUTI Reduction
Tactic Comments
Question the
Foley criteria
• Evidence based
• Daily assessment for Foley catheter need; done on the day
shift only
• Nurse pursues an order to discontinue Foley catheter if the
8. patient no longer meets the criteria
Physician
support
• Support from the chief medical officer crucial
• Physician champion helpful (e.g., chief of infectious diseases)
• Physician assisted with review of medical records
• Enforced process with fellow physicians
Informatics
collaboration
• Designed nursing documentation in electronic medical record
to include 8-point criteria
• Designed physician documentation and ordering to reflect the
criteria
• Created customized reports for tracking and monitoring
Targeted
education
• Created diverse education sessions for nurses and physicians
• Varied hours and shifts
• Case presentation, explanation of process and eight-point
criteria
Daily
monitoring
• One RN responsible only
• Track physician orders, insertions, use of criteria
• Report outliers and statistics
9. • Identify CAUTI from microbiology report
• Identify all staff involved in the care of a patient with CAUTI;
letters sent to all involved
urinary catheters should be con-
tinued and which ones were no
longer being used for a specific
purpose and should thus be dis-
continued. A long-term care cen-
ter in Illinois had tackled this
issue and, through its work with
implementing an evidence-based
practice, created criteria based on
the literature that would provide
nurses with situations to assess
whether a Foley catheter should
be continued (Robinson et al.,
2007). These criteria, evaluated for
NURSING ECONOMIC$/November-December 2015/Vol.
33/No. 6322
their applicability to the inpatient
setting of a community hospital,
addressed similar patient popula-
tions. White Plains Hospital’s
adaptation of the criteria was
called Question the Foley, and it
provided decision points for nurs-
es to use daily to assess whether
continuation of a Foley catheter
was appropriate (see Figure 1).
10. In addition to establishing the
eight-point criteria, the hospital
put into place an algorithm for
nurses to use for specific patient
circumstances. There is no auto-
matic stop order or discontinua-
tion of a urinary catheter without
a physician’s order. Therefore, the
daily assessment of Foley catheter
continuation was done on the day
shift to eliminate unnecessary
phone calls to physicians during
off-hours. Furthermore, if the
nurse was uncertain about the
need to continue a Foley catheter,
it allowed the nurse a chance to
either speak to the physician
directly during his or her rounds
or have a detailed conversation
with the physician by phone dur-
ing normal office hours. If a nurse
reviewed the criteria and the
patient was assessed as needing to
have the Foley catheter continued,
then the nurse would document
his or her assessment in the elec-
tronic medical record and remind
the physician to renew the order
daily. If a nurse reviewed the crite-
ria and the patient was assessed as
no longer requiring the Foley
catheter, the nurse would speak
directly to the physician and
secure an order to discontinue the
Foley catheter and monitor the
11. patient accordingly.
Physician Support
Physician support and com-
mitment were crucial to the suc-
cess of this initiative. A report was
created by the author for the chief
medical officer (CMO) highlight-
ing the incidence of hospital-
acquired CAUTI and the proposed
Question the Foley criteria. The
CMO approved the plan and
agreed to be a liaison between
nursing and the medical staff for
physicians who were not willing
to comply with the process.
Additionally, the section chief of
infectious diseases became aware
of the proposed initiative and vol-
unteered to be a physician cham-
pion. In this role, he would edu-
cate physicians about the need to
reduce hospital-acquired CAUTI,
and he would advertise the useful-
ness of the Question the Foley ini-
tiative. This physician also assist-
ed with reviewing medical re-
cords as needed.
Informatics Collaboration
White Plains Hospital con-
verted to an electronic medical
record (EMR), MEDITECH, in
12. 2006 and has maximized many of
the capabilities an EMR offers.
The chief nursing officer identi-
fied internal experts with profi-
ciency in the use and functionali-
ty of the MEDITECH system and
created two distinct roles to man-
age the informatics needs: the
clinical informaticist for nursing
and the clinical informaticist for
physician services. Each role is
designed to assist either nursing or
physicians with documentation,
data mining, and the generation of
customizable user reports. The
clinical informaticist for nursing
changed the nursing documenta-
tion and included the eight-point
Question the Foley criteria. A cus-
tomized report was created that
lists all patients with a Foley
catheter (room number, name, and
medical record number) along
with the date and time of the first
documentation by a nurse within
a 24-hour period. This report
would be invaluable for tracking
patients on a daily basis and
assessing compliance with the ini-
tiative.
The clinical informaticist for
physician services created two
orders for physicians for Foley
catheters: one for the initial inser-
tion of a Foley catheter and one for
13. an ongoing Foley catheter. Phy -
sicians were instructed to use the
insertion order for any new Foley
catheter placed. Once completed,
this order remains active for 48
hours before an electronic remind -
er message is generated to the
physician through the Physician
Desktop. If a physician and a
nurse concur the Foley catheter
should remain in place past 48
hours, then an ongoing continua-
tion order is given. An ongoing
order will generate an electronic
reminder message to the physi-
cian every 24 hours. The expecta-
tion, then, is the need for a Foley
catheter will be evaluated daily
past 48 hours of insertion and that
a daily reorder is required for each
day a Foley catheter remains in
place.
Targeted Education
Educating nurses and physi-
cians was required. In the past,
Foley catheters remained in place,
and the need to continue them
was not addressed on a daily
basis. The director of nursing
quality created diverse education
sessions for the nurses. Some ses-
sions were offered in large group
settings, such as the hospital audi-
14. torium, while others were done
with small groups of nurses on the
nursing units at staff meetings or
daily staff briefing sessions (“hud-
dles”). Huddles, for example,
were opportunities for the nurses
to identify patients with a Foley
catheter on the unit and review
one or two key strategies for
CAUTI reduction. In contrast, the
content of the larger education
session focused on the high inci-
dence of hospital-acquired CAUTI
and introduced the Question the
Foley criteria as a process change.
Case presentations were given to
demonstrate the process of assess-
ing a patient daily, and allowed
role playing of the conversation a
nurse might have with a physician
to pursue a maintenance or dis-
continuation order. These larger
education sessions were offered
on day, evening, and night shifts,
and incorporated the assistance of
clinical nurse specialists and staff
development educators. During a
323NURSING ECONOMIC$/November-December 2015/Vol.
33/No. 6
2-month period, over 400 nurses
(approximately 75% of the nurs-
ing staff) attended an educational
15. session.
Physician education proved to
be a challenge. White Plains Hos -
pi tal has more than 800 physi-
cians on staff, including a robust
hospitalist program, and reaching
key members was difficult. Phy -
sicians rely heavily on the hospi-
tal’s email system as their pre-
ferred method of communication,
so an email was generated by the
CMO to the physicians outlining
the Question the Foley initiative,
the reasons behind it, and what
was expected from the physicians.
A printed mailing was created and
distributed to all physicians
through a monthly mailing sent to
their homes or offices. Hospitalists
have their offices on-site, so in-ser-
vice education was created for
them and provided during lunch
hours or at their monthly staff
meetings. More than 90% of the
active hospitalist physicians were
educated about the Question the
Foley initiative.
Daily Monitoring
Monitoring the Question the
Foley initiative was left to the
director of nursing quality, who
was primarily accountable for sus-
taining the process. Each morning,
16. the director of nursing quality
generates the customized report
from the previous day of all
catheterized patients in the organ-
ization. Patients from the materni-
ty unit are excluded first, due to
standard orders that allow Foley
catheter discontinuation within
24 hours of delivery. Using a
checklist, the author identifies
and tracks which patients have
had a Foley catheter inserted or
have an ongoing catheter. Cath -
eterized patients on all other units
are reviewed daily, including five
medical-surgical units, an eight-
bed intensive care unit, an eight-
bed coronary care unit, and two
telemetry/critical care step-down
units. Through the EMR, the
director of nursing quality can
quickly scan the patient’s record
for an existing physician’s order
and review nursing documenta-
tion simultaneously. If a physician
order is missing, a log is main-
tained that is shared daily with
the CMO, the hospitalist program
directors, and the individual
nurse manager and assistant nurse
manager. If nursing documenta-
tion needs to be addressed, an
email is sent to the nurse manager
and assistant nurse manager, and
the nurse is counseled according-
17. ly. From this report, monthly
totals are tabulated, including
total patients, total catheter days,
average catheter dwell time per
unit, catheter utilization rates, and
total number of missing orders.
A concurrent report is gener-
ated daily from the microbiology
department that identifies all pos-
itive urine cultures, and it is sent
via email every morning to the
director of nursing quality. This
report is reviewed in collaboration
with the infection control preven-
tionist to confirm any suspected
hospital-acquired CAUTI. A thor-
ough chart audit follows to identi-
fy when and where the infection
was contracted. Each nurse in -
volved in the care of that patient
then receives a letter from the
director of nursing quality identi-
fying that a patient has contracted
a hospital-acquired CAUTI and
inviting the nurse to participate in
a root cause analysis of the events
surrounding the hospital-acquired
CAUTI. During the analysis, each
nurse is encouraged to identify
any barriers in or breaks to the
prevention initiative. Letters sent
to nurses, and the need to perform
analyses, have decreased over the
past 4 years.
18. Additional Measures
Other evidence-based prac-
tices have been identified as valu-
able in combating the incidence of
CAUTI since the introduction of
the Question the Foley initiative.
For example, the use of silver
alloy Foley catheters, implement-
ing the use of securement devices
to limit Foley catheter movement
after insertion, strict adherence to
proper drainage tube placement to
avoid touching contaminated sur-
faces, and incorporating the
removal of Foley catheters by day
1 or 2 for most postoperative
patients were additional strategies
that demonstrated efficacy in the
overall reduction of hospital-
acquired CAUTI (Trautner, 2010).
These measures were implement-
ed progressively between 2008
and 2011. The infection control
department and nursing division
developed a combined, ongoing
education plan for infection pre-
vention incorporating these strate-
gies in conjunction with the
Question the Foley initiative.
Results
Dramatic reduction in the
incidence of hospital-acquired
19. CAUTI occurred within the first
year of the Question the Foley ini-
tiative (see Figure 2). By 2009, the
total number of hospital-acquired
CAUTI decreased. Specifically,
the CAUTI rate decreased dramat-
ically from 4.9/1,000 catheter days
in 2008 to 3.9/1,000 catheter days
in 2009. Further, the rate contin-
ued to decrease from 2009 to the
first quarter of 2013 where the rate
was only 0.2/1,000 catheter days.
The number of catheter days also
decreased over the same time peri-
od, signifying a direct correlation
between catheter utilization and
CAUTI rates.
White Plains Hospital had a
surge in its annual inpatient cen-
sus since 2010; despite the
increased number of patients
catheterized per month, the time
Foley catheters remained in place,
or dwell time, decreased. In 2008,
Foley catheters remained in place
for an average of 5.6 days, and by
the end of 2009, that number
dropped to 3.7 days. No benchmark
was known to compare our dwell
time, but a goal was to mimic the
emerging data for postoperative
patients that catheters should be in
no longer than 48 hours. Since
2009, the average dwell times for all
20. NURSING ECONOMIC$/November-December 2015/Vol.
33/No. 6324
2008 2009 2010 2011 2012
Q1 & 2
2013
Total catheterized patients 5,561 4,174 3,995 3,904 3,022 2,256
Total catheter days 22,212 15,513 13,659 13,523 13,249 6,833
Average catheter dwell days 5.6 3.7 3.4 3.2 3.1 2.4
Total acquired CAUTI 110 56 13 11 5 2
CAUTI incidence rate 4.9% 3.7% 3.4% 3.2% 3.1% 0.30%
ability of the EMR, interdiscipli-
nary collaboration, and support
from nursing and physician ad -
ministration.
The Question the Foley crite-
ria satisfied the hospital’s need to
change practice on the basis of the
latest scientific evidence. The pro-
tocol is simple to compile and
implement, and it contains nor-
mal clinical situations not foreign
to nurses practicing in community
hospitals. The practice change
that followed was not difficult for
the nurses, and hardwiring the
change occurred within a short
21. amount of time. New nurses will
require time to become familiar
with the process, but skilled pre-
ceptors can be an asset for role-
modeling the behavior.
The EMR has multiple capa-
bilities, but the role of clinical and
technologic experts within the
organization who are accessible to
the nursing division and who
have time allotted to dedicate to
new projects is essential. The clin-
ical informaticists played a key
role in creating customized re -
ports, working through revisions
of those reports, and evaluating
ways to enhance those reports
during system upgrades. White
Plains Hospital, recently designat-
ed as a Magnet organization, creat-
ed a nursing informatics council,
which works closely with the clin-
ical informaticists to not only gain
expertise and knowledge of the
MEDITECH system, but also con-
tributes its clinical expertise when
new documentation or reports are
created. The clinical experts, as
the end users of the technology,
are in a key role to ensure adher-
ence to documentation. The com-
Figure 2.
Total Acquired CAUTI and Incidence Rate, 2008 to Quarter 2,
2013
23. 4.9%
3.7%
3.4% 3.2%
3.1% 0.3%
2008 2009 2010 2011 2012 Q1 & 2,
2013
Table 2.
Cost Savings Over Time for Implementing a Nurse-Driven
Process for CAUTI Reduction
2008 2009 2010 2011 2012 2013
Number of CAUTI cases 110 59 13 11 5 2
Treatment @ $1,200/case $132,000 $70,800 $15,600 $13,200
$6,000 $2,400
Savings compared to previous fiscal year $61,200 $55,200
$2,400 $7,200 $3,600
Cost with inflation adjusted (nurse salary to lead initiative)
$75,000 $77,625 $80,341 $83,152 $86,062
Cost savings $4,200 $62,025 $67,141 $77,152 $83,662
units, excluding the maternity unit,
has been sustained between 3.1 to
2.4 days. Further, the overall total
cost to the organization to treat
CAUTI decreased (see Table 2). For
example, using the current lowest
cost estimate (e.g., $1,200 per hospi-
24. tal-acquired CAUTI), costs to
treat hospital-acquired CAUTI de -
creased from $132,000 in 2008 to
$2,400 in the first quarter of 2013.
Additionally, for making one nurse
accountable for the success of the
quality monitoring process, there
was an overall cost savings and
return on investment to the organ-
ization of $83,662 (see Figure 3).
Results were printed in tables dis-
played on each nursing unit and
discussed during unit council
meetings. The results continue to
be formally presented to both the
hospital’s performance improve-
ment committee and the board of
trustees on a quarterly basis.
Recommendations for Nurse
Leaders
A nurse-driven system for
decreasing the number of hospi-
tal-acquired CAUTI is effective
and useful for a community hospi-
tal. One nurse with accountability
for implementing a simple evi-
dence-based protocol can dramat-
ically decrease the total incidence
of hospital-acquired CAUTI. The
basis for the success of this initia-
tive at White Plains Hospital
therefore relied heavily on the
ease of using the eight-point Ques -
25. tion the Foley criteria, the avail-
325NURSING ECONOMIC$/November-December 2015/Vol.
33/No. 6
bination of clinical experts with
technological experts helps expe-
dite projects to completion and
decreases turnaround time for
special requests.
Utilizing experts outside the
nursing division improves collab-
oration and communication across
disciplines. Having a physician
champion such as the section
chief of infectious disease and the
support of the CMO helped gain
support for the initiative among
the multiple physicians within
the organization. The infection
control preventionists were essen-
tial by identifying the presence of
infection, confirming which ones
were present on admission or
acquired during hospitalization,
and suggesting strategies for con-
tainment and treatment. The col-
laboration of nursing, medicine,
and infection control presented a
united force to physicians and
nurses alike and conveyed the
import of the project. Recognition
from the chief executive officer
26. and the chief nursing officer,
along with celebration of sus-
tained results, reinforced the
efforts of the bedside nurses and
physicians and fostered the col-
laboration and communication
between the disciplines.
A nurse leader with the ability
to critically analyze each clinical
scenario, make pertinent recom-
mendations, and demonstrate leader -
ship savvy to correct inconsisten-
cies can pioneer a similar project
and ensure success for a commu-
nity hospital. With collaboration
and support from nursing leader-
ship, the goals for patient safety by
re ducing hospital-ac quired CAUTI
can become a reality in a short
period of time. $
REFERENCES
Bruminhent, J., Keegan, M., Lakhani, A.,
Roberts, I., & Passalacqua, J. (2010).
Effectiveness of a simple intervention
for prevention of catheter-associated
urinary tract infections in a communi-
ty teaching hospital. American Jour -
nal of Infection Control, 38, 689-693.
Gokula, M., Smolen, D., Gaspar, P.M.,
Hensley, S.J., Benninghoff, M.C., &
Smith, M. (2012). Designing a proto-
27. col to reduce catheter-associated uri-
nary tract infections among hospital-
ized patients. American Journal of
Infection Control, 40(10), 1002-1004.
Hanchett, M. (2012). Preventing CAUTI: A
patient-centered approach. Preven -
tion, 43, 42-50.
Milstein, A. (2009). Ending extra payment
for “never events”: Stronger incen-
tives for patient safety. New England
Journal of Medicine, 360, 2388-2390.
Palmer, J.A., Lee, G.M., Dutta-Linn, M.,
Wroe, P., & Hartmann, C.W. (2013). In -
cluding catheter-associated urinary
tract infections in the 2008 CMS pay-
ment policy: A qualitative analysis.
Urologic Nursing, 33(1), 1-9.
Rebmann, T., & Greene, L.R. (2010). Pre -
venting catheter-associated urinary
tract infections: An executive summa-
ry of the Association for Professionals
in Infection Control and Epidemi -
ology, Inc., elimination guide. Ameri -
can Journal of Infection Control, 38,
644-646.
Robinson, S., Allen, L., Barnes, M.R., Berry,
T.A., Foster, T.A., Friedrich L. A., ...
Weitzel, T. (2007). Development of an
evidence-based protocol for reduction
of indwelling urinary catheter usage.
28. MEDSURG Nursing, 16(3), 157-161.
Trautner, B. (2010). Management of cath -
eter-associated urinary tract infection
(CAUTI). NIH Public Access, 23, 76-
82.
Wilson, M., Wilde, M., Webb, M.I, Thompson,
D., Parker, D., & Harwood, J. (2009).
Nursing interventions to reduce the
risk of catheter-associated urinary
tract infections: Part II. Staff educa-
tion, monitoring and care techniques.
Journal of Wound Ostomy & Conti -
nence Nursing, 36, 137-154.
Figure 3.
Return on Investment for Implementing a Nurse-Driven Process
for
CAUTI Reduction
$140,000
$120,000
$100,000
$80,000
$60,000
$40,000
$20,000
30. to lead initiative)
Number of CAUTI Cases
Savings Compared to Previous Fiscal Year
Cost Savings
Copyright of Nursing Economic$ is the property of Jannetti
Publications, Inc. and its content
may not be copied or emailed to multiple sites or posted to a
listserv without the copyright
holder's express written permission. However, users may print,
download, or email articles for
individual use.