1. Research Critiques and PICOT Statement.
Research Critiques and PICOT Statement. Research critiques and PICOT statementPICOT
statementThe PICOT statement is presented that: “For hospitalized adult patients (P), does
use of the CAUTI Bundle/Guide (I) compared with CAUTI without the use of Bundle/Guide
(C) reduce the rate of CAUTI (O) within 180 days of process improvement implementation
(T)?”ORDER A PLAGIARISM-FREE PAPER HERE Proposed evidence-based practice
changeThe high incidence ofcatheter-associated urinary tract infection (CAUTI)among
inpatients is a source of concern for any medical facility. That is because it not only has a
negative effect on care outcomes, but it also increases care costs. Perhaps the most
distressing aspect of CAUTI is their avoidable nature that can be realized through deliberate
actions. In particular, favorable results can be realized through CAUTI bundles and guides
that synthesize the most current evidence to direct catheter use among hospitalized
patients. It is undeniable that CAUTI is a source of concern in inpatient care settings,
particularly for long-term care units. That is because indwelling urinary catheters are
common invasive medical devices used in both non-acute and acute care settings. Despite
the need for these catheters within care setting, it cannot be overlooked that they are a
source of infection. It is this awareness that has necessitated the presentation of
comprehensive CAUTI care bundles that use converging strategies to improve hygiene
levels and reduce CAUTI rate. As a result, the PICOT statement was presented that: “For
hospitalized adult patients (P), does use of the CAUTI Bundle/Guide (I) compared with
CAUTI without the use of Bundle/Guide (C) reduce the rate of CAUTI (O) within 180 days of
process improvement implementation (T)?” This statement acknowledges that although
CAUTI care bundles can reduce the incidence of infections associated with indwelling
catheters use, their effectiveness is influenced by the presence and use of established
evidence-based guides. In essence, catheters are an important medical tool that medical
facilities cannot do without, especially in the inpatient care setting. However, there is a
concern that although using catheters is necessary, it is accompanied by risks that include
urinary tract infection. Given that inpatient care settings cannot function without catheters,
then it is proposed that using bundles and guides that deliberately target CAUTI would be
instrumental in producing favorable care outcomes. Krein et al. (2013) supports these
sentiments by noting that catheter use is expected to remain high among inpatients unless
an alternative medical device that could serve the same function is presented. This means
that since catheter use is expected to remain high, then there is a need to ensure that they
are not accompanied by any unintended negative effects. Oman et al. (2012) similarly notes
2. that catheter use is linked to unintended infection incidences that can be significantly
reduced through nurse-led interventions. The present paper explores the contributions that
Oman et al. (2012) and Krein et al. (2013) make towards understanding the research topic
and PICOT statement Research Critiques and PICOT Statement.Research
critiquesQualitative StudyBackground of studyKrein et al. (2013) acknowledges that
catheters are necessary in inpatient care settings. However, it adds that their use is
responsible for avoidable CAUTI incidences. The major concern is that 10% of inpatients
report contracting hospital acquired infection with CAUTI significantly adding to that
number. Based on this awareness, it is only logical that medical facilities should develop
strategies for reducing CAUTI incidence since their primary concern is to improve care
outcomes. In addition, the article mentions that halting unnecessary use of catheters would
significantly reduce the infection rate by eliminating opportunities for infection. Also, it led
to the development of bladder bundles that amalgamate the best evidence to guide catheter
use. Besides that, it notes that although bundles have been applied to reduce catheter use by
30%, there are opportunities that can be leveraged to present better results (Krein et al.,
2013). As a result, the study sought to identify the specific barriers to the bundles use with
the intention of improving their use to reduce CAUTI incidence.Method of studyKrein et al.
(2013) applied a qualitative research methodology to evaluate the factors influencing the
successes and failures in applying Bladder Bundle. The study was conducted from May 2009
to February 2011. It first applied purposive sampling to recruit participants from 3
hospitals. The inclusion criteria was the use of Bladder Bundle. The participants were
subjected to semi-structured phone interviews that evaluated their perceptions concerning
the bundle, particularly its facilitators and hindrances. In addition, data was collected
through observing the bundle in use. All the interviews and observations were transcribed
as primary data. Once the primary data was collected, it was subjected to thematic analysis
that noted how the application of the bundles in each one of the three facilities influenced
infection incidences (Krein et al., 2013). Using a qualitative research methodology ensured
that the study collected the required primary data that allowed it to examine the prevailing
themes.Results of studyKrein et al. (2013) identified two themes from the collected data.
Firstly, the bundle application was either supervised by an infection preventionist or a care
team. Secondly, bundle implementation faced unique barriers to include difficulty with
engaging nurses and physicians, patients and their families presenting preferences that are
contrary to the bundle, and unclear role of the emergency department with regards to
catheter insertion. The results further noted that although there was evidence to support
the use of these bundles since they produced the desired outcomes, nurses and physicians
were generally unwilling to buy into the bundle use. Also, it mentioned that some patients
and their families insisted on the bundle being used despite contrary advice presented by
the bundle and even refusing to accept a replacement. Besides that, the study noted that an
unclear role of the emergency department with regards to catheter insertion, the
participants noted that the emergency department personnel were under the false
perception that every patient getting into the department would require a catheter before
being transferred to other departments (Krein et al., 2013).Ethical considerationsKrein et
al. (2013) mentions that ethical approval was sought for the study. The approval was sought
3. and received from institution review boards of the University of Michigan, VA Ann Arbor
Healthcare Systems, and the hospitals that participated in the study. This is an indication
that the researchers has placed ample measures in place to ensure that the participants
were protected from intentional or incidental harm. Although there is not mention about
whether or not the participants sighed an informed consent before inclusion in the study,
the fact that the study received approval to proceed from the institutional review board is
an indication that the participants were well protected and informed consent could have
been receive even if not mentioned (Krein et al., 2013). In this respect, it can be assumed
that the participants were protected during the course of the study.Quantitative
StudyBackground of studyOman et al. (2012) mentions that CAUTI incidences are common
among hospital patients, and they have serious consequences to include both the cost and
associated morbidity. This is a concern since 25% of inpatients use catheters and 10% of
them report CAUTI incidences. It further mentions that despite the presence of guidelines to
reduce CAUTI incidence, their inconsistent application has reduced their effectiveness. To
address this concern, the study proposes that nursing personnel can take on a leadership
position in directing the guidelines application thus being responsible for consistent
application. The underlying intention is to identify the value of nurse-directed interventions
in reducing CAUTI (Oman et al., 2012). In this respect, the study explores the contributions
that nursing personnel can make to reduce central line-associated bloodstream infection
(CLABSI) incidence when they direct interventions as leaders.Method of studyOman et al.
(2012) applies a quantitative research approach that entailed collecting numerical data that
would then be subjected to analysis to determine the strength of relationships between the
variables and the significance of that relationship. The study applies a pre-post intervention
design to evaluate the effects of evidence-based nurse-led interventions as quality
improvement approaches. The participants were recruited from among patients and
multidisciplinary care teams in two medical/surgical units within the same facility. The
study protocol was applied in three phases. The first phase was conducted over three
months and it entailed collecting baseline data from the two units. The second phase
involved applying house-wide intervention that entailed integrating the efforts of nursing
personnel, patients and family members to apply evidence-based practice in reducing
CAUTI incidence among hospitalized patients to be accompanied by data collection. The
final phase involved applying focused intervention that included educational sessions,
competency training and journal clubs to be accompanied by data collection. Data collection
focused on demographic data (age, gender, surgical procedure and length of stay in the
hospital), CAUTI rates (number of infections for every 1,000 catheter days for the
participating patients), IUC duration, and bladder scanner log. The collected data was
subjected to statistical analysis that presented the appropriate descriptive statistics and
student t-test with the confidence interval set at 95% (Oman et al., 2012). The study
methodology is appropriate since it collected numerical data that facilitated direct
comparisons thus presenting the statistical significance of the relationship between the
study variables.Results of study219 patients were recruited in the first phase. 238 patients
were recruited in the second phase. 238 patients were recruited in the third phase. Of the
947 medical personnel who attended the health stream module,96% of them completed the
4. module. An evaluation of catheter duration over the three phases showed a reduction for
both the pulmonary unit (p=0.076) and general surgery unit (p=0.018) with an average
decrease from 400 days to 305 days. CAUTI incidence was maintained at 0.0 in the
pulmonary unit but it increased for the surgical unit from 1.9 in phase one to 3.4 in phase
two before settling at 2.2 in phase three. Length of stay in the pulmonary unit progressively
decreased from 7.39 in phase one, to 7.21 in phase two before settling at 6.72 in phase
three. For the surgical unit, the length of stay initially increased from 6.91 in phase one to
8.03 in phase two before reducing to 6.55 in the phase three. The study determined that the
program allowed the facility to save $52,000 every year. Although the study did not produce
definite results for changes in CAUTI rates, a reduction in catheter-days was achieved to
imply that nurse-led interventions can improve nursing care outcomes (Oman et al.,
2012).Ethical considerationsThe study was exempted from ethical oversight by the
institutional review board. That is because it focused on improving quality while not
exposing the participants to any harm. Given that it used medical records as a primary
source of information, there was an assurance of the patient data being kept confidential
and stored in password-protected locations. Also, information that could identify the
participants was not included in the study thus ensuring that they remained anonymous as
required by the law. The project was financially supported by a quality improvement small
grant from the University of Colorado Hospital and the University of Colorado Denver
School of Medicine thus showing that there was no conflict of interest that could unduly
influence the results (Oman et al., 2012).ConclusionOne must accept that CAUTI incidences
among inpatients is a source of concern, particular because they negatively affect care
outcomes and increase care costs. In addition, one must acknowledge that CAUTI bundles
and guides offer a solution for reducing incidence. Krein et al. (2013) supports these
sentiments when noting that budnles and guides significantly reduce incidences. Oman et al.
(2012) similarly supports the use of CAUTI bundles and guides by mentioning that although
there do not affect rates, they reduce catheter days thus diminishing the risk of CAUTI
incidence. In this respect, there is a concession that the use of CAUTI bundles and guides
reduce the rate of CAUTI.
