It’s a little funny, and maybe a little uncomfortable to think about, but it’s also darn near unforgettable. Lisa Hopp’s nursing students were looking for a way to remind fellow nurses to remove foley catheters as soon as possible, and “Holy Moly, Remove the Foley,” was born.
But the project was much more than an opportunity to be creative. Hopp, an associate professor of nursing at Purdue Calumet, was awarded an RCHE seed grant to research a method of improving catheter-associated urinary tract infections (CAUTI). Over the course of the project, Hopp, her students, and her hospital partner, St. Mary’s Medical Center in Hobart, IN, showed that reductions in infection rates and improvements in behaviors can be both successful and sustainable.
CAUTIs are often considered a potentially preventable healthcare-associated infection and they have been targeted by the government as a priority for reduction. Between 15 and 25 percent of patients who have inpatient surgery will require a urinary catheter during their hospital stay. Research shows that bacteria increase between three and 10 percent for each day the catheter dwells in the patient. Urinary tract infections are the most common infection, resulting in increased morbidity, mortality, length of stay, and cost.
Hopp focused on implementing existing evidence-based guidelines for using foley catheters. The guidelines included rigorous documentation of the date of catheter insertion, emptying the bag when it was two-thirds full, maintaining the bag below the level of the bladder, and removing the catheter as soon as practicable post-operatively.
The study involved the front-line nurses at every step, including brainstorming remedies to barriers and getting feedback on the need for new devices and ways to adhere to the evidence-based care. Nurses identified a new device to secure catheters that also contributed to improved CAUTI rates. Analysis and feedback sessions allowed the nurses and the research team to discuss results, barriers, and opportunities for improvement.
The results are in
Before the study, the unit had a CAUTI rate of 5.9 infections per 1,000 catheter days. In the first six months of the study, the infection rate decreased to 2.8 infections per 1,000 catheter days, and adherence to the evidence-based guidelines improved by between six and 49 percent. In fact, in the second six months, because the infection rates had become so infrequent, the hospital was able to shift its focus away from CAUTI surveillance.
Hopp attributes the project’s success to the well-researched methods chosen for engaging the nurses. Passive ways of informing nurses about what the evidence says, though common, she says, don’t work. People don’t feel engaged; they don’t own the problem or the solution. Instead, Hopp’s team encouraged the nurses to participate in brainstorming and feedback sessions, and hospital staff followed up on their ideas.
“By involving nursing students, we have also created a new generation of nurses who know about evidence-based guidelines and the role of research, and are interested in using both,” Hopp and her fellow faculty member, Beth Votterro, say. During the study, three undergraduate and three graduate nursing students worked with Hopp and the St. Mary’s team. “As a student participating in this study it was a great opportunity to see the evidence-based practice approach at work. This helped to confirm my confidence in the choice that I made to become a clinical nurse specialist. It also inspired me to see that changes can occur within an organization if there is evidence to support the changes. There is satisfaction in knowing that quality care based on evidenced-based practice does make a difference!” said graduate student Jennifer Ewing.
With its CAUTI rate under control, St. Mary’s is now considering applying the methods used in Hopp’s study to other priority areas.
The study was funded by a seed grant from the Regenstrief Center for Healthcare Engineering. In addition to Lisa Hopp, other participants who were instrumental to the success of the project include Beth Vottero and Susan Scachitti, both collaborating faculty in the Indiana Center for Evidence-Based Nursing Practice; students Jennifer Ewing, Doreen Zokvic, Connie Adams, Ruthshun Lumpkins, Eloisa Perez, and Christi Selby; and Debbie Krejci, Tammie Finn, and managers and staff of the St. Mary’s Medical Center inpatient units.
Translating research, transforming care
Join your global companions in moving evidence into action! Purdue University Calumet School of Nursing and the Indiana Center for Evidence-Based Nursing Practice, a Joanna Briggs Institute Collaborating Center are proud to invite you to the 7th Biennial Joanna Briggs International Colloquium “Knowledge to Action: The Next Generation of Evidence Based Practice”.
The 2010 colloquium will bring together over 500 clinicians, researchers and systematic reviewers, evidence-based guideline developers, educators, policy-makers, administrators and consumers from across the world. In a word, these are professionals who want to improve global health by making evidence actionable. This is a chance to network, learn and contribute to an integrated approach to improving global health care by turning evidence into action. There will be a mixture of internationally recognized plenary papers, concurrent scientific sessions, symposia, industry exhibits and social and professional networking events.
The Joanna Briggs Institute is the premier international organization promoting all aspects of evidence-based healthcare through evidence generation, synthesis, transfer and implementation. The colloquium represents all aspects of moving knowledge into action. Since this is the first time the event has been hosted in North America, American nurses, physicians, and other healthcare providers will have an unprecedented opportunity to participate in this global event.
The “knowledge to action” themes include shaping policy to speed knowledge use, implementation science and models, engaging the media to move evidence to consumers, education and leadership, and enhancing safety and quality with evidence. The colloquium offers something for all levels of expertise in evidence-based practice.
Knowledge to Action: The Next Generation of Evidence-Based Practice
September 13-15, 2010
Chicago Sheraton Hotel
For more information:
Or contact Dr. Lisa Hopp at firstname.lastname@example.org
Closing the loop — creating positive change in the healthcare system through one’s research — is no longer just a noble goal. Those reviewing funding applications will notice that implementation and impact have become increasingly common and required parts of the applications. Understanding how and why this came to be, as well as how to create the researcher-provider partnerships that enable this impact, was the topic of RCHE’s spring 2010 conference.
Impact and integration
“Uncle Sam wants ROI,” Dave Zook told conference attendees. Zook, of Washington firm Baker & Daniels, has seen the university funding landscape change in Washington. Zook recalled former NIH director Elias Zerhouni once struggling for examples of how research had completed the pipeline and led to healthcare improvements. The result was initiatives like the NIH roadmap, increased emphasis on translational research, and a more robust system to track return on investment. Recently, feedback systems set up in the stimulus bill, America Competes, and health information technology research all emphasize the importance of research translation and impact on the healthcare system, he said.
Increased integration will continue to be critical. The recent health reform bill mandates inter-agency dissemination and cooperation to reduce redundancies. Research institutions are also expected to network. “This is the notion that one research institution probably can’t find all of the necessary ingredients for the best outcome,” he said.
Researchers partnering with providers is essential in creating solutions that are both proven and practical. Jim Benneyan, professor of industrial engineering at Northeastern University, discussed a program where engineers were embedded in medical centers, providing them with a stronger understanding of the organization’s issues, workflow, and processes. Gaining this understanding of the context is essential to current researchers and also to students considering this field, he said.
In developing the SmartPump Informatics system with the Indianapolis Coalition for Patient Safety (ICPS), Ann Christine Catlin visited Dan Degnan at Community Health Network many times. “Scientists, engineers, pharmacists … everybody has their own language,” she said. “We can’t help them unless we understand their problem and their world.”
Catlin created an interactive system for pharmacists to review and learn from data being generated by infusion pumps. As the project expands, the partnership continues to provide Catlin with ideas for refinements. Working through the ICPS also allowed Catlin to work with multiple hospitals. “The main agreement of being part of the ICPS is that the CEO has to agree that you will never compete on safety,” Degnan explained. This created an environment conducive to sharing information and developing more comprehensive solutions.
While this environment may be relatively unique, the ability to conduct research with multiple providers and multiple settings is important. Aside from provider and hospital differences, community differences also change the way a given intervention may work. “Some things, for example, were great at Mayo, but can they be done in the local community? Are they going to work in those settings?” Zook said.
Putting it out there
Best practices in research continue to be developed, but there is a need for best practices in dissemination, Benneyan said. “No one owns dissemination.” Researchers, providers, and partnerships with professional organizations can all help turn research results into practice improvements. And the government and funding agencies are looking to researchers and centers to direct some of the strategic dissemination, said Zook. Beyond publishing in journals, it is the ability to drive innovation across providers and organizations.