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:
http://www.joannabriggs.edu.au/events/2010Chicago/index.php or contact Dr. Lisa Hopp at firstname.lastname@example.org
Implementation, impact, and return on investment
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.
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.
Graduate student earns educational technology award
Lisette Reyes, a graduate student working with the Health Informatics and Learning Technologies center, won the DeBruicker Graduate Award in Educational Technology. The award is given annually based on performance in the completion and reporting of basic and applied research projects.
Faculty recognized for discipline strength, outstanding mentorship
Yuehwern Yih, professor of industrial engineering, was named a Fellow of the Institute of Industrial Engineers (IIE).
Joseph Thomas III, professor of pharmacy practice, recieved the Provost’s Award for Outstanding Faculty Mentors.
Same e-mail, new signature: Meet RCHE’s program coordinator
It’s the same e-mail but a different signature. Mary Schultz is now RCHE’s Program Coordinator. She continues to assist the center in scheduling and events, and coordinating DURI students and technology needs; however, her new title better represents her role in assisting with project coordination.
I-HITEC program to bring EHRs to 2,200 Indiana providers
Two years from now, Indiana’s Health Information Technology Extension Center (I-HITEC), led by Purdue’s HealthcareTAP with support from Engagement and RCHE, will have assisted 2,200 Indiana providers in adopting and using electronic health records. The program is funded by a $12 million grant from the Office of the National Coordinator.
In 2004, President Bush set a goal of having most Americans using electronic health records by 2014. Five years later, as part of theAmerican Recovery and Reinvestment Act, the 2014 date became a mandate. Initially, providers using electronic records, which typically include e-prescribing, would receive reimbursement incentives. By 2014, the incentives would be replaced by penalties for those who did not use electronic records.
The I-HITEC center was funded to help Indiana providers transition to electronic records. The center is focusing on priority provider groups — primary care practices with fewer than 10 providers, public or critical access hospitals, and providers serving the un- or underinsured, underserved, or at-risk populations. Center staff will identify and recommend electronic health record software that meets federal standards for a certified EHR. They will also help providers get the software up and running.
I-HITEC is a milestone-based program, meaning that there are several milestones providers need to hit for the adoption to be considered successful. The first milestone is signing a technical assistance agreement. The second is being able to document that providers are ‘live’ on a certified electronic health record and have active quality reporting and electronic prescribing. The final milestone is meeting the meaningful use criteria established by the Secretary of Health & Human Services.
Meaningful use criteria are still being finalized. “Meaningful use says that it’s not enough to just have an EHR or to even to use it. You must show that you are using it in a way that improves the health outcomes of your patients,” says Steve Witz, director of RCHE.
Indiana Healthcare IT Extension Center (I-HITEC)
Vision: The promise of EHR will be realized in the State of Indiana
Mission: To assist the Indiana healthcare community in realizing the promise of EHR by facilitating EHR adoption and use.
Testing criticisms and controversies
Hospital supply chains are very different from consumer products, which is what makes them so interesting to Leroy B. Schwarz, professor in the Krannert School of Management. “The most unusual thing about them is the role played by GPOs (group purchasing organizations),” he says. In procuring supplies, hospitals can negotiate directly with the manufacturer, negotiate as a group of hospitals, or work through a group purchasing organization, which negotiates with manufacturers on behalf of its members. Because they represent many hospitals, GPOs say they can negotiate lower prices than a hospital negotiating alone.
But the purchasing power comes with its own share of criticisms, he says. GPOs charge manufacturers a contract administration fee, which is capped by the Social Security Act at three percent of the cost of all of the manufacturer’s sales on contract. “Since a GPO is supposed to negotiate the lowest possible price for its members, there is a conflict of interest; e.g. the lower the price a GPO negotiates, the lower the contract administration fee it receives,” says Schwarz. This fee is very controversial, he says. A second criticism is that manufacturers say that since the fees increase their cost of doing business, everyone pays more for their products, whether they use a GPO or not. The final criticism is that some believe that GPOs hinder innovation. “If a GPO has a contract for some product and a new company develops a competitive product, then the new company, in order to sell its products, first has to sell the GPO. However, if the GPO already has a contract with the competition, then it will be less interested in the new company,” Schwarz says.
Schwarz had heard the criticisms of group purchasing organizations, and developed a project to determine if they were true. Using mathematical models and running various purchasing scenarios, Schwarz and his colleagues determined that some of the criticisms are valid. GPOs do reduce the incentive to innovate by reducing the premium for a new, competing product. However, they’re still beneficial to the overall healthcare supply chain in terms of cost, he says.
“They reduce overall costs and increase competition, even for hospitals that don’t use them, because they put pressure on the manufacturer to lower prices.” Other research has shown that GPOs are not unequivocally the lowest price and that direct negotiations with the manufacturer can sometimes yield lower prices. Hospitals using GPOs typically report lower internal administrative costs.
Schwarz hopes that the results can help hospitals evaluate purchasing options. “Many hospitals believe they are getting the lowest prices when they buy through a GPO, but they could, on a case-by-case basis, be better off buying direct,” he says. The research team is looking at other questions related to GPOs, including how the size of the hospital or provider group affects the level of benefit they derive from using a GPO.
The project was funded by a seed grant from the Regenstrief Center for Healthcare Engineering.
Research with Dyads and Families: Challenges and Solutions in Working with Independent Data
Sponsored by Purdue’s Center for Families
May 18-19, 2010 at Purdue University
Event preview: RCHE in Fall 2010
Coffee & Collaboration Meetings
First Monday of each month, beginning in September
Hear first about RCHE focus areas for funding, project opportunities, and insights from RCHE partners.
Faculty “Welcome Back” Breakfast
August 30, 2010, 8:00 a.m., Mann Hall, Room 203
A great way to greet the new year and new colleagues! Join new and returning faculty from around Purdue for this networking opportunity.
Student Ambassador Call-Out Dinner
August 31, 2010, 5:00 p.m., Mann Hall, Room 203
RCHE student ambassadors host guest speakers, assist with center events and activities, and serve as representatives of RCHE and Discovery Park. The interaction with guests and faculty provides an excellent opportunity for student interested in healthcare to learn about key issues and begin to network. Contact Mary Schultz, email@example.com for more information.
Fall 2010 Conference
September 28, 2010, location TBD
RCHE Recognition Breakfast
November 15, 2010, location TBD