How One Institution Used Evidence-Based Practice to Reduce CAUTIs
Catheter-associated urinary tract infections (CAUTIs) are associated with significant morbidity and mortality (https://www.cdc.gov/hai/surveillance/index.html), with an estimated 93,300 urinary tract infections (UTIs) and 13,000 UTI-related deaths occurring each year in acute care hospitals. A preventable cause of UTIs is the use of long-term indwelling urinary catheters, an ideal focus of evidence-based practice (EBP) initiatives.
A team of nurses at Loma Linda University Medical Center in California published a report (https://doi.org/10.1188/17.CJON.460-465) of an EBP project to decrease the incidence of CAUTIs in an oncology population. Carol Nielsen, BSN, PHN, RN, OCN®, and Charis McCoy, MSN, FNP-BC, APRN, discussed their project and the factors that led to their success: particularly the importance of a team-based approach to EBP and the need for evidence in making practice changes.
A Team-Based Approach
McCoy and Nielsen explained that the CAUTI project was conducted by a unit-based research team of staff on a medical-surgical acute care oncology unit. Although they had internal support from the director of nursing research, administration, and physicians, local involvement from the team was crucial. This enabled proposed changes to come from colleagues, not from administration, and for the team to be involved in identifying the evidence. The team members could ask and answer the important question, “Is our practice the best it can be?” An unintended benefit of the project, according to McCoy, was that having more nurses involved in the EBP project created a ripple effect that brought the knowledge of EBP to more bedside nurses who feel empowered to use best-care practices for their patients.
Incorporating the Evidence
The staff followed the Johns Hopkins review process (https://www.hopkinsmedicine.org/evidence-based-practice/ijhn_2017_ebp.html) to identify the quality and level of relevant evidence. Reviewing the literature was time-consuming but illuminating, according to Nielsen, and using Hopkins’ standard process was essential and helped the staff overcome initial overwhelming thoughts about reviewing such a large body of literature. To ensure staff buy-in on the project, the staff reviewed and leveled approximately 60 articles as a group. McCoy also noted the benefit of exposing all staff to the evidence: “It’s hard to argue with the evidence.”
The group did not start out envisioning where it could eventually go, how big of a project it would grow to be, and the positive impact it would have on patient care. Rather, they wanted to make a difference for their patients. As McCoy learned, “Nurse-led change is the most sustainable and impactful way to improve the care we provide to our patients. I would encourage other nurses to not be intimidated by the literature.”