Date of Graduation

Fall 12-14-2018

Document Type

Project

Degree Name

Doctor of Nursing Practice (DNP)

College/School

School of Nursing and Health Professions

Program

Executive Leader DNP

First Advisor

Elena A. Capella, EdD, MSN/MPA, CNL, CPHQ, LNCC

Second Advisor

Juli Maxworthy, DNP, MSN, MBA, RN, CNL, CPHQ, CPPS, CHSE, FSSH

Abstract

Problem Description: Hospitals compromise quality care and the health of its patients by subjecting the patients to risks that are preventable, such as nosocomial infections (IOM, 1999). The most preventable infection is a catheter-associated urinary tract infection (CAUTI) (Tenke, Meizei, Bode, and Koves, 2016). CAUTIs remain prevalent in the acute care setting (CDC, 2016).

Context: Prior to the implementation of this DNP project, the organization of focus did not have a nurse-driven protocol in place to guide urinary catheter management. Joint Commission mock surveyors recommended a protocol be implemented. A nurse-based protocol would benefit this Magnet hospital. Implementing such a protocol also empowers the nursing staff.

Interventions: In January 2018, the Magnet hospital implemented a nurse-driven protocol for urinary catheter management. The protocol provided nurses with the decision support for assessment and discontinuation of indwelling urinary catheters. Implementation also included in-services.

Outcome Measures: Outcome measures comprised of pre- and post-CAUTI data. Outcome measures were the CAUTI National Healthcare Safety Network (NHSN) Standardized Infection Ratio (SIR), the number of CAUTIs per 1,000 catheter days, and the number of indwelling urinary catheter days.

Results: Implementing this protocol resulted in a 2.6% decrease of indwelling urinary catheter days. The aim of decreasing indwelling urinary catheter days by 1% within three months of project implementation was achieved. The goal of reducing the SIR to ≤ 1 was not met. Lastly, 97.6% of nurses reported the in-service and nurse-driven protocol for urinary catheter management gave empowerment to their practice.

Conclusion: This DNP project did have a reduction in indwelling urinary catheter days. However, catheter utilization, and the NHSN’s SIR rate did not improve. This project is the beginning of improving this quality metric to ensure safe, evidence-based care for patients. Future implications for the advanced practice nurse (APN) include incorporating innovation to continue this project using another PDSA cycle.

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