C301 Task #1 Nursing Practice Change.pdf - Translational...

Translational Research for Practice and Populations
Nursing Practice Change
Task 1
Melanie Troxell, BA, RN-BC
Western Governors University November 4, 2018
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Translational Research for Practice and Populations
Current Nursing Practice
A current nursing practice within many acute care medical facilities that really needs to change is
that urine is often allowed to lie, static, in the catheter tubing, including the common presence of
a “dependent loop” in the tubing of a patient urinary catheter. While the policy of most hospitals,
accordance with CDC recommendations (CDC, 2017, p. 13) demands that, among other
precautions, the drainage tubing of a catheter be placed at a continuously downward angle, above
the level of the floor, but below the level of the patient’s bladder, it is frequently still the case that
foley tubing looped or curved in ways that allow urine to remain static, a form of flow
obstruction, in the tube for indeterminate lengths of time.
This author recently visited a 180 bed acute care hospital in the Southeastern United States
during a period of a one day shift. With permission from the charge nurses, she conducted an
inquiry into the nineteen patients with current, temporary, indwelling urinary catheters in eight
ICU and medical-surgical units. One patient was counted out for the purposes of the following
percentages because it was a chronic urinary catheter, placed outside of the facility under
discussion.* Only six of the eighteen catheters, 33%, were positioned safely, according to
hospital policy, with the tube free of dependent loops and at an ever downward angle away from
the patients’ bodies. The remaining twelve catheters, 66%, were on a spectrum of misplacement,
with dependent loops in most, and some with the catheter higher than the level of the bladder.
* Interestingly, it was about 14 inches shorter than the ones under consideration and was in the correct position. On
further research, it was likely a Brandi catheter, sold by McKesson Medical Surgical, which is a 48” long, one
piece tube. (Urinary Drain Bag, n.d.)
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Translational Research for Practice and Populations
Why Change?
Anytime change is contemplated, the pros and cons, the cost for remaining and the cost for
change, must be evaluated. In Guideline for Prevention of Catheter-Associated Urinary Tract
Infections (CAUTI), The Centers for Disease Control and Prevention (CDC) recommends that
“Proper Techniques for Urinary Catheter Maintenance” include that maintaining a downward
flow of urine, ever away from the bladder, is a premiere concern when seeking to prevent urinary
system infections in all patients. (CDC, 2017, p. 13) But just because something is recommended
doesn’t always meant that it’s better or necessary. What is the cost of not doing everything
possible to prevent CAUTIs? There is a heavy cost for patients. Anything that puts the life,
health or safety of our patients at risk should be avoided as much as possible. It is believed that
hospital acquired infections (HAI) cost healthcare institutions $45,000,000,000 and cause