My proposed evidence.docx - My proposed evidence-based...

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My proposed evidence-based practice change (EBP) is to implement Chlorhexidine gluconate (CHG) bathing once a shift for any patient with a foley catheter in place on the adult medical-surgical unit. The reason for this change would attempt to decrease the incidence of catheter associated urinary tract infections (CAUTI). Currently the unit I work on follows a protocol of every other day bathing with soap and water to all the patients on the unit, even if the patient has a foley catheter or central line. Since the hospital is a small rural facility, the number of patients on the medical- surgical unit is generally small, but even so the facility has a high number of catheter -associated urinary tract infection cases. Some patients that arrive on the unit already come in with a foley due to various reasons or have a foley catheter placed during hospitalization. A variety of the adult patients on the unit end up staying for more than just a couple of days and continue with the foley catheter in place and only receive every other day soap and water bathing. Research suggests that daily CHG bathing has been proven to reduce the incidence of hospital acquired infections such as CAUTI’s as opposed to simple daily soap and water bathing (Pallotto et al., 2018). Current practice on the unit shows that only the patients going for a surgical procedure receive the CHG bath as part of the pre-operative work up. The major stakeholders in my EBP change would be the patients involved in the CHG bathing, physicians caring for the patients, as well as the unit director, hospital chief nursing officer, and chief financial officer . The unit director, chief nursing officer and chief financial officer would need to approve the increased amount of CHG wipes allowed in supply closet to facilitate the increased need for CHG bathing. The anticipated barriers for this EBP change is the nursing and nursing assistant resistance to change as it implies more duties during the shift due to increased bathing/wipe down with CHG wipes, needing both nurse and nursing assistant present at bedside during bath, as well as both signing off on CHG bath book. Since CHG bathing takes into consideration more workload and time than just a basic soap and water bathing , other barriers could include patient hypersensitivity, staffing issues, clinical stability, patient refusal of bath, facility and organizational factors such as availability of CHG soap and/or wipes, actual implementation of the CHG policy, and support from nursing director to remind the use of CHG bathing on patients with foley catheters (Musuuza et al., 2017). The abovementioned barriers could be overcome by having adequate education for nursing unit staff, support from physicians to implement more strict guidelines on when foley catheters should or shouldn’t be placed, support from administration to implement practice changes as well as provide adequate staffing ratios and CHG wipes/soap supply.

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