evidence-based practice, a patient with a catheter is more likely to have an infection than a patient with a permanent access. The company has a committee that is made up of clinical managers and educators that closely monitor the percentage of patients on dialysis with a catheter instead of a permanent access. This committee works with the vascular access center as well as the patients to help ensure the patient has the proper appointments set up in a timely manner after starting dialysis for their vein mapping, which is the first step in the patient getting a permanent access. Evidence-based practice has shown us that the faster a patient is able to get their permanent access, the less likely they are to receive a life-threatening infection from the catheter. The clinic’s goal is to have all patients in the clinic with a permanent access within a year of starting dialysis. The company also has three nurse educators in this local area that are experts in dialysis. They chair committees in the organization such as the vascular access
NURSE LEADER 7 committee, and the CAUTI committee. Both of these are areas that are very important to the dialysis patient as their access is their lifeline. Each of these committees’ review evidence-based practice to improve processes of the clinic. A change in catheter care was recently implemented based on evidence-based practice research that has shown a decrease in catheter infection rates. (T.Vest, personal communication, February 23, 2018) Quality improvement projects that are currently being worked on throughout the clinic are ways to decrease catheter-based infections, as well as ways to increase permanent access from catheters. They are currently looking at new procedures of catheter care to decrease infection rates. Clinics also have list of current catheters and are looking at ways to get permanent accesses placed in these patients. Another quality improvement project is a process that allows staff to drive changes that can improve quality care in each clinic. The staff are able to identify a problem and use a cycle to implement an improvement in a process. This process improves the quality of care. (T.Vest, personal communication, February 23, 2018) The recommendation by this author is that the clinic add a monthly round with the staff nurses. During this monthly round the staff nurse would be able to review medications, diet, labs, and other issues with the doctor, dietician, social worker, and the manager. This would also give the nurse time to discuss anything that the patient has concerns about. Currently the procedure for monthly rounds does not include the staff nurse. The staff nurse being included in these monthly rounds would allow the staff nurse to know what is being discussed with the patient.
- Spring '17
- Nursing, nurse leader