1. Urethral Catheter Removal Using the HOUDINI Protocol Candace Keck, RN BSN
Introduction
Background
Team and Plan
Urinary tract infection (UTI) is the most frequent occurring type of healthcare-associated infection (HAI). Urinary tract infections account for more than 35% of infections reported by acute care hospitals. Catheter-associated urinary tract infections (CAUTIs) have been associated with increased morbidity, mortality, hospital cost, and length of stay (BJC HealthCare, 2012). Urinary tract infections (UTIs) are the second most common type of healthcare-associated infection (BJC HealthCare, 2012). This is tied with pneumonia. That puts UTIs second only to surgical site infections and account for more than 15% of infections reported by acute care hospitals (BJC HealthCare, 2012). Virtually all healthcare-associated UTIs are caused by insertion of some sort of device into the urinary tract.
The team will consist of the following:
Team Lead: Infection Prevention/Control
RN Champions: One nurse from each unit to help educate staff and make sure protocol is being followed
Physicians': Three physician from the executive counsel to educate other physicians' and ask the nursing staff to follow protocol
Librarian: To pull the most up to date information
Clinical Project Manager: Help keep team on point
Clinical Project Coordinator: Help coordinate team project
Administrative Assistant: Schedule meetings and prepare notes pre and post meetings
The plan will take place in three phases:
Phase One: Baseline data will be collected and staff education will be started ( October 1, 2015-March 1, 2016). Education plan consists of a series of roll out implementation dates, one on one training of staff requiring return demonstration, competency, and evaluation.
Phase Two: Nurse driven protocol implemented (March1, September1, 2016). Ongoing data collection of outcome and observation of protocol practices.
Phase Three: Data collection and comparison of pre/post evaluation measures followed reinforcement of educational strategies, review of practices with staff for adjustments or improvements, advance plan for sustainability and implementation across all hospital units (October 1, 2016-September 1, 2017).
A review of articles was conducted with the goal of finding a protocol to reduce catheter associated urinary tract infections (CAUTIs) and improving patient care. The HOUDINI protocol and the fill and pull technique were found to be beneficial in this review. Desired outcomes: reduce CAUTI rates; reduce catheter days: reduce average time to first void following catheter removal; improve patient care experience of quality of care and increase nursing autonomy of practice .
HOUDINI Protocol/Fill and Pull Technique
Evidence-Based Practice Model and Theoretical Framework For Change
The Johns Hopkins Nursing Evidence Based Practice Model (JHNEBP) will guide this project. The JHNEBP model is founded on three cornerstones of nursing: practice, education, and research. This model uses a process in three phases: the practice question, evidence and translation and translation to facilitate practice change.
Kanter’s Theory on Structural Empowerment will be used as a basis of empowerment to affect change throughout shared governance.
The HOUDINI protocol is an evidence based, nurse-led practice aimed at initiating urinary catheter removal and decreasing CAUTI rates. Open communication between nurses and physicians’ regarding the indication for urinary catheter paves the way for autonomous nursing practice and better patient outcomes. H-Hematuria gross O-Obstruction, urinary U-Urinary Surgery D-Decubitus ulcer I-Input and output measurements N-Nursing end of life care I-Immobility The pull and fill technique is an evidence based procedure for urinary catheter removal which involves the instillation of an isotonic solution prior to catheter removal. This procedure demonstrates an increase in patient comfort during catheter removal and decrease in urinary retention, promoting more complete bladder emptying. Together, these outcomes reduced the length of stay and CAUTI rates.
PICO
References
Assessment Tools
PICO Question:
In adult patients hospitalized in an acute care facility, how does the use of a nurse-driven protocol for evaluating the appropriateness of urethral catheter removal using the HOUDINI protocol and fill and pull technique, compared with no protocol, affect the number of catheter days and CAUTI rates over a six month period?
BJC HealthCare. (2012). Retrieved from Prevention of catheter associated urinary tract infection Retrievedfrom: CAUTI%20Module% pdf CDC. (2015, January). Retrieved from Urinary tract infection and non-catheter associated urinary tract infection and other urinary system infection events: Laschinger, H., Gilbert, S., Smith, L. & Leslie, K. (2010). Towards a comprehensive theory of nurse/patient empowerment: Applying Kanter’s empowerment theory to patient care. Journal of Nursing Management, 118, Doi: /j x Additional references available upon request
The Student Satisfaction The student Satisfaction and Self-confidence in Learning is a 13-item instrument used to measure satisfaction and self- confidence in learning, and will be used to assess nurses’ learning after the education intervention. The Short Assessment of Patient Satisfaction (SAPS) survey assesses seven dimensions of patient satisfaction, and will be used to assess patient satisfaction following the fill and pull procedure.