scholarly journals To What Extend does Reported Practice from Nurses in Management of Indwelling Urinary Catheters Reflect National Evidence-based Guidelines?

2019 ◽  
Vol 4 (1) ◽  
Keyword(s):  
Urinary Catheter ◽  
Poor Performance ◽  
Evidence Based ◽  
National Guidelines ◽  
Training And Education ◽  
Hospital Acquired Infections ◽  
Bladder Scan ◽  
Induction Process ◽  
Evidence Based Guidelines ◽  
Hospital Acquired

In recent years, Catheter-Associated Urinary Tract Infection (CAUTI) has progressively developed into a major hospital complication accounting for 60% of hospital-acquired infections; it is costly and morbid. Nurses account for more than half of the catheterisation conducted within hospitals. Due to this reason, it was important to identify whether nursing practice on the management of indwelling urinary catheter was in the reflection of the current national guidelines. The survey is conducted on 32 participants who reveal the strengths and limitation within the areas. Nurses account for more than half of the catheterisation conducted within the hospital. In order to prevent CAUTI complication, the research suggested training and education as the main solution since nurses significantly exhibited poor performance in terms of knowledge and skills in the area of catheterisation, especially in the induction process. Moreover, the study reveals that the use of bladder scan and system intervention which has been identified to reduce the number of catheter insertions contributes to the reduction of urinary bacterial infection.

Buprenorphine management: a conundrum for the anesthesiologist and beyond - a one-act play

2020 ◽  
Vol 45 (8) ◽  
pp. 656-659
Author(s):  
Shilen Thakrar ◽  
Josh Lee ◽  
Caitlin E Martin ◽  
John Butterworth IV
Keyword(s):  
Patient Outcomes ◽  
Perioperative Management ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Local Level ◽  
Evidence Based ◽  
National Guidelines ◽  
Evidence Based Guidelines ◽  
One Act ◽  
Patient Centric

We have witnessed a worldwide upsurge of streamlined enhanced recovery after surgery (ERAS) pathways advocating for consistency and compliance within their guidelines. At a recent national conference, two experts defended their institutional policies on perioperative management of buprenorphine, one defending its continuation, while the other suggesting its discontinuation. The moderator diplomatically proclaimed the need to have guidance at the institutional level and following it for favorable patient outcomes. Unfortunately, perioperative management of buprenorphine remains an understudied topic with a lack of national guidelines leading to variations at a local level despite its increased use nationally in the current opioid crisis. Although the moderator made a valid statement, we demonstrate via our one-act play the importance of recognizing a subset of the population within an ERAS pathway that necessitates multidisciplinary discussion, communication, and patient-centric care to formulate a perioperative plan coordinating a patient’s care. More robust research is needed to minimize variability in current practices and to further develop comprehensive evidence-based guidelines that encompass risk factors and anticipated postsurgical and peripartum pain for patients on buprenorphine.

Reducing Foley Catheter Device Days in an Intensive Care Unit

2006 ◽  
Vol 17 (3) ◽  
pp. 272-283
Author(s):  
Laura Reilly ◽  
Patty Sullivan ◽  
Sharon Ninni ◽  
Denise Fochesto ◽  
Karen Williams ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Foley Catheter ◽  
Hospital Costs ◽  
Evidence Based ◽  
Tract Infections ◽  
Evidence Based Guidelines ◽  
Hospital Acquired

The prolonged use of indwelling urinary catheters can lead to many complications, the most prevalent being urinary tract infections. These hospital-acquired infections can increase hospital costs, length of stay, and mortality rates. Evidence-based guidelines for the prevention of urinary tract infections are compared and discussed. Minimizing indwelling urinary catheter use is well-recognized in the literature to reduce the risk of these infections. To decrease the incidence of catheter-associated urinary tract infections, the staff of a 22-bed, mixed medical, surgical, and trauma intensive care unit focused on reducing the number of foley catheter device days. A multidisciplinary team was convened to create an evidence-based plan. Staff nurses were engaged in the development and implementation of the plan. Criteria-based foley catheter guidelines, a decision-making algorithm, and a daily checklist were implemented that led to a significant reduction in foley catheter device days and a decrease in catheter-associated urinary tract infections.

Evidence-Based Clinical Guidelines and Their Impact on Prevention of Catheter-Related Bloodstream Infections

2012 ◽  
Vol 5 (1) ◽  
pp. 18-30
Author(s):  
Paula McCauley
Keyword(s):  
United States ◽  
Health Care ◽  
Clinical Practice ◽  
Health Care Professionals ◽  
Bloodstream Infections ◽  
The United States ◽  
Evidence Based ◽  
Hospital Acquired Infections ◽  
Equity And Efficiency ◽  
Hospital Acquired

The growing concern for hospital-acquired infections in health care has stimulated the development of evidence-based practice (EBP) guidelines. Health care institutions across the United States are increas- ing their focus on the implementation of clinical practice guidelines using current EBP. Adherence to these guidelines by health care professionals is expected to improve the quality, equity, and efficiency of patient care.

Operative vaginal delivery: a review of four national guidelines

2020 ◽  
Vol 48 (3) ◽  
pp. 189-198 ◽  
Author(s):  
Ioannis Tsakiridis ◽  
Sonia Giouleka ◽  
Apostolos Mamopoulos ◽  
Apostolos Athanasiadis ◽  
Angelos Daniilidis ◽  
...  
Keyword(s):  
New Zealand ◽  
Postnatal Care ◽  
Practice Patterns ◽  
Vaginal Birth ◽  
Evidence Based ◽  
National Guidelines ◽  
International Evidence ◽  
Vaginal Deliveries ◽  
Zealand College ◽  
Evidence Based Guidelines

AbstractThere is a broad range in the rates of operative vaginal deliveries (OVD) worldwide, which reflects the variety of local practice patterns, the number of trained clinicians and the lack of international evidence-based guidelines. The aim of this study was to review and compare the recommendations from published guidelines on OVD. Thus, a descriptive review of guidelines from the Royal College of Obstetricians and Gynaecologists (RCOG), the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), the Society of Obstetricians and Gynaecologists of Canada (SOGC) and the American College of Obstetricians and Gynecologists (ACOG) on instrumental vaginal birth was conducted. All the guidelines point out that the use of any instrument should be based on the clinical circumstances and the experience of the operator. The indications, the contraindications, the prerequisites and the classification for OVD are overall very similar in the reviewed guidelines. Further, they all agree that episiotomy should not be performed routinely. The RCOG, the RANZCOG and the SOGC describe some interventions which may promote spontaneous vaginal birth and therefore reduce the need for OVD. They also highlight the importance of adequate postnatal care and counseling. There is no consensus on the actual technique that should be used, including the type of forceps or vacuum cup, the force and duration of traction or the number of detachments allowed. Hence, there is need for international practice protocols, so as to encourage the clinicians to use OVD when indicated, minimize the complications and reduce rates of cesarean delivery.

scholarly journals Electronic Health Record: Driving Evidence-Based Catheter-Associated Urinary Tract Infections (CAUTI) Care Practices

2013 ◽  
Vol 18 (3) ◽  
Author(s):  
Lois Welden
Keyword(s):  
Urinary Tract ◽  
Electronic Health Record ◽  
Urinary Tract Infections ◽  
Urinary Catheter ◽  
Evidence Based ◽  
Health Record ◽  
Care Practices ◽  
Tract Infections ◽  
Evidence Based Care ◽  
Hospital Acquired

Catheter-associated urinary tract infections (CAUTIs) continue to account for most hospital-acquired infections; yet records for up to 50% of hospitalized patients who received an indwelling catheter lack documentation of evidence-based criterion for the insertion decision. Newer guidelines emphasize prevention of infection by limiting both catheter use and duration of use so as to decrease the number of hospital-acquired, urinary tract infections (UTIs). In this article, we review the literature and describe the method employed in our quality improvement (QI) project using the electronic health record (EHR) to assist in driving evidence-based care. We developed an infrastructure that provided clinical-decision support, drove evidence-based care delivery practices, and maintained sustainability. Next, we present the results of this QI project that demonstrated a significant decrease in positive urine cultures, improved catheter care practices, and documentation of evidence-based criterion for catheter utilization. We discuss the benefits of using the EHR to decrease urinary catheter usage and conclude by recommending the using the EHR to decrease UTIs by limiting urinary catheter usage.

Hospital-acquired urinary tract infection

2017 ◽  
Author(s):  
Roger Bayston
Keyword(s):  
Urinary Tract ◽  
Enteric Bacteria ◽  
Prophylactic Antibiotics ◽  
Evidence Based ◽  
National Surveillance ◽  
Aseptic Technique ◽  
Surveillance Studies ◽  
Hospital Acquired Infections ◽  
Tract Infections ◽  
Hospital Acquired

Urinary tract infections (UTIs) account for the majority of hospital-acquired infections (HAI), and most of these occur in catheterized patients. However, for most the presence of bacteria in the urine (bacteriuria) is asymptomatic, yet in many institutional and national surveillance studies it is still attributed as ‘infection’. Although guidance is that only symptomatic UTI should be treated, except in pregnancy, bacteriuria in catheterized patients is frequently overinvestigated and antibiotics overused. Most infections are caused by enteric bacteria such as Escherichia coli, but other bacteria such as Proteus mirabilis and staphylococci are more prominent in HAI. Aseptic technique for catheter insertion and during subsequent catheter care together with minimizing catheter duration are very important to prevent catheter-associated UTI (CAUTI). Prophylactic antibiotics should be avoided. National and international action to adopt evidence-based consensus protocols for management of catheterized patients and judicial use of antimicrobial chemotherapy promise to be of greatest benefit.

Epistemological deliberation: the challenges of producing evidence-based guidelines on lifestyle habits

2021 ◽  
Author(s):  
Helena Lagerlöf ◽  
Teun Zuiderent-Jerak ◽  
Morten Sager
Keyword(s):  
Public Health ◽  
Health Knowledge ◽  
Healthy Lifestyle ◽  
Disease Incidence ◽  
Evidence Based ◽  
National Guidelines ◽  
Lifestyle Habits ◽  
National Board ◽  
Evidence Based Guidelines ◽  
Based Medicine

Background: Promotion of healthy behaviour is increasingly highlighted worldwide as a way to improve public health, prevent disease incidence, and decrease long-term costs for healthcare. In Sweden the National Board of Health and Welfare (NBHW) used the well-established format of national guidelines to facilitate a more widespread use of approaches for promotion of healthy lifestyle habits in healthcare.Aims and objectives: The aim of this case study was to explore the tensions between public health knowledge and the tenets of evidence-based medicine (EBM) in the creation of national guidelines on lifestyle habits.Methods: Based on data from interviews with guideline professionals and the collected documents of the national guidelines, we examine how NBHW negotiated the conflicts between public health knowledge and the format of national guidelines. An analytical model based on approaches from the sociology of standardisation is used to explore the ramifications of these negotiations.Findings: In line with findings in the sociology of standardisation, we show how conflicts between public health knowledge and the format of national guidelines result in both having to yield on certain points. This, we claim, results in compromise, but perhaps also compromised notions of validity and causality.Discussion and conclusion: This case offers important learning about the general compatibility of public health and currently dominant methods of EBM. Important crossroads are outlined, concerning how validity and causality are configured in public health guidelines and how these require extensive epistemological deliberation.<br />Key messages<br /><ul><li>Epistemological commitments on validity and causality within public health have been compromised to fit the format of national guidelines;</li><br /><li>Similarly, the format of national guidelines has been subordinated to the public health valuation of risk assessments;</li><br /><li>Integrating public health into an EBM format requires extensive epistemological deliberation.</li></ul>

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