SECTION 1 BACKGROUND: IDENTIFYING A PROBLEM
\nEleanor is a 52-year-old patient who has had a hip replacement 1 day ago who is on your assigned patient
\ncare team. You complete patient care rounds and assess Eleanor\u2019s vital signs, comfort level, intravenous
\n(IV) site and wound dressing. Eleanor has an IV for fluid replacement and medication administration. She
\nalso has an indwelling urinary catheter. She tells you that her pain level is a 4 out of 10 and she is
\nreluctant to move around because of the pain.
\nYou know that the patient\u2019s pain control is a high priority and that the physician ordered the indwelling
\nurinary catheter until the patient is able to get out of bed easily and tolerate fluids. The urinary catheter is
\nconvenient in that the patient will not experience pain getting up to the bathroom and it provides an
\naccurate measurement of output. On the other hand, you know that the longer the indwelling urinary
\ncatheter is in place, the higher the risk of an infection.
\nYou ask a trusted senior nurse when is the right time to remove the catheter since Eleanor is now
\ntolerating ice chips. The senior nurse tells you that the catheter is usually kept until the patient is able to
\nget up and ambulate independently. You wonder if there are any contraindications or problems with
\nremoving Eleanor\u2019s indwelling catheter now. You decide to follow the senior nurse\u2019s advice, leaving the
\nindwelling urinary catheter in place and reevaluate for removal in the morning.
\nSECTION II BACKGROUND: INTERPROFESSIONAL TEAMS AND STAKEHOLDER
\nENGAGEMENT
\nThis section is focused on the identification of a clinical problem and the steps of forming an interprofessional team
\nto work on fixing the problem. The intent is to understand who are the stakeholders for this problem and the
\nimportance of engaging stakeholders in the quality improvement (QI) project. Examine the problem of CAUTIs
\nholistically to identify stakeholders.
\nYou return to work the next day to learn that Eleanor has a low-grade fever of 99.8\u00b0 F that was reported to
\nthe physician. The physician ordered an immediate urine culture and removal of the catheter the previous
\nafternoon. The urine culture was positive for Escherichia coli, representing the presence of catheterassociated urinary tract infection (CAUTI). During the bedside report, you find that although Eleanor
\nstates she is tired, she is able to get up to the bathroom with a walker independently. She is also tolerating
\noral fluids and foods.
\nThe presence of the CAUTI bothered you enough that you spoke to your Unit Director about looking into
\nevidence-based interventions to reduce CAUTIs. The Unit Director tells you that the rate of CAUTIs for
\nthe medical\u2013surgical unit has steadily risen over the past year and the monthly total is twice the number
\nfrom 2 years ago. You volunteer to convene a committee to work on the problem. Your first step is to
\nidentify others who should be on your team. You know that the stakeholders are individuals who
\ninfluence or are influenced by the clinical problem under investigation. Review the discussion on
\nstakeholders in Chapter 15 for guidance on selecting appropriate stakeholders.
\nSECTION III BACKGROUND: LEADING A QI TEAM
\nThis section is focused on power gradients and leadership styles within an interprofessional team. Consider how to
\nlead a team consisting of various healthcare professionals.
\nYou identified a variety of interprofessionals to include on your committee including two direct care
\nnurses from the medical\u2013surgical unit, one nurse from the operating room, two certified nurse assistants, a
\nnurse supervisor, a physician, the medical\u2013surgical clinical nurse specialist, a pharmacist, a laboratory
\nrepresentative, and a dietician. You feel that these individuals clearly represent all aspects of patient care.
\nReview the information on communicating within a team and with different power gradients in Chapter 8.
\nBy working closely with the clinical nurse specialist (CNS), you are able to convene a meeting of the
\nteam.<\/p>\n
—-
\nSECTION IV BACKGROUND: CLARIFYING THE PROBLEM
\nThe intent of this section is to work through the causative factors to fully understand the clinical problem. The focus
\nis to use a root cause analysis approach to examine the big picture and pull out the factors that contribute to the
\nproblem.
\nIn this section, you will use information provided from previous sections of the case study and your research to
\ncreate a root cause analysis. If needed, create scripts from the perspective of the various stakeholders who might be
\ninvolved with the process being investigated to illustrate the various perspectives.
\nUse the Healthcare Quality Improvement Partnership\u2019s Root Cause Analysis for Clinical Audit guide (accessible at
\nwww.hqip.org.uk\/resources\/using-root-cause-analysis-techniques-in-clinical-audit\/) to guide the students through a
\nroot cause analysis. Complete the cause\u2013effect or fishbone diagram. A resource that includes a fillable template for
\ncreating a cause\u2013effect diagram can be accessed through the Institute for Healthcare Improvement (a free account
\nis required, accessible at www.ihi.org\/resources\/Pages\/Tools\/Quality-Improvement-Essentials-Toolkit.aspx).
\nChapter 12 Patient Safety includes an example of a root cause analysis.
\nThe clinical nurse specialist (CNS) decides to work through a root cause analysis and use a cause\u2013effect
\ndiagram (fishbone diagram) with the team to identify potential causes for catheter-associated urinary tract
\ninfections (CAUTIs). You work with the CNS to complete this activity with the team.
\nSECTION V BACKGROUND: PLANNING FOR CHANGE
\nThe intent of this section is to create a preliminary plan for action by using the PLAN-DO-STUDY-ACT model as
\noutlined in chapter 13.
\nThe team decides to use the Plan-Do-Study-Act model to determine small tests of change that can be undertaken to
\nimprove CAUTI\u2019s in the patients the team cares for. You work with the team to develop a map of the PDSA model.<\/p>\n","protected":false},"excerpt":{"rendered":"
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