Assignment 2/Developing the Evidence Matrix/PICO Essay

Catheter associated urinary pamphlet contagions (CAUTI) are the most prevalent of either nosocomial transmission systems inflicted upon patients while hospitalized. Approximately 30% of all hospital describe transmission systems are of the urinary piece of ground (Joint commission peeled year bequeath usher in new-fashioned CAUTI measure requiremants, 2011). The Joint Commission estimates the yearbook cost of CAUTI attention is in excess of $400 million furthermore, CAUTI tutelage is targeted by Medicaid and Medicare services as a non-reimbursable infection.For years, surgical urinary catheter use of goods and services has been contested regarding the appropriate criteria required for its application, maintenance, and discontinuation. forbearings hospitalized for small term operative care, specifically, orthopedic patients, are a great deal catheterized due to their circumscribed immobility. The goal of therapy with surgical orthopedic procedures is to improve mobi lity, not render the patient immobile. Urinary catheters are often viewed as cumbersome, inconvenient instruments of immobility by the patient. Conversely, nurses have often viewed urinary catheters as an instrument of convenience and standard of care for hospitalized patients. The use of short term urinary catheter use, whether subjective or intermittent, in orthopedic patients has been surveyed finished multiple studies, resulting in ontogenesisary switchs in the standard of care of postoperative orthopedic patients.The contrasts in patient outcomes utilizing intrinsic catheterization, intermittent straight catheterization, and non-use of catheterization lead be reviewed.PICOIn postoperative orthopedic patients, how does the discontinuation of an ingrained urinary catheter compare to non-catheterization in relation to the legal profession of urinary tr make infection?INDWELLING urinary CATHETERS AND THE POSTOPERATIVE orthopaedic perseveringPopulation postoperative or thopedic patientsIntervention Discontinuation of an indwelling catheterComparison Non-catheterization of postoperative orthopedic patients Outcome The patient will not exhibit any symptomology of a urinary tract infection show Based Practice Models The Johns Hopkins nurse Evidence Based Practice Conceptual Model (JHNEBPCM) can be utilized in this area of focus as it comprises the foundations of nursing employ, education, and re assay. in that respect are three phases to this model known as the PET demonstrate Practice question, Evidence, and Translation. The practice question identifies a problem with a authorized practice. Evidentiary support to answer the practice question is produced through the practice session and evaluation of research and non-research bear witness. The outcome of the implemented research is then translated into practice transport, the measurement of those outcomes, and the dissemination the new research (Buchko & Robinson, 2012).The Iowa Model of Evidenced Based Practice (IMEBP) is appropriate for use in this area of focus. It allows for the full(a) healthcare system to be utilized in determining the use up for change in the delivery of care. Employing this model allows the researcher to elect to take on in the midst of a water naturally problem and new research as the basis for change in patient care. Once the trigger has been substantiated as a priority, a team is put in place to assemble, critique, and chance if nice research has been presented to pilot a change in current practices. If there is sufficient evidence for change and the pilot program is successful, a change in practice will occur. Once a change has been made, the entropy obtained from the practice change can be further  genuine utilizing this model and continuing the evolutionary cycle of improving standard of care practices.INDWELLING URINARY CATHETERS AND THE POSTOPERATIVE ORTHOPEDIC longanimousOtherwise, if there is not enough evidence , further research may be conducted to provide enough of a base to continue toward obtaining a practice change (Dontje, 2007). The distinctions between the JHNEBPCM and the IMEBP are minor. They some(prenominal) provide a common goal to change current practices by employing evidenced establish research to foster the evolution of healthcare practices. Both models use a question or a trigger to initiate a change in practice. The minor difference between the JHNEBPCM and the IMEBP is the JHNEBPCM validates its change of practice question with the application of non-research data in addition to its research data. In this way, the JHNEBPCM can consider patient discernment as an indicator to best practices.Determining the Question The national Patient preventive Guidelines, as determined by the Joint Commission, include the prevention of indwelling CAUTI, emphasizing the nimble removal of these instruments and the observation for subsequent infection (Joint commission New year w ill usher in new CAUTI prevention requiremants, 2011). The initial question was, In admitted orthopedic surgical patients, does prompt removal of an indwelling Foley catheter within 48 hours of mathematical process reduce the incidence of catheter associated urinary tract infection? In order to have a broader result list in searching for articles, the PICO parameters were refined. The population parameter was trim down to postoperative orthopedic patients. The intervention parameter was refined to discontinuation of an indwelling catheter. This drawd the time constraint from the initial PICO question. Using non-catheterization, employed the comparison tool to serve as the basis for improved practice. The outcome parameter, prevention of urinary tract infection alignsINDWELLING URINARY CATHETERS AND THE POSTOPERATIVE ORTHOPEDIC PATIENTwith the Joint Commissions National Patient Safety Guidelines to preventing CAUTI, ensuring conk out patient care by eliminating infections.& nbspSearch of EvidencePubMed was the kickoff database searched for postoperative urinary catheter indications and subsequent infections. The light upon terms, indwelling urinary catheter AND urinary tract infection AND surgery, were entered into the search bar, yielding 320 results. Accordingly, a second search using the reveal terms, orthopedic surgery AND catheter associated urinary tract infection, resulted in eight articles. Of those eight, two articles were chosen for review due to their specificity to joint surgery and urinary catheterization.The Cumulated Index of Nursing and Allied Health (CINAH) database was the second database searched. The key terms, surgical patients and urinary tract infection, produced 14 articles, of which two retrospective age bracket studies were chosen for review based on the PICO criteria of urinary catheter use in the postoperative peak. Additionally, a search for the key terms, orthopedic surgery and catheter associated urinary tract infecti on resulted in zero hits. The third database searched was Science Direct. The key terms searched for in this database were, surgical patients, indwelling catheter, sterile field, and urinary tract infection. This search resulted in 845 articles in which they were further limited to, infection sustain, which yielded 27 articles. Of those 27 articles, two were chosen for further review a potential observational choose with descriptive and comparative design and a randomised control trial with cost-effectiveness analysis.INDWELLING URINARY CATHETERS AND THE POSTOPERATIVE ORTHOPEDIC PATIENTEvidence ReviewThe first, and oldest, article reviewed was discouraging. Knight and Pellegrinis (1996) randomized control trial determined utilization of indwelling catheters for urinary retention in postoperative total hip arthroplasty (THA) or total knee arthroplasty (TKA) procedures was estimable for the patient. It was also determined urinary tract infections were not a solvent of indwelling catheter usage. The level of evidence met level one criteria, yet the browse of recommendation was D due to the weak recommendations with alternative approaches likely to better suit a different group of patients, those requiring urinary catheterization for urinary retention.The close get wind, a retrospective cohort study, sampled 35,904 patients who underwent major cardiac, vascular, orthopedic, or gastrointestinal surgery. A urinary catheter was placed intraoperatively, resulting in the development of a urinary tract infection if left in for more than two days these patients were twice as likely to develop a urinary tract infection compared to patients whose catheters were removed within 48 hours of surgery (Wald, Allen, Bratzler, & Kramer, 2008). That same year, some other retrospective cohort study by two of the previous authors on with two additional researchers, concluded postoperative patients admitted to skilled nursing facilities where their indwelling urinary ca theters were maintained over the course of their care were associated with poorer outcomes. This study was restricted to the patients in skilled nursing facilities where direct patient care was limited and ongoing surveillance was minimal (Wald, Epstein, Radcliff, & Kramer, 2008). Both of these studies level of evidence met two-b criteria, grade of recommendation A and B respectively the first study could apply to most patients in most circumstances, while the second study could apply to most circumstances.INDWELLING URINARY CATHETERS AND THE POSTOPERATIVE ORTHOPEDIC PATIENTThe final review of Nyman, et.al, (2013), resulted in a one-a level of evidence with an A for grade of recommendation. This randomized control trial concluded the employment of indwelling catheters and intermittent straight catheterization during the postoperative period for hip surgery patients had both benefits and disadvantages, yet non-catheterization was best for postoperative patient outcomes. This study was the most upstart on record and aligned with the Joint Commissions National Patient Safety Guidelines.SummaryEvidence based practices have stupefy the cornerstone for the standard of care in healthcare facilities. Over the course of the past 20 years, healthcare providers have provided the research necessary to remove indwelling urinary catheters as the standard of care in postoperative orthopedic patients from advocating of their use for urinary retention in the late 1990s to limiting their utilization today.The higher incidence of CAUTI has provided Medicaid and Medicare programs support in rejecting reimbursement measures to facilities for these types of nosocomial infections. New nurse directed protocols supported by evidenced based research have decreased the incidence of CAUTI, although, if these practices are to continue to be successful, a physician culture change must be embraced. The ideal healthcare team must continue to participate in an participating role t o eliminate unnecessary and preventable infections, specifically CAUTIs. To appropriately act on the behalf of the patient, clinicians must ensure best practices not only for the well-being of the patient, but for the fiscal survival of a healthcare facility.INDWELLING URINARY CATHETERS AND THE POSTOPERATIVE ORTHOPEDIC PATIENTReferencesBuchko, B., & Robinson, L. (2012). An evidenced-based approach to decrease primeval postoperative urinary retention following urogynecologic surgery. Urology Nursing, 32(5), 260-264.Dontje, K. (2007). Evidence-based practice understanding the process. Topics in Advanced Practice Nursing e daybook, 7(4).Joint commission New year will usher in new CAUTI prevention requiremants.(2011). support ALERT, 26(11), 1-2.Knight, R., & Pellegrini, V. (1996). Bladder management after total joint arthoplasty. The Journal of Arthroplasty, 11(8), 882-888.Nyman, M., Gustafsson, M., Langius-Eklof, A., Johansson, J.-E., Norlin, R., & Hagberg, L. (2013). Inter mittent versus indwelling urinary catheterisation in hip surgery patients A randomised controlled trial with cost-effectiveness analysis. International Journal of Nursing Studies, 50, 1589-1598. inside10.1016/j.ijnurstu.2013.05.007 Wald, H., Allen, M., Bratzler, D., & Kramer, A. (2008). Indwelling urinary catheter use in the postoperative period Analysis of teh national surgical infection prevention project data FREE. Arch Surg, 143(6), 551-557. doi10.1001/archsurg.143.6.551 Wald, H., Epstein, A., Radcliff, T., & Kramer, A. (2008). Extended use of urianry catheters in old(a) surgical patients A patient safety issue? Infevtion Control and infirmary Epidemiology, 29(2), 116-124. doi10.1086/526433