Assignment 2/Developing the Evidence Matrix/PICO

Topics: Urinary catheterization, Catheter, Foley catheter Pages: 8 (1757 words) Published: April 15, 2014
Running head: INDWELLING URINARY CATHETERS

Indwelling Urinary Catheters and the Postoperative Orthopedic Patient Ashley Wood-Pollard
University of South Alabama

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INDWELLING URINARY CATHETERS AND THE POSTOPERATIVE ORTHOPEDIC PATIENT

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Catheter associated urinary tract infections (CAUTI) are the most prevalent of all nosocomial infections inflicted upon patients while hospitalized. Approximately 30% of all hospital reported infections are of the urinary tract (Joint commission: New year will usher in new CAUTI prevention requiremants, 2011). The Joint Commission estimates the annual cost of CAUTI care is in excess of $400 million; furthermore, CAUTI care is targeted by Medicaid and Medicare services as a non-reimbursable infection.

For years, postoperative urinary catheter utilization has been contested regarding the appropriate criteria required for its application, maintenance, and discontinuation. Patients hospitalized for short term postoperative care, specifically, orthopedic patients, are often catheterized due to their limited immobility. The goal of therapy with surgical orthopedic procedures is to improve mobility, 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 indwelling or intermittent, in orthopedic patients has been surveyed through multiple studies, resulting in evolutionary changes in the standard of care of postoperative orthopedic patients.

The contrasts

in patient outcomes utilizing indwelling catheterization, intermittent straight catheterization, and non-use of catheterization will be reviewed.
PICO
In postoperative orthopedic patients, how does the discontinuation of an indwelling urinary catheter compare to non-catheterization in relation to the prevention of urinary tract infection?

INDWELLING URINARY CATHETERS AND THE POSTOPERATIVE ORTHOPEDIC PATIENT

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Population: Postoperative orthopedic patients
Intervention: Discontinuation of an indwelling catheter
Comparison: Non-catheterization of postoperative orthopedic patients Outcome: The patient will not exhibit any symptomology of a urinary tract infection Evidenced Based Practice Models
The Johns Hopkins Nursing Evidence Based Practice Conceptual Model (JHNEBPCM) can be utilized in this area of focus as it comprises the foundations of nursing: practice, education, and research. There are three phases to this model known as the PET process: Practice question, Evidence, and Translation. The practice question identifies a problem with a current practice. Evidentiary support to answer the practice question is produced through the utilization and evaluation of research and non-research evidence. The outcome of the implemented research is then translated into practice change, 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 entire healthcare system to be utilized in determining the need for change in the delivery of care. Employing this model allows the researcher to elect to choose between a current 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 determine if enough 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 data obtained from the practice change can be further

INDWELLING URINARY CATHETERS AND THE POSTOPERATIVE ORTHOPEDIC PATIENT

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developed utilizing this model and continuing the...


References: Buchko, B., & Robinson, L. (2012). An evidenced-based approach to decrease early 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 eJournal, 7(4).
Joint commission: New year will usher in new CAUTI prevention requiremants. (2011). AIDS
ALERT, 26(11), 1-2.
Knight, R., & Pellegrini, V. (1996). Bladder management after total joint arthoplasty. The
Journal of Arthroplasty, 11(8), 882-888.
(2013). Intermittent versus indwelling urinary catheterisation in hip surgery patients: A
randomised controlled trial with cost-effectiveness analysis
Nursing Studies, 50, 1589-1598. doi:10.1016/j.ijnurstu.2013.05.007
Wald, H., Allen, M., Bratzler, D., & Kramer, A
Wald, H., Epstein, A., Radcliff, T., & Kramer, A. (2008). Extended use of urianry catheters in
older surgical patients: A patient safety issue? Infevtion Control and Hospital
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