Academic journal article Online Journal of Issues in Nursing

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

Academic journal article Online Journal of Issues in Nursing

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

Article excerpt

Abstract

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.

Citation: Weiden, L, (August 6, 2013) "Electronic Health Record: Driving Evidence-Based Catheter-Associated Urinary Tract Infections (CAUTI) Care Practices" OJIN: The Online Journal of Issues in Nursing Vol. 18 No. 3.

DOI: 10.3912/OJIN.Voll8No03PPT02

Keywords: electronic health record (EHR), catheter-associated urinary tract infection (CAUTI), evidence-based practice (EBP), clinical decision support (CDS), quality improvement (QI)

The increased pace of care, along with staffing shortages, challenges health care providers in terms of fully documenting care that is provided. Gould et al. (2010) have reported reviews of hospital records indicate that up to 50% of hospitalized patients who receive an indwelling catheter lack documentation of evidence-based criterion regarding the decision to insert a catheter. Failure to adequately document care places the institution at risk, as federal entities no longer assume that appropriate care was provided in the absence of documentation.

Although we have had, for the past 30 years, both guidelines to address the prevention and care of patients with an indwelling urinary catheter infection (Gould et al.. 2010J and technological advancements in urinary catheters, catheter-associated urinary tract infections (CAUTIs) remained among the most common of the hospital-acquired infections (Nicolle. 2010J. However, recent research and systematic reviews of the literature have led to revisions of the original guidelines.

One of the major, evidence-based, conceptual changes in the revised guidelines has been to minimize both the initiation and the duration of urinary catheter use, in contrast to a continued focus on prevention through use of recommended techniques of catheterization and care (Nicolle, 2010). This newer focus is based on the well-known fact that bacterial colonization increases with time (Wald. 2007). This increased bacterial colonization can result in a hospital-acquired infection (HAI), which is an infection that the patient did not have on admission and that may have been preventable by following generally accepted guidelines. A CAUTI is a common HAI, one that involves patient discomfort, fever, increased length of stay, increased costs, and other adverse effects. Thus, when a CAUTI occurs, and there is no documentation of the rationale for the catheter use or its duration, it is no longer assumed that appropriate care was provided. The additional cost of care associated with a hospital-acquired CAUTI has been targeted by the Centers for Medicare and Medicaid Services (CMS) for nonpayment (CMS. 2010). This additional cost of a CAUTI can range from $676 to $2836, thus adding an unnecessary half billion dollar increase to the cost of health care in the United States (US) per year. …

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