Discuss a healthcare safety concern using the SBAR (situation, background, assessment, recommendation) format by doing the following:
1. Describe a healthcare-related situation prompting a patient safety concern (S).
I have chosen the problem of CAUTIs or Catheter-Acquired Urinary Tract Infections, specifically, those patients who develop CAUTIs from the use of indwelling catheters in the acute care setting.
2. Analyze background information about the concern by doing the following (B):
a. Describe the data that support or would support the need for change.
This study showed the intervention strategy and CAUTI bundle can greatly decrease the IUC use rate and CAUTI rates, as well as improve quality and safety regimens in a large ICU while being able to create a durable cultural change regarding the use of IUC in hospital staff (Gupta, 2017). The importance of in-and-out catheterization and bladder scanning instead of IUC was also shown to prove a large role in the decrease of UTIs (Gupta, 2017).
b. Explain how one or more national patient safety standards apply to this situation.
3. Discuss the impact of the safety concern on the patient(s), staff, and organization (A).
The use of indwelling catheters unnecessarily exposes patients to CAUTIs, which can cause other problems associated with the UTI such as longer hospital stays and frequent use of antibiotics which can, in turn, lead to antibiotic resistance.
The use of indwelling catheters should be carefully monitored, used only when necessary and no longer than needed.
a. Explain how the safety concern affects value for the patient(s) and the organization.
4. Recommend an evidence-based practice change that addresses the safety concern (R).
I believe the best intervention to decrease the rates of CAUTIs is the reinforcement of education or better training on the appropriate usage, cleaning techniques, and removal guidelines for indwelling catheters.
a. Discuss how this recommendation aligns with the principles of a high-reliability organization.
b. Describe two potential barriers to the recommended practice change.
I think there are several barriers that could be encountered such as the new practice not being followed by staff who are resistant to change or feel that it is easier to deal with multiple patients if they have an IUC.
There is also the issue of incontinent patients that can develop skin integrity issues which is why many patients have an IUC.
c. Identify two potential interventions to minimize the barriers from part A4b to the recommended practice change.
For incontinent patients more frequent trips to the bathroom or use of a bedpan, diaper or chucks could be helpful in not using an IUC. For staff that is resistant to change, ask them why they feel the new guidelines are not achievable and if they have any ideas that they feel could be implemented that would be helpful to the issue.
d. Discuss the significance of shared decision-making in implementing this recommendation.
I believe it would be important to involve the nurses that work at the bedside and make sure they understand how important it is to implement the new changes along with getting their input on how the changes are positive or negative as well as the unit leaders or managers that will be enforcing the new changes and providing training on how to insert, use and care for IUCs following the new guidelines.
The physicians that work on the unit should be included in the teaching exercises and informed on why this change needs to be implemented and their opinions considered since they are the ones who prescribe the IUCs.
e. Describe an outcome measure that could be used to evaluate the results of the recommendation.
The outcome that would measure my recommended change would be a decreased number of cases of hospital-acquired CAUTIs in an acute care unit over 3 months compared to the 3 months before the changes were implemented.
f. Discuss how the care delivery model in this organization would be impacted by this change.
