Centers for Medicare and Medicaid Services (CMS) Essay

Procedure Until recently it was not un commonplace for patients admitted to an acute burster installing to feel an indispensable catheter anchored for supererogatory reasons. Patients that came in thru the emergency department typically were sent to the units with unnecessary congenital catheters in place and it was not unusual for a surgery patient to have an indwelling catheter anchored before or during a procedure. Once a patient was admitted and was transported to the units treat would also anchor indwelling catheters for multiple unnecessary reasons.These Catheters could be anchored for many unnecessary days and in some cases until discharge. In 2008 the Centers for Medic ar and Medicaid run (CMS) initiated a policy counter mixed bag to no longer reimburse hospitals for additional cost that were incurred imputable to catheter associated urinary pamphlet transmissions or in another term CAUTIs (Palmer, 2013). The CMS recognized that CAUTIs are the most common type of hospital acquired infection. The CMS also determined that when separate based practices are initiated and embraceed they can be highly preventable, threeing to a change in practice.Current PracticeUp until 2012 there were no policies pertaining to the anchoring or removal of indwelling catheters in the facility I make for. Nursing would complete their assessment of the patients and per their ingenuity they would determine if an indwelling catheter by their standards is appropriate. An indwelling catheter could be deemed appropriate according to breast feeding for multiple reasons including urinary incontinence, retention, convenience, rack ulcers, strict output recordings and in some cases per patient request. The nurse was required to obtain an club from the physician in order to anchor a catheter and most cases the physician would comply. aft(prenominal) the nurse anchored a catheter it would most likely stay anchored until discharge or until and order was given by the phy sician to abdicate it.These procedures lead to the unnecessary length of dates catheters were kept in place and the need for change.Rational and historyEven though in 2008 Medicare and Medicaid changed their reimbursement policies it wasnt unit 2012 when the Joint Commission added guidelines for the prevention of CAUTIs and the facility I work for initiated change. Prior to the Joint Commissions new guidelines management relied on breast feeding to make the proper decisions for their patients and rewarded nursing when they deemed it necessary to anchor a catheter. In 2012 when the guidelines were initiated management chose to follow them when picture based seek supported CAUTIs were preventable when the appropriate protocols were followed. Hospital management initiated evidence based practices that were supported by CMS and the Joint Commission that would assist nursing on when anchoring a catheter was necessary.The police squad responsible for these changes included the clin ical manager in charge of all medical surgical units, apiece medical surgical unit manager where these changes were to bear place and the medical surgical educator. This team reviewed evidence based research and practices on how to improve CAUTIs and thru this research came up with a plan to consume nurse driven protocols that would be beneficial to our facility. These protocols instructed nursing, thru protocols on the patients EMR to guide nursing when anchoring a catheter would be appropriated and it also gave nursing the ability to remove a catheter when it was deemed unnecessary. After the protocols were initiated management began to notice a reduction in the use of catheters and a decrease in CAUTIs resulting in cost enduringness and higher patient satisfaction scores for the hospital.ReferencesBernard, Michael S, Hunter, Kathleen F, Moore, Katherine N. (2012). A Review of Strategies to simplification the Duration of Indwelling urethral Catheters and Potentially Reduce th e Incidenceof Catheter-Associated Urinary pathway Infections. Urologic Nursing, 32 (1) 29-37.Carter, Nina M, Reitmeier, Laura, Goodloe, Lauren R. (2014). An Evidence-Based orgasm To the Prevention of Catheter-Associated Urinary Tract Infection. Urologic Nursing, 34 (5)238-45.Hooton, T., Bradley, S., Cardenas, D., Colgan, R., Geerlings, S., Rice, J., Nicolle, L. (2010). Diagnosis, prevention, and treatment of catheter-associated urinary track infection in adults 2009 international clinical practice guidelinges from the infectious diseases society of America. Clinical Infectious Diseases, 50(March) 625-663. Knoll, Bettina M. W even off, Deborah Ellingson, LeAnn Kraemer, Linda Patire, Ronald Kuskowski, Michael A. Johnson, James R. (2011). diminution of Inappropriate UrinaryCatheter Use at a Veterans Affairs Hospital Through a mixed Quality Improvement Project. Clinical Infectious Diseases. Vol. 52 Issue 11, 1283-1290. DOI 10.1093/cid/cir188.Mori, C. (2014). A-Voiding Catastrophe Im plementing a Nurse-Driven Protocol. MedSurg Nursing. 23 (1), 15-28.Clinical ImplicationsAn employ change that would reduce the order of CAUTIs in acute health care facilities would be evidence based nurse lead protocols. The protocols would not only emolument the hospitals but they would also contribute to patient satisfaction scores. Approximately 80% of all nosocomial infections are contributed to CAUTIs and are the most common form of nosocomial infections (Knoll, 2011). some(prenominal) of the symptoms that contribute to the patients discomfort include hematuria, flank pain, fever and in some cases altered mental status. After a patient develops a CAUTI the patient receives the pressed treatment of antibiotic therapy.Antibiotic therapy could last up to 7 days which could result in an increase of stay (Hooton et al., 2010). Evidence supports that when nurse led or information processing led interventions are apply CAUTIs were decreased (Bernard, 2012). The interventions tha t assist in the prevention ofCAUTIs are protocol bundles that include insertion policies, removal policies, maintenance policies and competency training (Carter, 2014). If the proper prevention measures are implemented patient satisfaction scores would improve, infection rates would improve leading to a decrease infection rate and shortening patients length of stay.Recommended ChangesIf the prevention protocols that are listed above were implemented changes would occur that would lead to multiple benefits for both the acute care facilities and the patients. Extended hospital days due to CAUTIs has added to approximately 90,000 days per year and due to Medicaid and Medicare no longer paying the associated cost for CAUTIs the hospitals out of pocket expenses are estimated at approximately 424 million dollars per year (Mori, 2014). The changes that are discussed and supported in this research paper would have a positive impact on decreasing this data. If the protocols are implemented n ot only would they benefit the patients but they would also benefit the hospitals. Patients would have a decrease risk in acquiring nosocomial infections and hospitals would have the opportunity to use the millions they are losing to benefit the patients. The hospitals could apply the money they are losing for research and/or other areas to improve overall satisfaction, increasing hospital census.StakeholdersThe stakeholders in implementing this change at the facility I work for would be the unit managers and the nurse educators in the units where these changes would take place. For the unit managers the increased costs that are acquired due to CAUTIs would have a pass impact on them along with the patients overall satisfaction scores. The evidence based research that would be implemented would be presented to the unit managers and the nurse educators. The unit mangers would be the ones to determine if and when the new protocols would take effect. The nurse educators would be the o nes educating staff on the new protocols and would be a vital part of evaluating the protocols along with suggesting and implementing changes if necessary. Change would happen in shows with the first stage beingness the unfreezing stage.This stage occurs when stakeholders receive the information on a change along with supporting evidence to why the change would be beneficial. The second meter would be the moving stage. This is the stage when goalsand dates are set to when the change is to take place. The refreezing stage is the last stage. The refreezing stage is when the change is implemented and becomes hospital protocol. The end stage is when the nursing staff would need the most support until the change becomes the hospitals new standard (Cherry & Jacob, 2010). The steps listed will assist getting everyone on board with the change and complying with it.BarriersAnytime when new protocols or procedures are implemented barriers may occur. Not everyone is open to change and many may have a hard time adjusting. Many nurses have been following the same policies and procedures for many historic period and may be noncompliant due to habit. Another barrier may be the patients, frequent fliers or patients that frequent the hospital regularly have become accustomed to old protocols and may not be receptive to change. The frequent fliers are used to coming in and requesting catheters so they dont have to get up to the bathroom or if they have incontinency issues. Management and the educators will have to work diligently with nursing to initiate change and nursing may have a difficult time adjusting to the change along with educating patients and enforcing the protocols.StrategiesStrategies to overcome the barriers of change would include using Lewins Change Theory. This theory suggests that change should be initiated slowly and making the necessary changes with only the staff that would be involved (Cherry & Jacob, 2010). Management and the nursing educator shoul d provide staff with the evidence based research as to why the change is being made so nursing can understand why the change is necessary. By following these strategies nursing may be more compliant with the change and can be better advocates for the patients.Application of FindingsCDC guidelines recommend catheters to be inserted for necessary reasons which include urinary retention, strict intake and output, certain surgical procedures, healing for pressure ulcers in incontinent patients and in palliative care patients (Gray, 2010). As research has provided indwelling catheters should be hardened only when deemed necessary and removed when they are unnecessary. The facility I work for along with quality maneuverand the nursing educator put together CAUTI prevention strategies using evidence based research practices.Protocols were initiated in the patients electronic medical record (EMR) that would assist nursing in making the right decision whether to cath or not and when it wou ld be appropriate to remove an indwelling catheter. The charge nurses monitor the chassis of catheters each unit has and researches if they are deemed appropriate to keep anchored. All of these measures have decreased the occurrences of CAUTIs in the facility I work for. Continued monitoring by quality control is still mandatory to insure assessments are completed properly and to monitor if the measure the protocols are working.ReferencesBernard, Michael S, Hunter, Kathleen F, Moore, Katherine N. (2012). A Review of Strategies toDecrease the Duration of Indwelling Urethral Catheters and Potentially Reduce the Incidenceof Catheter-Associated Urinary Tract Infections. Urologic Nursing, 32 (1) 29-37.Carter, Nina M, Reitmeier, Laura, Goodloe, Lauren R. (2014). An Evidence-Based Approach To the Prevention of Catheter-Associated Urinary Tract Infection. Urologic Nursing, 34 (5)238-45.Cherry, B., & Jacob, S. (2010). Contemporary Nursing Issues, Trends, and Management. (5th ed.) St. Louis, MO Mosby Elsevier.Gray, M. (2010). Reducing catheter associated urinary tract infection in the critical care unit. AACN Advanced Critical Care, 20(3), 247-257.Hooton, T., Bradley, S., Cardenas, D., Colgan, R., Geerlings, S., Rice, J., Nicolle, L. (2010). Diagnosis, prevention, and treatment of catheter-associated urinary track infection in adults 2009 international clinical practice guidelinges from the infectious diseases society of America. Clinical Infectious Diseases, 50(March) 625-663. Knoll, Bettina M. Wright, Deborah Ellingson, LeAnn Kraemer, Linda Patire, Ronald Kuskowski, Michael A. Johnson, James R.(2011). Reduction of Inappropriate UrinaryCatheter Use at a Veterans Affairs Hospital Through a Multifaceted Quality Improvement Project. Clinical Infectious Diseases. Vol. 52 Issue 11, 1283-1290. DOI 10.1093/cid/cir188.Mori, C. (2014). A-Voiding Catastrophe Implementing a Nurse-Driven Protocol. MedSurg Nursing. 23 (1), 15-28.