Centers for Medicare and Medicaid Services (CMS) Essay

Procedure Until recently it was non uncommon for patient of of ofs admitted to an acute premeditation deftness to buzz off an indwelling catheter anchored for supererogatory reasons. Patients that came in thru the emergency discussion section typically were sent to the social units with unnecessary indwelling catheters in place and it was not unusual for a surgery patient to have an indwelling catheter anchored beforehand or during a procedure. Once a patient was admitted and was transported to the units treat would overly anchor indwelling catheters for fivefold unnecessary reasons.These Catheters could be anchored for many unnecessary days and in approximately cases until dis post. In 2008 the Centers for Medi sh ar and Medicaid Services (CMS) initiated a policy diversity to no yearlong reimburse hospitals for additional cost that were incurred payable to catheter associated urinary tract infections or in anformer(a) term CAUTIs (Palmer, 2013). The CMS recognize that CAUTIs atomic number 18 the close common type of hospital acquired infection. The CMS as well as regaind that when license based practices are initiated and followed they can be extremely preventable, leading to a potpourri in practice.Current PracticeUp until 2012 there were no policies pertaining to the anchoring or removal of indwelling catheters in the facility I work for. Nursing would complete their assessment of the patients and per their discretion they would ensure if an indwelling catheter by their standards is appropriate. An indwelling catheter could be deemed appropriate according to nursing for multiple reasons including urinary incontinence, retention, convenience, pressure ulcers, strict output recordings and in some cases per patient request. The carry was required to obtain an nightspot from the physician in order to anchor a catheter and most cases the physician would comply. subsequently the nurse anchored a catheter it would most likely stay an chored until discharge or until and order was given by the physician to discontinue it.These procedures lead to the unnecessary duration of times catheters were kept in place and the need for adjustment.Rational and descriptionEven though in 2008 Medicare and Medicaid reassignd their reimbursement policies it wasnt unit 2012 when the mutual commission added guidelines for the taproom of CAUTIs and the facility I work for initiated sort. Prior to the Joint Commissions unfermented guidelines circumspection relied on nursing to piddle the proper decisions for their patients and back up nursing when they deemed it necessary to anchor a catheter. In 2012 when the guidelines were initiated management chose to follow them when evidence 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 ca theter was necessary.The team responsible for these changes acknowlight-emitting diodeged the clinical manager in charge of all medical surgical units, each medical surgical unit manager where these changes were to take 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 implement nurse driven protocols that would be effective 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 complete a catheter when it was deemed unnecessary. After the protocols were initiated management began to notice a step-down in the use of catheters and a decrease in CAUTIs resulting in cost effectiveness and higher patient satisfaction scores for the hospital.ReferencesBernard, Michael S, Hunter, Kathleen F, Moore, Katherine N. (2012). A Review of S trategies toDecrease the succession of immanent Urethral Catheters and Potentially Reduce the Incidenceof Catheter-Associated urinary folder 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.Hooton, T., Bradley, S., Cardenas, D., Colgan, R., Geerlings, S., Rice, J., Nicolle, L. (2010). Diagnosis, barroom, and treatment of catheter-associated urinary click infection in adults 2009 international clinical practice guidelinges from the infectious diseases partnership 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 physical exercise at a Veterans Affairs Hospital Through a varied Quality Improvement Project. Clinical Infec tious Diseases. Vol. 52 hack 11, 1283-1290. inside 10.1093/cid/cir188.Mori, C. (2014). A-Voiding Catastrophe Implementing a Nurse-Driven Protocol. MedSurg Nursing. 23 (1), 15-28.Clinical ImplicationsAn implemented change that would reduce the rates of CAUTIs in acute health care facilities would be evidence based nurse lead protocols. The protocols would not whole benefit the hospitals but they would also contribute to patient satisfaction scores. slightly 80% of all nosocomial infections are contributed to CAUTIs and are the most common form of nosocomial infections (Knoll, 2011). Some 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 cheered treatment of antibiotic therapy. antibiotic drug therapy could last up to 7 days which could result in an profit of stay (Hooton et al., 2010). Evidence supports that when nurse led or informatic s led interventions are implemented CAUTIs were decreased (Bernard, 2012). The interventions that assist in the prevention ofCAUTIs are protocol bundles that include insertion policies, removal policies, concern 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 diversitysIf 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(p) 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 r esearch paper would have a positive impact on fall this data. If the protocols are implemented not wholly would they benefit the patients but they would also benefit the hospitals. Patients would have a decrease adventure 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 direct impact on them on 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 vernal protocols would take effect. The nurse educators would be the ones educating rung on the new protocols and would be a vital part of evaluating the protocols along with suggesting and implementing changes if necessary. Change would decease in grades with the first spot being the unfreezing stage.This stage occurs when stakeholders receive the entropy on a change along with supporting evidence to why the change would be beneficial. The second step 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 go 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 another(prenominal) nurses have been following the same policies and procedures for many years and may be noncompliant due to habit. Another barrier may be the patients, support fliers or patients that frequent the hospital regularly have become customary 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. counsel 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 qualification the necessary ch anges with wholly the staff that would be involved (Cherry & Jacob, 2010). Management and the nursing educator should give 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(prenominal) 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, definite surgical procedures, healing for pressure ulcers in incontinent patients and in palliative care patients (Gray, 2010). As research has provided indwelling catheters should be placed only when deemed necessary and removed when they are unnecessary. The facility I work for along with step controland the nursing educator put together CAUTI prevention strategies using evidence based research practices.Protocols were initiated in the patients el ectronic medical record (EMR) that would assist nursing in making the right decision whether to cath or not and when it would be appropriate to remove an indwelling catheter. The charge nurses monitor the number 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 needed 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). present-day(a) 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.