QStudent #4: Evidence Based Practice

Evidence-Based Practice (EBP) is the topic for our forth post. EBP can, and usually does, go hand in hand with Quality Improvement (QI), which was our topic in the last post.

Evidence-Based Practice is defined as “integrating best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care” (QSEN, 2003).

QI projects should be based off of evidence from the research that has been done on a particular subject. All guidelines and protocols found in all healthcare facilities are produced based on research. Medical associations, hospital QI teams/committees, and other healthcare officials only implement what will produce the most benefits and least amount of risks or harm to their patients. In order to meet these criteria, interventions must have been researched and there must be evidence to support their effectiveness.

An example of a newly researched topic is the nurse driven foley catheter removal protocol. The research has shown that when nurses are given permission to remove foley catheters, without a physician order, provided that the patient no longer meets the criteria for the foley and the nurse deems it necessary, the number of healthcare associated urinary tract infections (CAUTIs) drops significantly (Burase, B., 2013). Read the full article below!

Some questions:

Do you agree or disagree with the nurse driven foley catheter removal protocol? Why or why not?

What Evidence Based Practice topics have you learned about? How will you implement that research into your practice?

http://www.apic.org/Resource_/TinyMceFileManager/Periodical_Images/CAUTI_PS1304-Winter-FINAL-2.pdf

74 thoughts on “QStudent #4: Evidence Based Practice

  1. The nurse driven foley catheter removal protocol, in my opinion, is a great thing. Nurses having the ability to remove catheters when they deem necessary not only can reduce infection but gives them a form of autonomy that empowers nurses. The idea of giving nurses the right to make calls similar to this is an idea that we should expand upon as long as it is in the patient’s best interest.

    1. Liz,
      I agree 100%, nurses are the backbones of health care. We provide all the bedside care and I think we know the patient so much more than the doctors. If we had the opportunity to make more decisions I think that there would be good outcomes, only if it was in the best interest of the patient. I believe that nurses are very smart and well educated, if they even had more in-training that would benefit the patients’ health and health care decisions would be so beneficial with the nurse and doctor working together.

    2. Liz,
      After reading the article, I did not think about how this decision making process would make a nurse feel. So, I like how you stated that this independence would empower the nurse. I think this is important because if a nurse is making confident decisions, ultimately the patient will benefit. I also like how you explored the possibility of revising other protocols to make them based upon a nurse’s judgement.

    3. Elizabeth,
      By placing patient’s interests at the top of the care is an ideal example of patient-centered-care. By empowering both patients and nurses on decision making about foley removal will decrease infection rates among heath care insitutions. Also, educating staff and patient’s on sooner foley removal is beneficial in order to prevent further complications.

    4. Liz,
      I totally agree with your comment. I think this can definitely help to reduce infections. Also, since the nurses are the ones with the patients all the time it would only make the most sense that they play a role in this part of their care. Nurses judgements are extremely important and this is a great way for them to use their knowledge for their patients best interest.

    5. Liz,

      I agree with your comment. Nurses are held accountable for both themselves and the patients. On top of this nurses are the ones who have the most continuous interaction with the patient. It would make sense that the nurse would be the one to determine when the foley is due to come out. I agree that the nurses should be given more responsibility to make calls pertaining to their patient.

  2. Implementing the nurse driven Foley catheter removal is an excellent idea. It allows the nurses to be move proactive in patients care and not have to wait on an order from a physician. The guidelines that need to be followed are easy to comprehend and basically if the patient falls under certain criteria the Foley catheter will stay or be removed. It also clearly tells the nurses if the patient has this Foley catheter due to, “ urologic surgery, bladder injury, pelvic surgery, and/or recent surgery involving structures contiguous with the bladder or urinary tract a physician’s order is needed” (Buras, 2013, p. 36). I think if it helps for better patient outcomes and lower infection rates due to catheter-associated urinary tract infections (CAUTIs) why not try to implement it into practice.

    1. I completely agree with your post and the approach that you are making about the Foley catheter being left in the patient if they do or do not need it. Given that nurses are implementing to remove the Foley catheter based on their decision can possible help decrease the rate of how any UTIs are caused.

      1. Patient-centered care should be base on the interest of the patient and nurses should base their care in respecting patient, minimize harm and providing optimum care for every patient. infection control should be an important plan of care and removal of Foley will decrease the risk of infection in the health care system. Educating staff and patient’s about Foley removal will be beneficial as well as preventing further complications.

    2. Shari,
      Thank you for pointing out that the guidelines indicated by the protocol are easy to comprehend. I made a similar point, saying the protocol was very specific. I believe this was key. Without clear cut guideline to follow, the nurses would not have been confident in their decision to keep a catheter in place or remove it. Without confident and safe decision making by the nurses, CAUTI rates would not have decreased at the rates in which they did.

    3. Shari,
      It is a useful nursing strategy that you are bringing by saying nurses need to be more proactive. It is also a good aspect of a time management. Nurse on the busy floor can prioritize care to patient’s by following clinical care guidelines and achieving a better outcome and decreasing CAUTI’s in the healthcare.

    4. Shari,
      I completely agree with you. I feel that the nurse driven foley catherter removal is a great idea that should be practiced in all health care facilities. It should probably fist be tested out on a few floors of a facility and proven to become accurate so that the whole hospital will see the postive outcome. The guidelines are very simple and acuurate for the nurses to follow also. As you stated, if the outcome is proven to lead to better patient outcomes and lower the risk of infection, it should definitly be taken into action.

    5. CAUTIs are a continuous problem that the healthcare systems faces so I to believe that implementing this protocol into practice is a great idea. I agree that this protocol allows the nurse to be more proactive in their patients care which is key because we know our patients best. The protocol is indeed straight to the point and easy which should make it easy to include in everyday practice. Giving the nurse some boundaries as to when it is not appropriate to remove Foley’s is also important.

  3. I think that the nurse implementing the Foley catheter removal was a great decision. This gives the nurses to become more independent in making decision based on the information they have to determine their decision. The nurse is in some way advocating for the patient and is doing what they think is best for them. If they have to decide if the patient has to keep the Foley catheter, they can assess them with the criteria provided in the protocol for that particular facility. Most of the time patients have catheters for after they have had surgeries and physician decides if the patients should keep it if they are able to assist themselves. I believe from experiences, that this was a good thing to do considering that urinary tract infections are one of the leading factors to cause other problems to patients and add additional cost to the facility. This is a good benefit for the patient and the facility.

    1. Anissa,
      Health care is so complicated these days, infections are so easy to get and it makes so much more sense to take the Foley out as early as possible and with the doctors not being there that often that gives the responsibility to the nurse which is perfectly okay because then we have the judgment to say when based on the patient. Yes it 100% benefits not only the patient but the facility as well and this can lead to wonderful outcomes for both parties.

    2. Anissa,
      Nurse’s autonomy on making a clinical decision about Foley removal is a great idea,because nurse is 1:1 contact with patient throughout the patient’s stay. Nurses role as a patient’s advocate plays an important role on decision making. Your idea about decreasing cost and promoting better health outcomes for patients is a troubleshooting two problems with a single step.

    3. Anissa,
      I completely agree with you. The idea of nurses deciding and implementing the removal of a foley catherter is a brillant idea. It allows the nurse, who spends more time with the patient to assess the need of the foley. This will not only lower the risk of UTI’s but it will also aide in shortening the patient’s stay at the hospital and direct the nurse into advocacy for the patient. This is an all around good implementation for the nurse, the patient and the facility and should be practiced more often.

    4. I believe it is great idea that nurses implement Foley catheter removal. What is your thought on the nurses that might abuse that power? I believe with having more patients to one nurse ratio, with the stress of managing time and priorities. Do you think that can more than likely happen? The protocol seems simple and efficient to follow but there is a loop hole in implementing care for the patient.

    5. Anissa, I agree with your comment. Allowing nurses to be more independent in decision making for their patients can increase patient care and outcomes. I like that you brought up the cost issue because that is a point that I did not think about with this article. Urinary tract infections do cause other issues with patients and at times complications. When that occurs the costs for the patient and for the hospital increases. Hospitals do not want to increase the costs for their facility and want to be pro active in making sure that does not occur when possible. One way is the nurse implementing the foley catheter removal. I also believe that nurses know what is best for the patients because they spend so much time with them, from the time they are admitted until they leave. They see all changes within the patient and are aware of all steps taken and done while they are under care. The nurses have the ability to decrease infection without waiting for a doctor. I think this is a great benefit for nurses, hospitals, patients, and the whole healthcare team.

  4. I think that the nurse judgment call on taking out Foleys is an excellent idea because if your patient has overcome certain expectations when the doctor or anyone else is not there then the patient doesn’t have to wait to have it taken out. I think that the nurse judgment is what truly matters. We are the ones that are with the patient the whole time, we do all the care, we know them and how their body works. To prevent infection you need to say on top of things such as this, Foleys are reservoirs for CAUTI’s and if you take it out before it can become one then you are one step to discharging that patient and making them better.

    1. Katarina,
      I think you made an excelled point when you said that if a patient has met the required criteria for catheter removal, why wait on a physician’s approval. The amount of time in which a foley catheter remains in the body is directly related to infection rates, so if it is safe to remove it should be done as soon as possible. I agree with you, a nurse’s judgement matters.

    2. It is an interesting idea that nursing judgement comes from critical thinking. Also, as you stated: “one step to discharging that patient and making them better”, is an excellent approach into nursing practice. Often times patients experience modesty, embarrassment, temporarily limited ADL’s and disturbed body image due to having a Foley catheters. By removing them sooner and without an order will benefit patients and improve their self-esteem.

    3. Katarina,
      I think you made a great point about not having to wait for the doctor to give permission to take the catheter out. This can help reduce the risk of infection because the nurse is the one with the patient and can make decisions quicker if necessary.

    4. Katarina,
      Nurses do tend to spend the most time with the patient. Therefore we are the ones that can make a clear assessment and decide whether the patient has developed into needing their foley removed or not. Sometimes doctors take a while to put orders in such as a removal of a foley. They sometimes wait untill discharge which is not good for the patient. Just like you, I beieve that the idea of a nurse being able to decide and implement catheter removal is a good idea.

    5. Katarina,
      I totally agree with you about the fact that the nurses are the ones that are caring for the patient’s the whole time. They should be able to make that decision and have the autonomy over when to discontinue the Foley catheter. Again if there are guidelines available to assist nurses in the appropriate time to remove Foley catheters. Then why not allow them to proceed, while at the same time giving patients the best possible outcome.

    6. Katarina,

      I think you make a very good point by saying that the nursing judgment is what truly matters. We spend most of our time with the patient so we know them better than the physician. If we are taught the proper education and given the protocol for removal of the catheter, it makes more sense that the nurse removes it to prevent infections.

    7. Katarina,
      I agree with you 100%, the nurse judgment is what truly matters. We are like you said the ones at the patients bed side most of the time, we are the ones performing the most care for the patient. Allowing the nurse to have the say whether or not a foley needs to be removed can decrease the likelihood of a foley catheter staying in to long and potentially causing an infection. Our goal is to discharge healthy patients and we cant do that if patients are constantly developing hospital acquired infections.

  5. I agree with the nurse driven foley catheter removal protocol based on the fact that the catheter- associated urinary tract infection (CAUTI) team spent three months researching, collaborating, partnering with other medical staff and making revisions. Due to the fact that the protocol was highly researched, it was able to be produced with very specific requirements for when a foley catheter is to be left in place or removed. Based on the protocol’s specificity, the nurses were then able to make knowledgeable and safe decisions regarding the care of their patient. The nurse’s independent decisions led to a significant decreased in CAUTIs. I also believe the educational opportunities provided to the nursing staff were a critical part of the process. Therefor, I agree with this protocol.

    1. Valerie,
      You did a great job bringing the evidence into this research. I think the nurses are the best choice for removing the catheters when necessary because, like you said, their decisions led to a significant decrease in CAUTIs, proving that nurses are very knowledgeable when it comes to make these kind of decisions for their patients.

    2. Val,
      I agree that in order to produce a new protocol research must be completed. I agree with the fact that these nurses took the time to look at this issue is important. The research showed that by implementing this new protocol, CAUTI’s are greatly decreased. In order to implement this new protocol, the nurses need to understand how to, so teaching the nurses about the protocol and allowing them to ask questions was a critical aspect to their research. I agree with Val, implementing this new protocol is a great way to decrease CAUTI’s.

    3. Valerie,
      I completely agree with the point you were making about the education for nurses on decreasing CAUTIs. If the nurses are constantly educated on specific things such as CAUTIs and how to decrease them , then they should be able to implement best to their knowledge and determining what is the right care for the patient. This protocol should be consider when the patient is showing signs that they should keep the Foley catheter.

  6. Valerie,
    You are bringing an evidence into practice, how the study was done and results that conducted clearly indicates to significant decrease on infection rate. Based on clinical protocol on Foley removal it is safe to make a decision about removing a Foley without an order. It is beneficial for nurses to get informed about better education on practice in order to achieve desired outcomes.

  7. The nurses action on removal of urinary Foley catheters aims to decrease the risk for urinary tract infections. I do agree with the article by Brooke Buras, because patient care team individualizes the intervention for patients who are at high risk for CAUTI’s. Nurse has an autonomy to initiate and perform removal of catheter if nurse determines patient can micturate within pre-determined time frame, It also represents interdisciplinary collaboration to implement practice to reach best care possible. In the future, as a member of interdisciplinary team, I will engage to recommendation given by Brooke Buras by attending to staff meetings or participating in-service activities by representing benefits of Foley removal by nurses will decrease risk of infection and achieve better patient outcomeS.

  8. I fully support the implementation of the Foley catheter protocol. Foley catheters need to be removed as soon as medically indicated. This might be a bit of a challenge for older adults who have limited mobility. For them it would be more to necessitate their care. There are benefits with the implementation of this protocol, such as decreased length of hospital stay, decreased medical cost, no sepsis, and no sentinel event. Protocols must be adhered to by all nurses in all clinical setting, which will result in better outcome.

    1. Marcia I agree with your post. The implementation of the Foley catheter protocol will not only decrease the risk of infection but also promote patient comfort. Foley catheters should be remove as early as possible except contraindicated. Older adult for example are at increase risk of infection and the insertion of Foley may alter their mobility which can also lead to more serious complications. Nurses should make it their responsibility to implement and follow the protocol and communicate with other caregivers to do the same for the benefit of the patient. Doing this empower nurses to be in control of patient plan of care and also promote patient-centered-care.

    2. I am interested in your thought about Foley catheter removal being a challenge for older adults with a limited mobility. I believe it all depends of the patient’s risks vs benefits and on the situation to base to remove the Foley catheter or not. However, inserting Foley catheters is not supposed to be used as a convenience for nurses but used to provide the best outcome for the patient.

      1. I agree that inserting a Foley catheter should not be used as a convenience for nurses. That was not the implication. This is a challenge for older adults because they might not be able to get up to go urinate, or experiencing urinary incontinence. This can lead to skin breakdown and even bacteria entering into the bloodstream.

    3. Marcia,
      These are also great points or factors that should be consider as well for everyone. Foley catheters can impact the hospital rate of cost for unnecessary them. They can also effect the length of stay because it can cause other issues other then the primary diagnosis. if the healthcare team actually consider other issues besides the infections it could help determine if they may need it.

  9. I think that the nurse implementing the foley catheter is a great idea for both the nurses and patients. The nurses are able to make decisions on their own, and this can also reduce the risk of infection for patients. Since nurses are the ones who spend the most time with their patients, this protocol would make the most sense because nurses can determine what is best for their patients. This is a great way for nurses to advocate for their patients and really become involved in their patients care, instead of just sending an order to the doctor. This is definitely a great protocol for everyone involved and it is especially in the best interest of the patient because it can help lower infection rates due to catheters.

    1. Kayla,

      I think that your post was great and addressed valid points. I agree with this protocol as well. I think that nurses are the ones to spend the most time with the patient and can determine what is best for them at any given moment. Now that nurses have the ability to remove that catheter with out having to wait for a doctors order the rate of infection reduces. Like you said it is a great protocol for everyone.

    2. I agree that nurse can makes decisions on their own about Foley catheter removal but the way the protocol is implemented by a series of checks and balances. It does not only utilize as a tool to determine the best clinical outcome for a patient. However, lets nurses collaborate as a team.

    3. Kayla,

      I completely agree with your post and like your thoughts on the idea of nurses advocating for their patients and taking an active role in reducing harm to them. Anything that helps decrease infection rate, especially with something that is a common issue in healthcare(CAUTIs), should be implemented. The nurse is the one who is spends the most time in the patient’s room so it would make sense that they would have a better idea when a catheter should be removed.

    4. Kayla,
      I agree with you about the nurses are the ones at the bed side most of the time and should be allowed to make decisions based on what is best for their patient. Nurses have a job and that is not to just follow orders given by the physician, but also be a advocate for their patient. If the nurse is able to recognize something is wrong based on their assessment, they should be able to act accordingly to the situation and not have to wait on a order from a physician. The new protocol is straight forward and as long as the nurse is able to follow the protocol and not cause any harm to their patient, the nurse driven foley catheter removal protocol is great intervention.

    5. Kayla,

      You brought up a great point about how this program is an example of a way nurses can advocate for their patients. It really shows how important nurses are in ensuring that the hospital protocols that are in place are in the best interest of the patients. Decreasing CAUTI’s is such an important goal to work towards. It is also an added benefit that this program gives nurses the autonomy to do what is best for their patients without waiting for a doctor’s order.

  10. I feel that nurse driven foley catheter removal protocol is truly a great initiative. Normally a nurse has to get an order from a doctor for catheter removal. With this addition in turnaround time the patient has an increased risk of infection. Moreover the interaction time between patient and nurse is much larger than that of patient and doctor. The amount of time spent between nurse and patient would make the nurse a greater expert in the patient’s ever changing daily condition. Nurses are on the front line of the care team, by granting them the autonomy to directly remove a catheter (when protocol requirements are met) not only increases positive patient outcomes, but also empowers nurses with another tool to provide great patient care.

    1. I totally agree with you Kevin. Nurses should take the responsibility of making patient comfortable. Nurses spend more time with patients which empower them to make decision about patient health. early removal of Foley decrease the risk of CAUTI.

    2. Kevin,
      Great post! I completely agree with what you said here. The nurse would have a better understanding of how the patient is changing and how their health condition is. Nurses understand when catheters are appropriate and understand when they are no longer needed so sense they spend more time day to day with the patient it would only make logical sense that they should be able to make the call to take the foley out.

    3. Kevin, Nurses are on the front line of the care team and I agree with you about giving them autonomy to directly remove the catheter it can increase positive patient outcomes and empowers nurses by giving them more independence with another way to provide great care. The nurse spends the most time with the patient, who better to have the ability to make a decision about foley catheter removal without an order from the doctor… I believe that risk for infection and risk for complications from infection will decrease with this protocol.

  11. I agree with your post! Since the nurse had the most contact with the patient the will be able to directly impact the patient with up the moment nursing interventions. I also agree with your statement that with input from the patient the nurse will be able to determine what is best for the patient. In conclusion this protocol is in the best interest for not only the patient but, as you said everyone involved. Great post!

  12. The nurse-driven foley catheter removal and protocal to prevent CAUTI’s is a very positivly driven implementation.It is also very simple and to the point reminding nurses of all the steps to access daily on patients with foleys and for patients when the foley is removed. If this protocal is followed by all the nurses, it will lead to postive outcomes. The actions of nurses is highly important and impacts various aspects involving the patient. I enjoyed reading the article and finding that a health care team got together to develop this idea because it definitly will decrease infection due to early removal of the device, which will in turn not only help the patient but helps the facility also. The team not only came up with this idea, but they also in turned helped educate the nursing staff become more comfortable with making such a big decision. This implemetation will allow nurses to be more involved with decision making and certainly promote a decrease in infection once it is enforced.

    1. India,
      I also like how a team of nurses were able to come together and find a solution to a serious problem. Even though the infection rate will not drop to 0%, it dropped which shows that their implementation of the nurse being able to discontinue foley catheters made improvements. I also like how the nurses were able to work together and teach other nurses the protocol and allow for them to become comfortable with the new protocol.

      1. The nurses also stated in the article that it is still a challenge to educate other nursing staff on the appropriate use of the protocol and making them feel comfortable about exercising autonomy in that decision making. So until then, the decreased rate of infection might never be reduced to 0%.

  13. CAUTI should be prevented at all time when a patient has a Foley and it is the duty of healthcare provider/nurse to implement the care of Foley catheter and the removal of Foley to prevent infection. early removal of Foley will decease the risk of infection as well as providing daily peri care. If these actions is implemented and follow by all caregivers or nurse it will promote patient-centered-care and positive outcome. This also will make nurses to be involved in the plan of care and decision making.

    1. Ighos,
      I agree with early removal of the Foley catheter there is a decrease in the rate of CAUTI’s. It is true that it is the provider and the nurse’s responsibility to prevent infections at all cost. That includes assessing for the best time for removal and providing perineal care when the Foley catheter needs to be in longer than expected.

  14. I believe that the implementation of a nurse foley removal protocol and post catheter was a good idea. A little device like the foley is most likely the least of a physicians worries so I believe they tend to forget or brush them off to the side and nurses tend to use foley’s as a connivence or don’t feel confident enough to speak up. As a result CAUTIs have always been a big problem for hospitals and patients. I liked how the CAUTI team let patients who have been affected by a CAUTI speak and share how they personally had been affected by CAUTIs to try to open nurses eyes. The protocols were short and straight forward so Implementing into everyday practice shouldn’t be a hassle, which is important especially when you have multiple patients. Overall I agreed with the protocol and loved how they not only addressed the removal of the foley but also what happens after the foley is removed and what should happen if there are any abnormalities.

    1. Lanina,
      That was an excellent post. I agree with that fact in order to implement a protocol, the nurses must know how too. I like how you said that the protocol was easy to follow, and it’s just taking these simple steps by the nurse to decrease the amount of infections dramatically. I also agree that sometimes catheters can be overlooked by physicians because they are so busy with many patients. Nurses have to wait for the physicians order in order to be able to remove their patient’s catheter. But, with this new protocol, nurses are able to implement care and decrease the amount of CAUTI’s.

  15. I agree with the nurse driven Foley catheter removal protocol. I believe it is an excellent way to reduce the amount of CAUTI’s. Having a catheter increases the patients risk of catching an infection, so the sooner the catheter is removed the better. The article stresses the importance of removing the catheter right away after observing that the patient doesn’t need it anymore. I strongly agree that checking catheters daily is a critical part of nursing care. Nurses should always have the best interest in mind for their patients, but sometimes nurses can become so busy that they put aside the task of taking out a catheter. However, with this new protocol, nurses were able to be educated by the CAUTI team about how critical it is to remove the catheter as soon as possible. Catheter care is very important in the nursing professions. Nurses are around the patients most of the day, they are patients advocates and have the right to implement care and determine when the catheter needs to be removed.

  16. Lanina,
    That was an excellent post. I agree with that fact in order to implement a protocol, the nurses must know how too. I like how you said that the protocol was easy to follow, and it’s just taking these simple steps by the nurse to decrease the amount of infections dramatically. I also agree that sometimes catheters can be overlooked by physicians because they are so busy with many patients. Nurses have to wait for the physicians order in order to be able to remove their patient’s catheter. But, with this new protocol, nurses are able to implement care and decrease the amount of CAUTI’s.

  17. I do agree with the nurse-driven foley catheter removal protocol. The purpose behind this protocol is to prevent CAUTI’s. This is great way to prevent infection. The nurse-driven foley catheter removal protocol combines evidence and research, both of which are then implemented into practice. The rate of infection is significantly reduced due to the nurse being able to advocate for the patient and remove the foley. Instead of noticing an infection beginning to develop, then having to contact the doctor and wait for an order to remove the foley. The ability to reduce patient’s susceptibility to developing foley catheter infections is very beneficial to the patient. I will implement what I have learned in this article into my practice. I will do so by following protocol and educating myself continuously.

    1. The continuous education for a nurse is essential to stay up to date on changes in evidence-based research. You also made an excellent point that since nurses interact with the patient more than the doctors. It is true that, as nurses, we can assess and determine removal of Foley catheter’s before an infection does develop.

  18. The nurse driven Foley catheter removal protocol is a great way to help prevent healthcare-associated infections (HAIs). Furthermore, it allows nurses to collaborate ideas and incorporates evidence-based practice for determining the best outcome. The Foley catheter removal protocol is a quick and convenient guideline to reference for nurses. Therefore, the protocol is utilize as a tool to monitor and asses the duration of Foley catheters among patients. However, this article also describes teamwork, education and feedback among staff members for optimal care.

  19. I do agree with the nurse driven Foley catheter removal protocol because it’s beneficial for the patient as well as the hospital. Within months after applying the protocol, catheter associated urinary tract infections decreased dramatically. However, I don’t think this should be implemented without the proper education. The institution as well as the CAUTI team in this article made sure every nurse knew about the new protocol, when it was appropriate to remove the catheter, and made sure all their questions were answered by providing individualized education. With the nurse being able to remove the catheter without a physicians order, it could prevent a lot of infections and save the healthcare facility a lot of money as well as the patient. In my opinion since it is valuable and helpful, I agree with the nurse driven Foley catheter removal protocol.

  20. I absolutely agree with this nurse driven protocol on removing Foley catheters. And I think it was great that the CAUTI team really tried to get nurses to understand this issue by telling them real life stories about patients being affected by these infections. This issue of these infections is of great importance because the patient suffers tremendously with CAUTi’s and I think is over-looked at times. Implementing this protocol is not only beneficial to the patient, but also the hospital because it will decrease costs and hospital stay. I also like that the CAUTI team took a lot of time to educate the nurse and get awareness of the protocol. Even though this puts a little more responsibility on the nurse it ultimately improves patient-centered care.

  21. I absolutely agree with this nurse driven protocol on removing Foley catheters. And I think it was great that the CAUTI team really tried to get nurses to understand this issue by telling them real life stories about patients being affected by these infections. This issue of these infections is of great importance because the patient suffers tremendously with CAUTi’s and I think is over-looked at times. Implementing this protocol is not only beneficial to the patient, but also the hospital because it will decrease costs and hospital stay. I also like that the CAUTI team took a lot of time to educate the nurse and get awareness of the protocol. Even though this puts a little more responsibility on the nurse it ultimately improves patient-centered care.

    1. I to liked the fact that the CAUTI team brought in real life patients who suffered from CAUTIs, I believe it helped the nurses open there eyes to see that Foley’s should be taken serious and used with caution not as a convince. You made a good point about the cost, I didn’t think about the hospital acquired cost for CAUTIs when I read the article but that is a good point. I agree that this protocol will overall improve patient-centered care.

    2. Annie,

      I agree with you. Using real life examples of the effects of CAUTIs on patients is a great way to reinforce the importance of prevention. I think sometimes we hear about the bad things that can happen, like infection, but it is so abstract that it doesn’t really have an affect on how someone acts. However, hearing a first hand account of the detrimental effects a CAUTI can have on someone can affect nurses enough so they will change their behavior and be more diligent in the care of catheters.

  22. I do agree with the nurse driven Foley Catheter removal protocol because it is a great way to prevent and reduce CAUTI’s. Prevention and reduction of CAUTI’s contributes to multiple factors because when they are decreased patient satisfaction goes up, hospital costs go down, and the nurses feel a sense of achievement from preventing their patient’s from acquiring CAUTI’s. Another awesome change was giving the nurse the autonomy to remove a Foley catheter, I feel as if it should have always been this way due to the fact the nurses are with the patient majority of their stay. Overall, this protocol was much needed and will continue to make a difference in the prevention and reduction of CAUTI’s.

  23. I think that implementing the nurse driven Foley catheter removal is a great decision. With nurses not having to wait on a physicians order they are able to be more independent with patient care. That to me is very important because nurses spend the most time with patients, the more independent they can be will help with better patient outcomes. The protocol, which was heavily researched, is straightforward where little confusion with the guidelines can occur. The CAUTI team spent months researching and making sure that their guidelines were very specific on when to remove and when to keep the catheter in. I think it can only benefit and help in decreasing CAUTI infection rates.

    1. Libby,

      I agree. I think that fact that the team devised such clear-cut protocols for nurses to remove Foley catheters is what makes this new program so successful. The flow sheet that guides you on to your next step, depending on whether or not your answer is yes or no, is such a great tool because it is easy to follow and understand. There is no chance for confusion.

    2. Libby, I agree, the nurses do spend the most time with the patient so they are able to see how the catheter looks from beginning and decide with their best discretion when they think the catheter needs to be changed or taken out to minimize the risk for infection. With out our nursing judgement it would take a while for the doctors to see each patient and decide whether or not for the foley to be removed

  24. I agree with this article and I think that nurse driven Foley catheter removal teams are a great idea. In hospitals today, nurses are the healthcare provider who have the most contact and time with the patient. The nurse is usually the first person to recognize a change in their patient, whether it is good or bad, because they have spent so much time around them. Therefore, it is logical that they would be the best at deciding whether or not a patient can have their catheter removed. Also, the fact that North Oak’s CAUTI rate plummeted after implementing the new protocols they devised for Foley catheter removal by nurses supports that importance of the new program.

  25. I strongly agree with the implementation of nurse driven foley catheter removal protocol. This protocol allows for nurses to make proper clinical judgments based on their assessment of the patient. This is also very convenient because the nurse does not have to get an order from the physician to discontinue the foley catheter. I also feel that the CAUTI team did a excellent job in letting patients who have been affected by a CAUTI speak about how they were personally affected. I believe this opened up some of the nurses eyes and allowed them to see from a different perspective how CAUTI’s can seriously affect someone’s life. Allowing nurses to make the decision of removing a foley catheter helps the nurse serve as an advocate for their patient as well. The nurse is at the bed side more than anyone on a patient’s health care team and it is important that the nurse to be able to determine what is best for their patients.

  26. I do believe in the removal foley protocal. As we have been learning in class, catheters are a high risk for infection, so I do believe it is in the patients best interest to have the foley removed upon the nurses best judgement when she or he thinks it is time for the catheter to be removed or changed out for a new one. Protocals are put in place based on what health care professionals have learned from other patients, by this they have learned what is best and what causes minimal infection for the patient.

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