Evaluation of a Difficult Urinary Catheter Team in an Academic Medical Center

Evaluation of a Difficult Urinary Catheter Team in an Academic Medical Center by David C. Price MSN, University of Tennessee, Knoxville, 1992 BSN, University of Tennessee, Knoxville, 1985 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University May 2018 Abstract The placement of an indwelling urinary catheter (IUC) is a commonly performed clinical procedure which may become challenging for the clinician and painful for the patient. In response to urologic complications attributed to repeated failed IUC insertion attempts by nurses, a difficult urinary catheter (DUC) team program was launched in October 2012. The purpose of the doctoral project was to conduct a quality improvement evaluation of the effectiveness of the DUC team program using retrospective data from May 1, 2013 through May 31, 2017. Benner’s novice to expert model was chosen as the theoretical framework to guide the additional training, critical thinking, problem-solving, and skill acquisition necessary for team member inclusion. The practice-focused question for the project answered whether DUC team nurses, through advanced training and demonstrated procedural competence, have been effective with DUC insertions. Sources of evidence included primary and secondary articles in peer-reviewed journals, as well as clinical evidence collected from internal sources. During the project time-line, 463 DUC team consultations were recorded with an insertion success rate of 89.6%. Based on the DUC team concept, additional didactic content and simulation training may be developed for other cognitive and skill-based clinical procedures. The implications for positive social change include improved patient safety and comfort, as well as cost savings for the organization and overall healthcare system.The placement of an indwelling urinary catheter (IUC) is a commonly performed clinical procedure which may become challenging for the clinician and painful for the patient. In response to urologic complications attributed to repeated failed IUC insertion attempts by nurses, a difficult urinary catheter (DUC) team program was launched in October 2012. The purpose of the doctoral project was to conduct a quality improvement evaluation of the effectiveness of the DUC team program using retrospective data from May 1, 2013 through May 31, 2017. Benner’s novice to expert model was chosen as the theoretical framework to guide the additional training, critical thinking, problem-solving, and skill acquisition necessary for team member inclusion. The practice-focused question for the project answered whether DUC team nurses, through advanced training and demonstrated procedural competence, have been effective with DUC insertions. Sources of evidence included primary and secondary articles in peer-reviewed journals, as well as clinical evidence collected from internal sources. During the project time-line, 463 DUC team consultations were recorded with an insertion success rate of 89.6%. Based on the DUC team concept, additional didactic content and simulation training may be developed for other cognitive and skill-based clinical procedures. The implications for positive social change include improved patient safety and comfort, as well as cost savings for the organization and overall healthcare system. Evaluation of a Difficult Urinary Catheter Team in an Academic Medical Center by David C. Price MSN, University of Tennessee, Knoxville, 1992 BSN, University of Tennessee, Knoxville, 1985 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University May 2018 Dedication This project is dedicated to my mother and other family members for their unconditional understanding of missed holidays and special occasions, as I struggled to balance my work and school commitments. Without their continued support and encouragement, my dream of a terminal degree in nursing would not have been realized. Acknowledgments I would first like to acknowledge my practicum preceptors and mentors: Teresa Stephens, PhD, MSN, RN, CNE, nursing research coordinator; Susan Marti, MSN, APRN, ACNS-BC, CMSRN, clinical nurse specialist; Theresa Renfro, MSN, RN, NEBC, nursing finance director; and Janell Cecil, MSN, RN, NEA-BC, senior vice president and chief nursing officer. Their willingness to allow me to intrude upon their work time, network, and collaborate with other professionals provided countless learning opportunities that would have otherwise been unachievable. I would also like to recognize the individuals who assisted me with the collection and analysis of the organizational data necessary for the completion of my project: Jennifer Radtke MSN, RN, CEN, TCRN, CIC and Tarry Samsel BSN, RN, CIC, infection prevention specialists; Justin Wolfe, performance improvement coordinator; Natalie E. Freeman, PhD, data management and research manager; Eric Heidel, PhD, associate professor of biostatistics; and Clint Wisdom, BSN RN MBA, LSSBB, pathways department assistant director. Finally, I would like to thank my DNP project committee faculty members: Dr. Nancy Hadley, second committee member; Dr. Mary Catherine Garner, university research review (URR); Dr. Janice Long, program coordinator; and special thanks to my DNP project chair, Dr. Joanne (Jody) Minnick. Her continued patience with my endless questions, guidance through unfamiliar and often intimidating processes, and words of encouragement at just the right time provided the support I needed to complete my final DNP program requirement.