Catheter-Associated Urinary Tract Infection Reduction in Critical Care Units Essay

Itoro Abatai
RE: Discussion – Week 4
COLLAPSE
Selecting a Policy Analysis Framework

Health policy often dictates clinical care protocols and helps physicians and other providers make evidence-based decisions about patient care. However, they warrant review if recommended actions are conflicting, clinically ineffective, cost-prohibitive, or result in questionable health improvements. Health policy guides many decisions clinicians make about patient care in preventive, acute, chronic, and end-of-life care. This can prompt them to reassess prevailing policies in specific contexts or with unique populations. As health policies profoundly impact patient care and the overall health of populations, health policy analysis is a critical research tool for primary care providers (Engelman, Case, Meeks, & Fetters, 2019). Catheter-Associated Urinary Tract Infection Reduction in Critical Care Units Essay

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Healthcare policy on Catheter-associated Urinary tract infection

Provisions in the American Medicare Modernization Act of 2003 and the Reduction Act of 2005 created the foundation for government-funded reimbursement to be limited for healthcare-associated infections. In 2008, the incidence of CAUTI reached almost two million cases per year, and the Centers of Medicare and Medicaid Services (CMMS) deemed CAUTI a “never event,” limiting reimbursement (Galiczewski, 2016). A never event is considered preventable. Preventative measures such as educational strategies, catheter avoidance, policies for catheter insertion, catheter selection, daily necessity review, and limiting catheter days have shown success in decreasing CAUTI rates nationally and abroad (Galiczewski, 2016).

Bardach’s eightfold policy analysis framework

Eugene Bardach established an eightfold policy analysis framework that is commonly applied in policy and administration research and public health. Bardach’s eightfold policy analysis framework includes defining the problem, assembling evidence, constructing alternatives, selecting criteria, projecting outcomes, confronting trade-offs, (7) decision-making, and sharing the process results. If we break down Bardach’s eightfold policy analysis framework using the same example to illustrate how Bardach’s more comprehensive approach can similarly illustrate the utility of policy on Catheter-associated Urinary tract infection Catheter-Associated Urinary Tract Infection Reduction in Critical Care Units Essay

Step 1. Define the problem: First, primary care researchers must define the problem in health policy analysis. Defining the problem is critical in policy analysis because it guides the research method and helps establish the structure for communicating the results (Engelman, Case, Meeks, & Fetters, 2019). The article by Conway, Pogorzelska, Larson, & Stone (2012) stated that multiple public policy incentives and private sector quality initiatives aim to reduce CAUTI and its resultant morbidity, mortality, and cost. Once the background is synthesized, a problem statement can be developed that will allow for improved public health policies (Engelman, Case, Meeks, & Fetters, 2019). Catheter-Associated Urinary Tract Infection Reduction in Critical Care Units Essay

Step 2. Assemble the evidence: Step 2 involves assembling the evidenceby investigating the background, trends, and systematic, institutional, interpersonal or financial barriers and facilitators to successful resolution (Engelman, Case, Meeks, & Fetters, 2019). The research design and scope of the study will dictate the approach to analysis. The data were obtained from a large nationwide, cross-sectional survey of IPC departments designed to examine the cost-effectiveness of infection prevention and control practices (Conway, Pogorzelska, Larson, & Stone 2012). Institutional review boards reviewed and approved study procedures (Conway, Pogorzelska, Larson, & Stone 2012). This process permits a comprehensive understanding of the problem to investigate and allows for a more focused literature review on policies, best practices, and key barriers as the policy focus evolves (Engelman, Case, Meeks, & Fetters, 2019). Catheter-Associated Urinary Tract Infection Reduction in Critical Care Units Essay

Step 3. Construct policy alternatives: Step 3 of Bardach’s framework, constructing policy alternatives, guides primary care researchers to consider the advantages and disadvantages of each policy alternative and consider using alternative approaches to policy alone or in combination with other alternatives (Engelman, Case, Meeks, & Fetters, 2019). Step 3, an explicit description of the assumptions and positions being made for each policy alternative, is critical for the successful implementation of the policy. The results of our multivariable analyses suggest that participation in the Keystone Bladder Bundle Initiative may have contributed to the increased odds of regular use of portable bladder ultrasound scanners, as well as urinary catheter reminders or stop-orders, or nurse-initiated catheter discontinuation (Saint et al., 2013). The use of a portable bladder scanner may serve as an alternative to catheterization. Catheter-Associated Urinary Tract Infection Reduction in Critical Care Units Essay

Step 4. Select the criteria: Step 4 in Bardach’s framework selects the criteria and explores how alternatives can be measured and evaluated (Engelman, Case, Meeks, & Fetters, 2019). This is an essential step in determining the effectiveness of current (Engelman, Case, Meeks, & Fetters, 2019). Criteria can be established based on prior research and include each alternative’s feasibility, given local, epidemiological, political, and socioeconomic conditions (Engelman, Case, Meeks, & Fetters, 2019). Considerations can also include primary health outcomes, cost-effectiveness, the feasibility of implementation, acceptability, political feasibility, sustainability, and practicality (Engelman, Case, Meeks, & Fetters, 2019). Catheter-Associated Urinary Tract Infection Reduction in Critical Care Units Essay

Step 5. Projecting the outcomes: Often considered the most challenging step, projecting the outcomes is an opportunity to consider how realistic or viable each alternative policy outcome is given resource constraints (Engelman, Case, Meeks, & Fetters, 2019). In order to project the outcomes, primary care researchers must consider both the direction and the magnitude of the outcome. In evaluating the alternatives, physicians can include any clinical or research knowledge on the cost-effectiveness of the alternative (Engelman, Case, Meeks, & Fetters, 2019). The decline in the national CAUTI rate led to decreased healthcare costs and improved patient mortality and morbidity (Galiczewski, 2016). A higher standard of care has resulted in better patient outcomes (Galiczewski, 2016). Catheter-Associated Urinary Tract Infection Reduction in Critical Care Units Essay

Step 6. Confronting trade-offs: In step 6, confronting trade-offs, the primary care researcher needs to consider the trade-offs between and within each policy alternative. The trade-offs need to be considered in terms of the criteria by which they can be evaluated, and the criteria themselves need to be weighted (Engelman, Case, Meeks, & Fetters, 2019).

Step 7. Decision-making: Decision-making is an opportunity for primary care researchers to go through the process of clarifying the costs and benefits in order to present a final decision to stakeholders (Engelman, Case, Meeks, & Fetters, 2019). This will ensure that their explanations are clear when they explain the costs and benefits, and the logic behind their choice is sound and easy to follow (Engelman, Case, Meeks, & Fetters, 2019). Catheter-Associated Urinary Tract Infection Reduction in Critical Care Units Essay

Step 8. Sharing the results of the process: Sharing the results of the process may take the form of a narrative, and primary care researchers need to clearly understand the reasons behind their decision (Engelman, Case, Meeks, & Fetters, 2019). Most importantly, primary care researchers need to define the audience and pitch the story to a target population, keeping in mind both the larger political environment and the story-telling medium (Engelman, Case, Meeks, & Fetters, 2019). Catheter-Associated Urinary Tract Infection Reduction in Critical Care Units Essay

Other stages in the policy process might an analysis framework provide guidance

Another useful framework model is the four stages of Plan-do-study-act (PDSA) (Van Decker, Bosch, Murphy, 2021). Based on CDC and IHI guidelines and delineated by the Healthcare Infection Control Practices Advisory Committee 2009 guidelines, the CAUTI task force drafted interventions based on available guidelines and then distributed intervention protocols to stakeholders (Van Decker, Bosch, Murphy, 2021). The CAUTI is rated monthly, and each PDSA cycle’s impact is evaluated using a standard run chart. The CAUTI task force used the PDSA cycle framework to serially implement initiatives to reduce CAUTI rates (Van Decker, Bosch, Murphy, 2021). The CAUTI task force created nursing and physician education courses targeting the preventability of CAUTIs and appropriate insertion and maintenance techniques of indwelling Foley catheters. The CAUTI task force created and published a list of hospital-approved indications for indwelling urinary devices, which they based on national guidelines and had reviewed by the urology department for their specialty-specific indications for bladder management (Van Decker, Bosch, Murphy, 2021) Catheter-Associated Urinary Tract Infection Reduction in Critical Care Units Essay

References

Engelman, A., Case, B., Meeks, L., & Fetters, M. D (2019). Conducting health policy analysis in primary care research: turning clinical ideas into action. Family Medicine and Community Health, 7, doi: 10.1136/fmch-2018-000076

Galiczewski, J. M., (2016). Healthcare policy and catheter-associated urinary tract infection. Annals of Nursing Research, 1(2), 1011. Retrieved from https://austinpublishinggroup.com/nursing-research-practice/fulltext/anrp-v1-id1011.php.

Conway, L. J., Pogorzelska, M., Larson, E., & Stone, P. W. (2012). Adoption of policies to prevent catheter-associated urinary tract infections in the United States intensive care units. American journal of infection control, 40(8), 705–710. https://doi.org/10.1016/j.ajic.2011.09.020. Catheter-Associated Urinary Tract Infection Reduction in Critical Care Units Essay

Saint, S., Greene, M. T., Kowalski, C. P., Watson, S. R., Hofer, T. P., & Krein, S. L. (2013). Preventing catheter-associated urinary tract infection in the United States: a national comparative study. JAMA internal medicine, 173(10), 874–879. https://doi.org/10.1001/jamainternmed.2013.101

Van Decker, S, G., Bosch. N., Murphy, J. (2021). Catheter-associated urinary tract infection reduction in critical care units: a bundled care model

BMJ Open Quality, 10. doi: 10.1136/bmjoq-2021-001534 Catheter-Associated Urinary Tract Infection Reduction in Critical Care Units Essay