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Getting the SKINny
Current events and issues of relevance to WOC Nurse practice, updates on new website features and links to external sources of interest to WOC nurses.
Friday, June 26, 2015

Catheter-Associated Urinary Tract Infections (CAUTI) are the most commonly reported hospital-acquired conditions, and the rates continue to rise. More than 560,000 patients develop CAUTI each year, leading to extended hospital stays, increased health care costs, and patient morbidity and mortality. The American Nurses' Association(ANA) recently spearheaded an initiative to reduce CAUTIs.  The ANA is now offering an innovative, streamlined, evidenced-based clinical tool to all nurses developed by leading experts.

Hospital-acquired conditions (HACs) are a major threat to patient safety with costs estimated to be $33 billion.  The U.S. Department of Health and Human Services (HHS) has identified a national strategy to reduce multiple health care--associated infections, a costly medical safety issue. Nurses are key players in the efforts to reduce infections, prevent avoidable harm, morbidity and mortality, and reduce cost.

ANA has partnered with the Centers for Medicare and Medicaid Services (CMS) Partnership for Patients in an effort to reduce avoidable HACs by 40% and reduce 30-day hospital readmissions by 20% compared to 2010. This partnership has already contributed to a significant reduction in multiple HACs and preventable 30-day readmissions. The HHS reported national reductions in adverse drug events, falls, some infections and other forms of harm are estimated to have prevented approximately 15,000 deaths in hospitals, decreased health care costs by $4.1 billion, and prevented 560,000 patient harms in 2011 and 2012.  

While the Centers for Disease Control and Prevention (CDC) report the rates of most HACs are improving, the rates of CAUTI continue to rise.  CAUTIs are the most commonly reported HAC in the United States. Among urinary tract infections acquired in the hospital, approximately 75% are associated with urinary catheters. Therefore, it is important that the overuse of urinary catheters is reduced, and should be removed per nurse-driven evidence-based protocols. Nursing research has found there is no universally accepted evidence-based tool to reduce CAUTI as there are for other HAIs.  The ANA took note of this tool gap and made CAUTI reduction a priority. As a result of their efforts, an evidence-based, user-friendly tool is now available to nurses to help prevent CAUTI in hospitals.

There are three areas to improve evidence-based clinical care to reduce the rate of CAUTI: (1) prevention of inappropriate short-term catheter use, (2) nurse-driven timely removal of urinary catheters, and (3) urinary catheter care during placement. Nursing screening and assessment and evidence-based management of urinary retention and incontinence is essential to reduce catheter overuse. ANA identified the opportunity to fill the tool gap and develop a steam lined evidence-based tool to reduce CAUTI.

Using a consensus process, ANA assembled a technical expert panel of nursing clinical experts to develop and disseminate an evidence-based CAUTI reduction tool for nurses. Members of this panel included ANA members, representatives from its specialty nursing organizational affiliates, including the WOCN Society, infection control specialists and patient safety authorities. The resulting one-page tool is based on the CDC’s 2009 “Guideline for Prevention of Catheter-Associated Urinary Tract Infections.” The evidence-based tool incorporates an algorithm to determine if a urinary catheter is appropriate based on nursing screening and assessments, as well as alternatives for retention and incontinence; timely removal; and a checklist on catheter insertion, cues for essential maintenance and post-removal care.

The tool is available following this link.

http://www.nursingworld.org/CAUTI-Tool


Monday, June 01, 2015
The 47th Annual Conference of the Wound, Ostomy and Continence Nurses Society is scheduled for June 6-10, 2015 in San Antonio, Texas.
 
Attending a National Conference seems to get more challenging each year, as many employers have drastically reduced education and travel budgets.  Clinicians can no longer count on the financial support of their employers.  And inidviduals bearing the bulk of conference costs have to balance multiple uses for their disposable income.  Given these challenges, it is still important for all nurses, and particularly specialty nurses, to attend a national conference on an annual or biannual basis. 
 
When it comes to improving your own professional advancement, nothing compares to attendance at a National Conference.  Continuing education is increasingly available in journals and numerous web-based activities.  But conferences are really the best way to hear about the most recent advancements in the specialty practice.  Poster abstracts at a National Confence can present data too new to be available in print.  In comparison, journal articles may be based on research data that is many months or even several years old, given the review process for journal publication. 
 
National Conferences also provide invaluable networking opportunities.  A clinician is able to find a new mentor or clinical resource, to meet new friends and reconnect with old friends, to learn about a current practice innovation occurring at another facility or agency, and get exposure to a wide and diverse variety of product vendors.  None of these opportunities can be realized in a 'one-stop' approach like the experience of a National Conference.
 
And lastly, it is a wonderful way to recharge your personal battery.  Health care today is stressful and demanding in all practice settings.  It is easy to get get bogged down and to lose perspective.  Stepping away from the daily grind and engaging with other professionals in a stimulating environment might be just the boost you need to help you face the day-to-day challenges of our complex patients.

Wednesday, May 06, 2015
In recognition of the impact ethical nursing practice has on patient outcomes and the quality of care, 2015 is designated as the "Year of Ethics."  Keeping with this focus, the theme for National Nurses Week (May 6-12, 2015) is "Ethical Practice. Quality Care."
 
*  All nurses have a critical responsibility to uphold the highest level of quality and ethical standards in their practice to ensure the delivery of superior health care to patients, families and society.
 
*  Ethics is an essential component of everyday nursing practice across all specialties and settings and is inextricably linked to quality care.
 
* The revised Code of Ethics for Nurses with Interpretive Statements ensures that it is applicable to modern clinical practice and advances in quality, keeping pace with transformations in health care..  This Code serves as a guide for carrying out nursing responsibilities in a manner consistent with quality nursing care and ethical obligations of the profession.
 
Nurses are recognized by the public for upholding high ethical standards and are highly trusted as a result.  An annual Gallop survey shows the public has ranked the nursing as the top profession for honesthy and ethical standards for 13 straight years.
 
Nurses are incorporating ways to measure the value of their services into national performance measurement programs.  Nurses are using that data in order to develop strategies to improve health care quality.  Nursing staffing has been demonstrated to be a critical component of quality care.
 
WOC nurses are nurses first, and specialty nurses second.  In that realm, we use the Code of Ethics as the basis for our specialty nursing practice.  I close this by thanking you for being a part of the nrsing profession.  As a professional, remember to be aware of your professional standards, know the law and rules that govern your licensure, take an active role in your professional organizations and become involved in the legislative process.  My salute to all my nursing colleagues during our special week.

Monday, April 13, 2015
Attending a National Conference seems to get more challenging each year, as many employers have drastically reduced education and travel budgets.  Clinicians can no longer count on the financial support of their employers.  And inidviduals bearing the bulk of conference costs have to balance multiple uses for their disposable income.  Given these challenges, it is still important for all nurses, and particularly specialty nurses, to attend a national conference on an annual or biannual basis. 
 
When it comes to improving your own professional advancement, nothing compares to attendance at a National Conference.  Continuing education is increasingly available in journals and numerous web-based activities.  But conferences are really the best way to hear about the most recent advancements in the specialty practice.  Poster abstracts at a National Confence can present data too new to be available in print.  In comparison, journal articles may be based on research data that is many months or even several years old, given the review process for journal publication. 
 
National Conferences also provide invaluable networking opportunities.  A clinician is able to find a new mentor or clinical resource, to meet new friends and reconnect with old friends, to learn about a current practice innovation occurring at another facility or agency, and get exposure to a wide and diverse variety of product vendors.  None of these opportunities can be realized in a 'one-stop' approach like the experience of a National Conference.
 
And lastly, it is a wonderful way to recharge your personal battery.  Health care today is stressful and demanding in all practice settings.  It is easy to get get bogged down and to lose perspective.  Stepping away from the daily grind and engaging with other professionals in a stimulating environment might be just the boost you need to help you face the day-to-day challenges of our complex patients.

Wednesday, March 04, 2015
Recently, the American Board of Internal Medicine (ABIM toughened the maintenance of certification requirements for physicians who are Board certified in Internal Medicine, causing a storm of controversy in the medical community, questioning whether a recertification exam is really a reliable gauge of physician knowledge, judgment, skills and familiarity with new standards.  The debate being aired out in that professional community should cause all of us to pause and ponder some of the same questions and processes in our specialty.
 
The idea of specialty certification for physicians, as well as nurses dates back many years as a way to protect the public and ensure that specialists do, in fact, have the appropriate knowledge, skills and training.  The idea of certification was originally conceived as a one time event, similar to licensure examination.  But as the pace of healthcare advancement and science changed so rapidly, specialty boards began to question whether a single test was the best way to ensure competency.  More frequent activities were deemed to be necessary to communicate to the public that professionals were keeping pace with advancements in their practice.  Our specialty nursing certification requires a 5 year recertification which is much more stringent that the 10 year recertification now required by the ABIM.  They are also 'grandfathering' older fellows completing training prior to 1990, an option not available in our nursing specialty certification. 
 
Yes, it is true that many healthcare professionals are dedicated to keeping up with advancements in their specialty practice.  There are many who would be meeting the equivalent of recertification requirements in their regular job duties.  There are a variety of ways to keep pace with advancements.  It is even easier to access information today in this digital world.  But we also must admit that there are those among us who would never seek out educational opportunities if they were not required to do so.  People who display specialty credentials, but whose practices clearly have not kept pace with scientific advances, give all of us a black eye.
 
Obtaining continuing education in one's specialty may be a vehicle to gain knowledge, but acquisition of knowlege alone is not a measure of one's competence.  The certification/recertification process is an attempt to measure judgment based on knowledge and prevailing standards.  The certification and recertification process may be a flawed method of ensuring competence in a specialty, but it is the best that we have right now.  It is much more than time-consuming busy work designed to support a certification structure.  It is one step in our ongoing efforts to improve patient care.
About the Author

Lee Ann Krapfl
Wound, Ostomy and Continence Nurse (1991 – present) at Mercy Medical Center in Dubuque, IA. Practices the full scope of wound, ostomy and continence care for adult and pediatric patients. Provides WOC nursing services in acute care, long term care, home care and outpatient settings. Has been an active member of the WOCN Society, most recently serving on the Council as the Chair of the Public Policy Committee.