Patients who use the Catheter for a prolonged time are at risk of contracting UTI and therefore it is prudent for caregivers to develop strategies of reducing the use of indwelling urinary catheter use. Use of catheter increases the risk of contracting other urinary tract related diseases which risk the wellbeing of the patient ( Mavin & Mills, 2015) . However, extended research by the caregivers has shown that reducing catheter use period can help reduce the risks that are associated with the prolonged use of the Catheter in patients. Nurses are at the forefront in developing strategies that ensure limited time use of the catheter in patients.
A four-step procedure is applied in the removal of the urinary catheter. The physician must identify that a patient has a catheter, then the physician must deduce that the catheter is no longer necessary, the removal order must be drafted by the doctor, and the nurses remove the catheter upon the physician orders ( Meddings, 2013) . Some of the intervention methods that can be used in reducing the use of Urinary Cather use in patients include use catheter reminder, stop orders and nurse-initiated removal protocol.
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According to Meddings (2013), reminders work to remind the nurses that the catheter in place should be removed because they are no longer needed or need to be emptied. Stop orders, prompt nurses, to remove the catheters based on given criteria such as 12 hours after surgery. A wide range of technology can be used to implement these intervention methods such as computer-generated stop orders or reminders. The reminders may be printed in a simple chart which indicates a post-procedure order, catheter bag or sticker reminder on the chart or a verbal reminder from the caregivers. All of these intervention strategies can be implemented by physicians or nurses. Nurses directed intervention involve activities such as reminding the physicians to order catheter removal, allowing nurses to remove unnecessary catheters or those that do not meet the criteria and nurse empowered stop orders.
Nurses can use catheter reminders as an intervention method. The reminder function by reminding the nurse that the catheter was still in place and needed to be removed if it is no longer in use. A different form of reminders is used by the nurses that include a list of appropriate indications. A significant decrease in catheter-associated urinary tract infections (CAUTIs), catheterization duration and the length of the day can prompt other care centres to implement similar strategies ( Meddings, 2013) .
Tools for quality improvement
To improve the quality of services the nurses provide to the nurses it is important to identify the various tools that can help in the quality improvement process. For patients with an indwelling catheter, the nurses can use a well-structured method to ensure that they reduce UTI prevention. For the implementation of each of these approaches, the nurses must have the standard procedure as a way of improving quality.
Nurses are required to help the patients clean the areas around catheter opening on a daily basis. Catheter users are at risk of contracting disease-causing organisms near the opening. In other times urine may touch the opening which also increases UTI risks. Cleaning catheter opening on a daily basis reduces the risk of contracting UTIs ( Mavin & Mills, 2015) . Nurses are required to remind the patients to clean the catheter with soaps and water. After every bowel movement, the patients must clean the rectal areas thoroughly. Nurses should ensure that the patient keeps the drainage bag lower than the bladder to prevent the urine already in the bag from flowing back into the bladder. Caregivers are supposed to help empty or remind the patient to empty the bag when it is full and in times of little urine production, the patient must empty the bag after every eight hours. The nurses must follow up on the process of changing the indwelling catheters on a monthly basis. Nurses should emphasize on patients cleaning their hands after touching the urine.
Other tools to improve that can be employed in quality improvement include developing standard procedures, for example, the use of catheter reminder, stop orders and nurse-initiated removal protocol. For nurses to develop applicable tools there must be materials available to help with designing and implementing such tools. For example, in the process of removal protocol initiated by the nurse. It should begin with the physician. The physician should develop printable educational materials which show the various options that the doctor have. The decision making an algorithm that is used in deciding the best alternatives. The physician should provide the urinary catheter project fact sheet to show how they developed the process of removal. The physician should present the process template to the management to receive a go-ahead ( Mavin & Mills, 2015) . The template should also be provided to the nursing staff with necessary data to help in the process of implementation. The nurses should execute the process of removing as indicated in the physician’s template. Such are the tools that improve the quality of nurses
Plan for the improvement of the issue
In the process of developing a plan to reduce CAUTIs and improve the safety of the patient, it is vital for the nurses to follow the recommended clinical guideline. According to Guide, (2011), the first step of the strategy is to engage the team. Improving the safety of the patients by reducing CAUTI and developing a culture of safety require a team’s effort. Therefore the plan should start by consulting the leaders, frontline staff, clinicians, the patients and the families to sustain the improvements made. Teamwork and communication will play a major role in developing long term care safety toolkit. The team must buy-in the idea so that the plan can gain support from different fronts.
Utilize data. Use data to show how the plan can work and also to monitor progress towards the achievement of the set goals ( Guide, 2011) . The plan must come with a way of collecting data that show that the implementation of the intervention is working. When there is objective information the team will begin asking the right questions in the process of trying to understand the problem. For patients, they want to see outcome changes that the changes applied are making an improvement. The implementation process must be documented to ensure that the process can is monitored and measured. Qualitative measures provide valuable subjective data that allow a comparison of the plan to other alternatives.
Implementation
The plan must show the available opportunities for improvement and then the plan can be implemented. The implementation process must focus on evidence-based practices and other effective strategies to improve the patient's safety. Plan-Do-Study-Act cycles an approach that can be used to implement the plan to ensure that the new plan is tested ( Guide, 2011) . It is recommended that the team implementing the changes be small and get to involve leadership and frontline staffs who ar4e interested in improving care.
The plan should be evaluated in a span of short periods to evaluate if it is making any improvement compared to the approach that was being used before. Data on short periods such as a month, three months, six and 12 months should be collected to evaluate the effectiveness of the new plan ( Guide, 2011) . In a span of six months significant improvement should be observed from the new plan. If the changes are positive, the caregivers should implement the strategy on a large scale.
The question that most residents ask is if the plan worked for others and made a change, will it work for them. Such questions can only be answered by the implementation of the plan on a large scale and see whether it will yield the same outcome as to when applied to a small population. A plan becomes standard when it can be implemented in a large population and show the desired changes (Guide, 2011) .
Quantity improvement strategies in nursing require testing and planning. Those strategies that make changes to the current approaches are coped and implements. For example, catheter reminders, stop orders, and nurse-initiated removal protocol has been implemented in different care facilities and has proven to be effective approaches to reducing the catheter-associated urinary tract infections (CAUTIs). Tools to improve quality are developed on a daily basis but the process development must be documented and tested to show how well they work in different conditions. The nursing is a practice which involves the use of evidence-based practices that follow the clinical guideline.
References
Guide, H. T. (2011). Prevent Catheter-Associated Urinary Tract Infection. Institute for Healthcare Improvement , 319-26.
Mavin, C., & Mills, G. (2015). Using quality improvement methods to prevent catheter-associated UTI. British Journal of Nursing , 24 (Sup18), S22-S28.
Meddings, J. (2013). Interventions to reduce urinary catheter use: it worked for them, but will it work for us?.
