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Innovative Strategies for Leading Evidence-Based Practice Change

30th International Nursing Research CongressCalgary, Alberta, Canada July 28, 2019

Emily Dimmer, BSN, RN, CMSRNMichele Farrington, BSN, RN-BCKirsten Hanrahan, DNP, ARNP, CPNP-PCDepartment of Nursing Services and Patient Care, University of Iowa Health Care, Iowa City, IA, USA

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Overview

1. Evidence-Based Practice Development for Practicing Nurses Across the Career Continuum

2. EBP Change Champion Program Creation and Evaluation

3. Empowering Frontline Clinicians as EBP Change Champions Improves Clinical Outcomes

Questions

?

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Evidence-Based Practice Development for Practicing Nurses Across the Career Continuum

30th International Nursing Research CongressCalgary, Alberta, Canada July 28, 2019

Kirsten Hanrahan, DNP, ARNP, CPNP-PCDirector, Nursing Research & Evidence-Based PracticeDepartment of Nursing Services and Patient Care, University of Iowa Health Care, Iowa City, IA, USA

Novice Expert

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Objectives and DisclosuresPRESENTER: Kirsten Hanrahan, DNP, ARNP, CPNP-PCDirector, Nursing Research & Evidence-Based PracticeDepartment of Nursing Services and Patient Care, University of Iowa Health Care, Iowa City, IA, USA

OBJECTIVE: Describe building a foundation for evidence-based practice (EBP) and creating EBP development for practicing nurses across the career continuum.

DISCLOSURES: • No sponsorship or commercial support was given to the

author for this presentation• Kirsten Harahan and Michele Farrington are co-authors of

EBP in Action: Comprehensive Strategies, Tools and Tips from University of Iowa Hospitals and Clinics. Authors do not receive royalties, they are used to support work in the Office of Nursing Research, Department of Nursing Services and Patient Care, University of Iowa Health Care

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Building on a strong foundation for EBP development across the career continuum

• 811-bed academic medical center• Annually

37,000 in-patients 58,000 ED visits 1 million clinic visits

• Over 3,000 nurses • 4 times Magnet designated• 2014 Magnet Prize

Blazing New Trails in EBP

KABOB Evaluation

Novice Expert

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Nurses must provide, lead, and sustain evidence-based high quality healthcare

… by the year 2020, 90 percent of clinical decisions will be supported by accurate, timely, and up-to-date clinical information, and will reflect the best available evidence

Institute of Medicine, 2010

80% of nurses be prepared with baccalaureate degrees by 2020

Nurses should be prepared to lead change to advance health.

IOM Future of Nursing, 2010

Academic preparation provides foundational knowledge, skills, and attitudes supporting adoption of EBP across a spectrum of degrees and specialties.

EN, 2018

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Currently there are gaps in EBP preparedness

Amount

Leadership preparation by start date

1980 1990 2000 2010 2020

EBP Content

Experience

EBP KnowledgeGap experience

Highly experiencedGap in EBP training

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Culture, structure, and process are the foundations for EBP

EBP FoundationStructureCulture Process

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Culture is created by leadership and owned by frontline staff

Identify Triggering Issues/Opportunities• Clinical or patient identified issue• Organization, state or national initiative• Data/new evidence• Regulatory agency requirements/regulations• Philosophy of care

EBP

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Structure is used to support EBP

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Process provides a clear path for EBP

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EBP training across the career continuum

EBP Internship

ResidencyEBP Projects

EBP Change Champions

Small Grants

Advanced EBP

Orientation & Preceptors

Leadership Partner

Experienced Nurse Fellowship CLDA

Clinical LeadershipDevelopment Academy

Staff NurseBSN

LeadersMA DNP

Novice Expert

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Use process and outcome metrics to demonstrate return on investment for EBP

Knowledge Attitude Behavior Outcome Balancing Measure

Knowledge• Practice• Technique

Perception• Importance• Support• Resources

Behavior/skills• Technique• Compliance checks

Outcomes • Patient• Staff• Cost

PROCESS OUTCOMES

Risks• Patient• Staff• Adverse events

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Use program metrics to demonstrate value to the organization

647 Books sold76 ebooks5,057 Chapter tools downloaded

Magnet Designation+ 3 re-designations

2014 Magnet Prize®

Academic Partnership Awards: AACN, MNRS

ADVANCED EBP

TRAINING

910 Total participants323 Unique organizations

Internal 39 Programs91 Participants

External 18 Programs819 Participants43 States + DC 9 Countries

EBP IN ACTION BOOK

AWARDSEBP CONFERENCE

2 Programs 58 Direct Care Nurses 8 Additional Participants 55 Leaders 14 Topics

26 Programs5,346 Participants48 states + Washington DC 16 countries

3,086 Requests50 States42 Countries

EBP CHANGE CHAMPIONS

9 Programs 50 Participants

93% Completed 80% Sustained

Presentations47 Local 34 National 4 International

16 Peer-reviewed publications

EBP INTERNSHIPIOWA MODEL REVISED

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Implications and Conclusion

• Culture, structure and process are foundational for EBP success

• EBP training spanning the career continuum builds organizational EBP capacity

• Process and outcome data including return on investment are key to EBP evaluation

• Nurses are ideally positioned to provide, lead, and sustain evidence-based high quality healthcare

• There is a need for innovative programs that fill the current gaps in EBP preparedness

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ReferencesCullen, L., & Hanrahan, K. (2018). Evidence-based practice and the bottom line: An issue of cost. Retrieved from

https://www.hfma.org/Content.aspx?id=58754Cullen, L., Hanrahan, K., Farrington, M., DeBerg, J., Tucker, S., & Kleiber, C. (2018). Evidence-based practice in action:

Comprehensive strategies, tools and tips from the University of Iowa Hospitals and Clinics. Indianapolis, IN: Sigma Theta Tau International.

Cullen, L., & Titler, M. G. (2004). Promoting evidence-based practice: An internship for staff nurses. Worldviews on Evidence-Based Nursing, 1(4), 215-223. doi:10.1111/j.1524-475X.2004.04027.x

Cullen, L., Titler, M. G., & Rempel, G. (2011). An advanced educational program promoting evidence-based practice. Western Journal of Nursing Research, 33(3), 345-364. doi:10.1177/0193945910379218

Cullen, L., Wagner, M., Matthews, G., & Farrington, M. (2017). Evidence into practice: Integration within an organizational infrastructure. Journal of PeriAnesthesia Nursing, 32(3), 247-256. doi:10.1016/j.jopan.2017.02.003

Gawlinski, A., & Becker, E. (2012). Infusing research into practice: A staff nurse evidence-based practice fellowship program. Journal for Nurses in Staff Development, 28(2), 69-73. doi:10.1097/NND.0b013e31824b418c

Hosking, J., Knox, K., Forman, J., Montgomery, L. A., Valde, J. G., & Cullen, L. (2016). Evidence into practice: Leading new graduate nurses to evidence-based practice through a nurse residency program. Journal of PeriAnesthesia Nursing, 31(3), 260-265. doi:10.1016/j.jopan.2016.02.006

Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press.

Mick, J. (2014). Nurse interns' experience with participation in the evidence-based practice project requirement of a nursing internship program. Nurse Educator, 39(2), 54-55. doi:10.1097/NNE.0000000000000017

Quality and Safety Education for Nurse (QSEN). (2018). QSEN competencies. Retrieved from http://qsen.org/competencies/pre-licensure-ksas/#evidence-based_practice

Warren, J. I., McLaughlin, M., Bardsley, J., Eich, J., Esche, C. A., Kropkowski, L., & Risch, S. (2016). The strengths and challenges of implementing

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EBP Change Champion Program Creation and Evaluation

30th International Nursing Research Congress Calgary, Alberta, CanadaJuly 28, 2019

Michele Farrington, BSN, RN-BCProgram ManagerUniversity of Iowa Health Care

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Objective and Disclosures

ObjectiveDescribe a program that provides frontline nurses with a professional development opportunity, operationalizing the role of an EBP change champion to improve priority organizational outcomes

DisclosuresMichele Farrington, BSN, RN-BC, Program Manager, University of Iowa Health Care, has no conflicts of interest or disclosures to report, and she did not receive sponsorship or commercial support

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Background

• Development of EBP champions as effective change agents – may improve integration of clinical practice recommendations through peer influence

• Current literature describes the change champion role – but gives little guidance for application

• Empirical evidence on impact is lacking

Breckenridge-Sproat et al., 2015; Bruheim, Woods, Smeland, & Nortvedt, 2014; Cullen et al., 2018; Dogherty, Harrison, Graham, & Keeping-Burke, 2014; Mello et al., 2014; Robinson, Tilford, Branney, & Kinsella, 2014; Shifaza, Evans, Bradley, & Ullrich, 2013

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Program Planning

• Identify the opportunity• Program planning team• Clarify the purpose• Organizational support

– Funding– Approval– Announcements

• Develop program plan• Expand the team• Facilitator preparation• Offer program • Evaluate to guide learning

Iowa Model Collaborative, 2017

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Team• Planning Group

– Robert Anderson, DNP, ARNP, CNP

– Laura Cullen, DNP, RN, FAAN

– Michele Farrington, BSN, RN-BC

– Kirsten Hanrahan, DNP, ARNP, CPNP-PC

– Kristen Rempel

• Topic Facilitators– Linda Abbott, DNP, RN,

AOCN, CWON– Robert Anderson, DNP,

ARNP, CNP– Angela Baker, MSN, RN,

CNL– Dana Cook, MSN, RN-BC– Renee Gould, MS, RN-

BC– Joseph Greiner, MSN,

RN, CPHQ– BJ Hannon, MSN, RN,

CPHQ– Jacqueline Nelson,

DNP, RN, NEA-BC– Anne Smith, MSN, RN-

BC

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Purpose

Pilot program created and launched in 2017 to provide nurses with a professional development opportunity, operationalizing the role of an EBP change champion to improve priority organizational outcomes

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Program Objectives

• Assist frontline nurses to function as a unit/clinic change agent applying evidence-based care in daily practice

• Expand infrastructure support for local unit/clinic nurse leaders serving as change agent

• Foster professional growth of frontline nurses and interprofessional teams and promote retention of experienced nurses at UI Health Care

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Priority Topics

• CAUTI• CLABSI• Clinical alarms• Early mobility• Falls• Pain• Pressure injury• Purposeful rounding• Restraints

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Program

• Prerequisites– Readings: role, implementation, and clinical topic– Online EBP module with CE credits

• Schedule– Change theory– Implementation– Role– Panel of staff nurses with expertise in the role– Clinical topic – evidence summary, learning activities, and

development of a plan with nurse leader partner– Develop action plan

Cullen & Adams, 2012

Cullen & Adams, 2012; Dogherty, Harrison, Graham, & Keeping-Burke, 2014; Iowa Model Collaborative, 2017

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Participants

• Participant selection (21 frontline nurse & nurse leader pairs)• Application

– Select clinical topic– Establish partnership with Nurse Manager and nurse leader

• Partner with Nurse Manager– Facilitate work/work time– Schedule non-patient care time– Keep a unit-based focus– Connect with resources– Trend practice and data

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EBP Change Champion Role

• Assist with adapting practice recommendations

• Tailor implementation plan and materials to fit local setting

• Share knowledge, rationale, and resources with peers

• Train, demonstrate, use, and role model practice change

Abdullah et al., 2014; Cullen & Adams, 2012; Cullen et al., 2018; Fleuren, van Dommelen, & Dunnink, 2015; Hauck, Winsett, & Kuric, 2013; Kaasalainen et al., 2015

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EBP Change Champion Role (cont.)

• Provide just-in-time encouragement and troubleshoot problems at the point-of-care

• Provide continuous feedback to frontline nurses

• Engage and update leaders to work through issues

• Collaborate with interprofessional team members

• Make documentation system changes to support EBP

Abdullah et al., 2014; Cullen & Adams, 2012; Cullen et al., 2018; Fleuren, van Dommelen, & Dunnink, 2015; Hauck, Winsett, & Kuric, 2013; Kaasalainen et al., 2015

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Immediate Post-Program Evaluation

3.5 3.4 3.4 3.6 3.6

1

2

3

4

Program materials useful

Prepared to be EBP Change Champion

Understand implementation strategies to use to implement and sustain change

Sufficient topic information provided to develop implementation plan

Stimulated innovative thinking

Strongly Agree

Strongly Disagree

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Immediate Post-Program Evaluation (cont.)

Most useful – “group work and getting to

share ideas in a relaxed, small setting”

Most useful – “meeting in teams to discuss areas

needing attention/change”

Need now –“time and ability to support change”

Most useful –“great

information presented in an effective way –activities/game”

Need now –“encouragement to approach co-

workers with change”

General comment –“this program was very

helpful in understanding how we implement change at

UI Hospitals and Clinics”

Need now –“deadlines and goals to stay

focused”

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1-2 Month Post-Program Evaluation

Themes – Change Champion Role• Need to connect with Nurse Manager to plan non-patient care

time• Identify early adopters• Collect baseline data• Recruit others to participate

Themes – Topic• Review available evidence• Observe clinicians to determine current practice

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1-2 Month Post-Program Evaluation (cont.)

Themes – Post-Program Assistance Needed• Secure access to data• Locate policies/procedures/protocols• Additional follow-up meeting in a few months as a whole group

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Implementation Strategies in UseCreate Awareness & Interest• Highlight advantages• Slogans & logos• Staff meetings• Unit newsletter• Unit in-services• Distribute key evidence• Posters and postings/fliers• Announcements

Build Knowledge & Commitment• Education• Pocket guides• Link practice change & stakeholder

priorities• Disseminate credible evidence• Make impact observable• Gap assessment/gap analysis• Clinician input• Focus groups for planning change• Resource manual or materials• Teamwork• Inform organizational leaders• Action plan

Cullen & Adams, 2012; Cullen et al., 2018

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Implementation Strategies in Use (cont.)

Promote Action & Adoption• Educational outreach/academic

detailing• Reminders or practice prompts• Demonstrate workflow or decision

algorithm• Try the practice change• Troubleshooting at the point-of-care• “Elevator speech”• Change agents• Role model• Provide recognition at the point-of-care• Audit key indicators• Actionable and timely data feedback• Rounding by unit/organizational

leadership• Link to organizational priorities• Unit orientation

Pursue Integration & Sustained Use• Personalize the messages to staff based on

actual improvement data• Peer influence• Review policy, procedure or protocol

Cullen & Adams, 2012; Cullen et al., 2018

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Conclusions

• Patients and families benefit when nurses lead EBP changes in collaborative teams to improve outcomes

• The EBP Change Champion pilot program provided an innovative approach to support nurse-led EBP improvements

• Formal training is one of the key elements in a comprehensive EBP program to facilitate nurse-led EBP across the care continuum

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References

• Abdullah, G., Rossy, D., Ploeg, J., Davies, B., Higuchi, K., Sikora, L., & Stacey, D. (2014). Measuring the effectiveness of mentoring as a knowledge translation intervention for implementing empirical evidence: A systematic review. Worldviews on Evidence-Based Nursing, 11(5), 284-300. doi:10.1111/wvn.12060

• Breckenridge-Sproat, S. T., Throop, M. D., Raju, D., Murphy, D. A., Loan, L. A., & Patrician, P. A. (2015). Building a unit-level mentored program to sustain a culture of inquiry for evidence-based practice. Clinical Nurse Specialist, 29(6), 329-337. doi:10.1097/NUR.0000000000000161

• Bruheim, M., Woods, K. V., Smeland, S., & Nortvedt, M. W. (2014). An educational program to transition oncology nurses at the Norwegian Radium Hospital to an evidence-based practice model: Development, implementation, and preliminary outcomes. Journal of Cancer Education, 29(2), 224-232. doi:10.1007/s13187-013-0575-9

• Cullen, L., & Adams, S. L. (2012). Planning for implementation of evidence-based practice. Journal of Nursing Administration, 42(4), 222-230. doi:10.1097/NNA.0b013e31824ccd0a

• Cullen, L., Hanrahan, K., Farrington, M., Deberg, J., Tucker, S., & Kleiber, C. (2018). Evidence-based practice in action: Comprehensive strategies, tools, and tips from the University of Iowa Hospitals and Clinics. Indianapolis, IN: Sigma Theta Tau International.

• Dogherty, E. J., Harrison, M., Graham, I., & Keeping-Burke, L. (2014). Examining the use of facilitation within guideline dissemination and implementation studies in nursing. International Journal of Evidence-Based Healthcare, 12(2), 105-127. doi:10.1097/XEB.0000000000000008

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References (cont.)

• Fleuren, M. A., van Dommelen, P., & Dunnink, T. (2015). A systematic approach to implementing and evaluating clinical guidelines: The results of fifteen years of Preventive Child Health Care guidelines in the Netherlands. Social Science & Medicine, 136-137, 35-42. doi:10.1016/j.socscimed.2015.05.001

• Hauck, S., Winsett, R. P., & Kuric, J. (2013). Leadership facilitation strategies to establish evidence-based practice in an acute care hospital. Journal of Advanced Nursing, 69(3), 664-674. doi:10.1111/j.1365-2648.2012.06053.x

• Iowa Model Collaborative. (2017). Iowa Model of Evidence-Based Practice: Revisions and validation. Worldviews on Evidence-Based Nursing, 14(3), 175-182. doi:10.1111/wvn.12223

• Kaasalainen, S., Ploeg, J., Donald, F., Coker, E., Brazil, K., Martin-Misener, R., . . . Hadjistavropoulos, T. (2015). Positioning clinical nurse specialists and nurse practitioners as change champions to implement a pain protocol in long-term care. Pain Management Nursing, 16(2), 78-88. doi:10.1016/j.pmn.2014.04.002

• Mello, M. M., Boothman, R. C., McDonald, T., Driver, J., Lembitz, A., Bouwmeester, D., . . . Gallagher, T. (2014). Communication-and-resolution programs: The challenges and lessons learned from six early adopters. Health Affairs, 33(1), 20-29. doi:10.1377/hlthaff.2013.0828

• Robinson, M., Tilford, S., Branney, P., & Kinsella, K. (2014). Championing mental health at work: Emerging practice from innovative projects in the UK. Health Promotion International, 29(3), 583-595. doi:10.1093/heapro/das074

• Shifaza, F., Evans, D., Bradley, H., & Ullrich, S. (2013). Developing evidence-based practice champions in the Maldives. International Journal of Nursing Practice, 19(6), 596-602. doi:10.1111/ijn.12106

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Empowering Frontline Clinicians as EBP Change Champions Improves Clinical Outcomes

30th International Nursing Research CongressCalgary, Alberta, CanadaJuly 28, 2019

Emily Dimmer, BSN, RN, CMSRNStaff NurseUniversity of Iowa Health Care

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Objective and Disclosures

ObjectiveDescribe a project, led by an EBP Change Champion, that expands the nursing assistant role in implementing evidence-based interventions to reduce catheter-associated urinary tract infection risk for post-surgical adult patients

DisclosuresEmily Dimmer, BSN, RN, CMSRN, Staff Nurse, University of Iowa Health Care, has no conflicts of interest or disclosures to report, and she did not receive sponsorship or commercial support

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Team

Name Role(s) Shared Governance Committee Link

Emily Dimmer, BSN, RN, CMSRN

Staff NurseEBP Change Champion

CAUTI Committee

Becca Miner, DNP, RN-BC, CNML

Nurse ManagerEBP Change Champion Mentor

Emily Rod, MSN, RN, CMSRN

Assistant Nurse Manager CAUTI Committee

Taylor Suchan, BSN, RN,CMSRN

Assistant Nurse Manager CAUTI Committee

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Purpose & Rationale

• Expand nursing assistant (NA) role in implementing evidence-based interventions to reduce catheter-associated urinary tract infection (CAUTI) risk on an adult, inpatient, surgical unit

• 32-bed acute, orthopedic and urology post-surgical unit

– Many patients at high-risk for CAUTI development – Role of NA is critical in CAUTI prevention

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Evidence-Based Practice Framework

(Iowa Model Collaborative, 2017)

EBP Change Champion Program

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Synthesis of Evidence

• CAUTI – among most common healthcare-associated infections– Estimated 250,000 cases occur annually in U.S. hospitals– Associated costs of $250-$450 million

• 75% of hospital-acquired UTIs from urinary catheter

• Common consequences of CAUTI:– Increased length of stay– Patient discomfort– Increased cost– Mortality

• >13,000 deaths annually from urinary tract infections; data from 1990-2002

(AHRQ, 2015a, 2015b; Clayton, 2017; Gould et al., 2017; Kaplan & Carter, 2018; Klevens et al., 2007)

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Practice Change

• 3 primary areas of focus:– Focused 1:1 education with NAs by the EBP Change

Champion– Discontinuation of routine urinalysis orders unless

patient symptomatic with suprapubic pain– Change from once to twice daily meatal care for

patients with indwelling catheter

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Practice Change (cont.)

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EBP Change Champion Actions

• Educate unit NAs– Supply evidence– “Keep it Simple” bundle– 7-item pre- & post-education knowledge questionnaire

• Meet with key stakeholders about urinalysis orders on POD#1

– Regularly ordered by total joint replacement team– Work with nursing staff to question urinalysis orders

• Develop educational materials for annual NA competencies

• Develop standardized audit tool– Educate nursing staff where to chart cares in electronic health

record

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Implementation Strategies

Implementation Strategies for Evidence-Based Practice – framework used to create a phased, evidence-based approach for selecting effective implementation strategies

(Cullen & Adams, 2012; Cullen et al., 2018)

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Implementation Strategies (cont.)

(Cullen & Adams, 2012; Cullen et al., 2018)

Create Awareness & Interest

Build Knowledge & Commitment

Promote Action & Adoption

Pursue Integration & Sustained Use

• Staff meetings• Unit newsletter• Unit in-services• Announcements &

broadcasts

• Education• Pocket guides• Change agents• Educational outreach or

academic detailing• Integrate practice change

with other EBP protocols• Gap assessment/gap

analysis • Match practice change

with resources & equipment

• Resource manual or materials

• Teamwork• Action plan• Report to senior leaders

• Academic detailing• Reminders or practice

prompts• Resource materials• Skill competence • Given evaluation results

to colleagues• Multidisciplinary

discussion • Change agents• Role model• Troubleshooting at the

point of care/bedside• Recognition at point of

care• Actionable and timely

feedback• Checklist• Report into QI program• Report to senior leaders• Action plan

• Peer influence• Audit and feedback• Report to senior leaders• Report into QI program• Trend results• Present in educational

programs

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Evaluation

CAUTI Pre-Test CAUTI Post-TestWhat does UTI stand for? What does UTI stand for?

What does CAUTI stand for? What does CAUTI stand for?

What does HAI stand for? What does HAI stand for?

How frequent should pericare and meatal care be performed on a patient?

How frequent should pericare and meatal care be performed on a patient?

What wipes should be used to perform pericare/meatal care?

What wipes should be used to perform pericare/meatal care?

What can I do to help prevent a CAUTI on our unit?a. Keep it Cleanb. Keep it Securec. Keep it a Closed Systemd. Keep it Low

What can I do to help prevent a CAUTI on our unit?a. ______________b. ______________c. ______________d. ______________

How many deaths from UTI occurred in 2002?a. 300b. 900c. 9,000d. 13,000

How many deaths from UTI occurred in 2002?a. 300b. 900c. 9,000d. 13,000

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Evaluation (cont.)

46%

92%

0%10%20%30%40%50%60%70%80%90%

100%

Pre-Education (n = 17) Post-Education (n = 17)

Nursing Assistant Knowledge (7-item questionnaire)

Average % Correct

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Evaluation (cont.)

• Unit CAUTI Rate– 6-months pre-program* – 0.78/1000 patient days– 6-months post-program – 0.00/1000 patient days

5.3 5.1 5.4

0

2

4

6

Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17

Infe

ctio

n R

ate

Per 1

,000

C

athe

ter D

ays

EBP Change Champion Program Start

NA Competency with Skills

*

— 52 —

Evaluation (cont.)

4.7

0

2

4

6

Infe

ctio

n R

ate

Per 1

,000

Cat

hete

r Day

s

Unit CAUTI Rate

NA Competency with SkillsRe-Education

— 53 —

Lessons Learned / Next Steps

Lessons Learned• Commitment and delegation are key• Keeping the project at the forefront and need to re-

educate was critical • Increase number of champions for best success – focus

primarily on NAsNext Steps• Continue to review content in annual NA competencies • Include additional units – convert to group education• Create a core group of NAs to provide 1:1 teaching

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Conclusions

• EBP Change Champion program participation empowered a unit-based emerging nurse leader to direct evidence-based improvements to positively impact patient outcomes

• Empowerment and confidence increased for NAs –ability to make appreciable difference in patient outcomes

• Commitment to project and protected project time for unit-based EBP Change Champion critical for success

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References

• Agency for Healthcare Research and Quality (AHRQ). (2015a). AHRQ patient safety toolkit helps hospitals reduce catheter-associated urinary tract infections (CAUTI). Retrieved from https://www.ahrq.gov/news/newsroom/press-releases/2015/cautitoolkit.html

• AHRQ. (2015b). Toolkit for reducing catheter-associated urinary tract infections in hospital units: Implementation guide. Retrieved from https://www.ahrq.gov/professionals/qualitypatient-safety/hais/cauti-tools/guides/implguide-pt1.html

• Clayton, J. L. (2017). Indwelling urinary catheters: A pathway to health care-associated infections. AORN Journal, 105(5), 446-452. doi:10.1016/j.aorn.2017.02.013

• Cullen, L., & Adams, S. L. (2012). Planning for implementation of evidence-based practice. Journal of Nursing Administration, 42(4), 222-230. doi:10.1097/NNA.0b013e31824ccd0a

• Cullen, L., Hanrahan, K., Farrington, M., Deberg, J., Tucker, S., & Kleiber, C. (2018). Evidence-based practice in action: Comprehensive strategies, tools and tips from the University of Iowa Hospitals and Clinics. Indianapolis, IN: Sigma Theta Tau International.

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References (cont.)

• Gould, C. V., Umscheid, C. A., Agarwal, R. K., Kuntz, G., Pegues, D. A., & Healthcare Infection Control Practices Advisory Committee. (2017). Guideline for prevention of catheter-associated urinary tract infections 2009. Atlanta, GA: Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/infectioncontrol/guidelines/cauti/

• Iowa Model Collaborative. (2017). Iowa Model of Evidence-Based Practice: Revisions and validation. Worldviews on Evidence-Based Nursing, 14(3), 175-182. doi:10.1111/wvn.12223

• Kaplan, J. A., & Carter, J. T. (2018). Near-perfect compliance with SCIP Inf-9 had no effect on catheter utilization or urinary tract infections at an academic medical center. American Journal of Surgery, 215(1), 23-27. doi:10.1016/j.amjsurg.2017.03.039

• Klevens, R. M., Edwards, J. R., Richards, C. L., Horan, T. C., Gaynes, R. P., Pollock, D. A., & Cardo, D. M. (2007). Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Reports, 122(2), 160-166. doi:10.1177/003335490712200205

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Questions/Comments