Investigating the Perceptions and Barriers to Implementation of a Nurse-Driven Protocol

Abstract

Purpose: This quality improvement project evaluated the perceptions of and barriers to the HOUDINI nurse-driven indwelling urinary catheter removal protocol with telemetry nursing staff.Background: The most often cited reason for catheter acquired urinary tract infection is the use of an indwelling urinary catheter. Insertion of such devices can cause non-infectious damage such as urethral strictures, nonbacterial urethral inflammation, and urinary infections. Catheter acquired urinary infections can progress to more complicated infectious processes such as pyelonephritis and sepsis, resulting in further complications including prolonged hospitalization, patient discomfort, and even death. Evidence-based preventative guidelines provide a standard that facilities can follow to reduce the incidence of urinary tract infections within their facilities. These guidelines help ensure timely removal of an indwelling urinary catheter once there is no longer justification for its use. These guidelines encourage site-specific development of protocols to allow for nurse-directed removal of unnecessary catheters as part of a comprehensive strategy to improve patient outcomes. Methodology: This quality improvement project utilized an informational session and post-session survey to introduce the HOUDINI protocol to participants. The project informed and then assessed potential for a change in practice with nurses working within the telemetry unit at Verde Valley Medical Center in Cottonwood, Arizona. The project was informed by Kurt Lewin’s change model and implementation of the intervention was organized using the Institute for Healthcare Improvement’s Plan Do Study Act model. Nurses were surveyed using a twelve-point questionnaire to assess their perceptions of the presented nurse-driven protocol and any barriers that might impede the protocol’s implementation. Results: This project successfully introduced eleven participants to the HOUDINI protocol on the telemetry unit. Overall, the participants viewed the use of a nurse-driven protocol in a positive light. Interestingly, the results also extracted an unfavorable view about facility support toward nurse autonomy, potentially hindering the use of a nurse-driven protocol within the unit surveyed. Conclusion: Further investigation is warranted to identify whether the findings regarding nurse autonomy are widespread among staff before the implementation of a nurse-driven protocol can be considered.