Practices Can and Will Change- EBP

Written by Professor Kirby

Image result for random controlled trial

Evidence-based nursing practice is a result of research studies or randomized controlled trials (RCT). However, from these trials, a compilation of the evidence is gathered that determines the direction of future trials. Often, the results or findings of the research article will indicate if further studies are warranted and indicated why these studies would be beneficial. Also, the possibility of any sampling error, or selection bias that may have of skewed results of the RCT. Wong and Myers (2015) place the responsibility in the hands of the managers, educators, and clinical nurse specialists to stay abreast of recommended changes, educate and evaluate their clinicians(p. 18). However, the weight of their due diligence begins with gaining knowledge and sharing it. Consequently, after education and implementation, the manager must also evaluate their employee’s competency.

Image result for foley catheter

Let’s discuss a common nursing practice that is no longer recommended by the Healthcare Infection Control Practices Advisory Committee of 2009. As a young nurse, long-term use of Foley catheters was more prevalent in long-term care settings than it is today. Consequently, when long-term use was warranted the nurse was required to change the Foley every 30 days or once a month. Nevertheless, in 2009 new guidelines indicated that “changing indwelling catheters or drainage bags at routine, fixed intervals is not recommended. Rather, it is suggested to change catheters and drainage bags based on clinical indications such as infection, obstruction, or when the closed system is compromised” (Gould et al., 2009, p. 13). This recommendation was a supported by quality evidence that suggested the clinicial benefits out weighed the potential harm (Gould et al., 2009, p. 10). Therefore, it was left in the hands for the manager to establish a guideline to follow for their clinical nurses. Many long-term care facilities have reduced the use of Foley catheters with the exception of use recommended by Healthcare Infection Control Practices Advisory Committee (HICPAC) guidelines.

References

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

Wong, P., & Myers, M., (2015). Clinical competence and EBP: An educator’s perspective. Nursing Management, 15-18.

37 thoughts on “Practices Can and Will Change- EBP

  1. To answer the question given, while this article was informational, I did not learn anything new. It put some knowledge into my body, but these were facts I already knew from previous times. Great work! It’s important to maintain what the picture shows in collecting data after implying a new treatment.

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  2. While I was aware of the constant need to monitor and test the way we do things in healthcare for both old and new practices, I was not aware of the recommendations regarding the Foley catheter. I don’t currently work in healthcare to have experience with this topic, and I never realized how long they could be used for. I assumed they were changed pretty often, so to hear that this is actually not recommended much at all is new information to me. It is always interesting to see how we learn and grow with our practices in the health care field.

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  3. I think it is interesting to know about the studies being done to get evidence based nursing. I think it is a very important topic because just like your example above, there are many things i think in the healthcare field that change almost daily. We are seeing these daily changes in healthcare “norms” especially during this COVID-19 pandemic.

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  4. i learned for the blog that there was a change in rules about foley begin change once a month which i think is good. Because it will help reduce infection which will keep the patient healthy and keep the staff save as well.

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  5. New information that I’ve learned from this article is about the foley catheter. I wasn’t aware that the foley catheter wasn’t used as much as it is today. I think changing the foley catheter every 30 days was very outdated since infection is always promoted in these kinds of devices. Great article to read and very informative!

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  6. This article was very informative. I did not know that foley catheters were used so commonly in past years . It is awesome to learn that research has resulted in a better practice to be implemented to reduce infections regarding the foley catheter.

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  7. I learned that the rule for changing catheter or drainage bag is now based on clinical indications instead of every 30 days. I get where they are coming from with the new rule but I think every 30 days is better unless before the 30 days is up you have a problem that it needs to be changed like infection.

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  8. After reading this blog, i learn that Foley/catheters were changed after 30 days or once a month. All of that change in 2009 when the healthcare infection control practice advisory committee came up with a new guideline about changing indwelling catheters or drainage bags at a routine and not a fixed interval as a recommendation. Foley/catheters should be changed base on infections, obstruction, or the closed area is compromised. It was good for them to make that change due to all the infections and other complications that comes with catheter when it is not taken care of properly.

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  9. i have learned that evidence based practice in nursing has advanced a great deal in recent years. Happy to see researchers able to confirm that some of the things they do actually improve outcomes for patients and focusing on patients’ needs. I am aware of Foley catheter also oxygen use for copd patients (i could be wrong)anyway what a great job they have done so far!

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  10. I was aware that new clinical trials were constantly being done to acquire new and updated research. I do not work in the medical field, therefore I was not aware about the new information regarding foley catheters. I think this is a great realization considering it can reduce the risk of infect.

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  11. The information that I learned was that the nurse was required to change the Foley every 30 days or once a month. I thought it was way more frequent than that. I think this blog was very informational for me, and taught me some new stuff that I did not know. I also learned that long-term care facilities have reduced the use of Foley catheters.

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  12. I already knew about basing the change of foley catheters on clinical indications, such as infection, obstruction, or when compromised as well as when it is no longer needed. I did not know that the catheter used to be changed routinely every 30 days. That blows my mind. I feel as though there would be more urinary infections or bacteria infections for these patients.

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  13. I learned EBP helps nurses determine an effective course of action for care delivery. I also learned that it is suggested to change catheters and drainage bags based on clinical indications such as infection, obstruction, or when the closed system is compromised,

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  14. I learned from this article that EBP has become a key component of exceptional patient care. With the utilization of EBP ,a better patient outcome occurs, which can decrease the demand for healthcare resources. Urinary catheters is an ideal focus of evidence-based practice (EBP) resourcefulness. This is a great approach decreasing the amount of infections. Great Read!

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  15. I have to start by saying I cannot even imagine being a patient and having the same catheter for 30 days! The sentence that stated “Consequently, after education and implementation, the manager must also evaluate their employee’s competency” really resonated with me. I feel as though some managers do not always take the necessary steps to ensure the employee’s competency. Also, I think that keeping the catheter in for 30 days should have been based more on the harms rather than the benefits. I just keep thinking about infection and other harmful scenarios. This was a great little read that provided much insight. Thanks, Mrs. Kirby!

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  16. I was not aware that it was as recent as 2009 that the Foley catheter change time frame happened. I remember my mom working in nursing homes and talking about their usage. When she talked about them, I did not understand the rationale, but knew that leaving them for up to 30 days was not a good idea. I am very glad that the change has been made.

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  17. Research has continued to play an important role as well as improving the nursing standards and care given to clients, for instance the article mentions the use and change of Foley catheters especially in the long term care facilities how it is has changed over the years.

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  18. Prior to reading this article, I hadn’t given Foley Catheter use much thought. Speaking generally, I have always been of the school of thought, “If it ain’t broke, don’t fix it.” So I can see why it might be better to leave the catheter alone unless there is a problem. I had no idea it was necessary to change the Foley Catheter every 30 days prior to reading this. It seems to me, you’d be potentially causing more harm than good by introducing bacteria with each changing. It’s interesting to me to see how things evolve and what we learn over time. What was acceptable yesterday may not necessarily be acceptable today! Small changes such as this is what is contributing to longer life expectancies over the last 50 years.

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    • True… Sometimes they are not discontinued when they should be and many times hospitals will send patients with Foley catheters in place that do not need them. Then the SNF nurse does not get an order to discontinue the catheter and the foreign object remains in place. A potential for a CAUTI to develop.

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  19. Honestly before reading this article I had assumed that Foley Catheter’s were changed every few weeks or were removed as quickly as they could be to lower the risk of healthcare associated infections. Reading the article about how the study concluded the Foley catheter should not be changed unless Complications such as an infection or blockage should occur. I kind of understand why that would be. The risk of changing them so frequently could cause infection. In some cases a manager may not properly ensure their employees are competent enough to properly change the Foley catheter. Really makes you wonder what other processes and procedures have been changed or will change due to clinical studies.

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  20. This was a very informative read, I have worked in geriatrics and pediatrics but I do not have any experience with Foley catheters. I did not know they were left in for that amount of time and it is nice to know that they came up with a better practice to reduce infections among patients.

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  21. This was a very didactic read for me especially learning about 2009 guideline on change of catheter and foley bag. As an aide , i have often requested for a new bag (leg bag/Foley) for my residents as soon as i start to notice a change in color or a tendency for infection on these bag ( i bet it may even be less than 30 days) because i fell i dont want to give room for infection . Little did i know that there is a guideline for this .
    Like you said the implementation and evaluation of employee’s competency about such guideline is very important because the infection control need seem flawed in many nursing home with the reduced use of Foley Catheter .
    Thanks Mrs. K

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  22. The reading was very informative and I learn a lot mostly about the Foley catheter. There are lot of nurses that don’t know more about catheter. It give me additional information to be added to my knowledge.

    Liked by 1 person

  23. Thank you, very interesting information.I learned from this article that it is necessary to change the Foley Catheter once a month. We just learned about catheters on BN. Information from the article can be useful for the clinic.

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  24. I was completely unaware that foley catheters were only changed every 30 days, I definitely would have thought that the new guideline to change the catheter if the system was compromised or infection arose would already be implemented. When it comes to EBP, I completely agree that “the weight of their due diligence begins with gaining knowledge and sharing it.”

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  25. This is new knowledge to me because I do not work in the nursing field yet . I do find this very interesting that they only use to change them every 30 days, I guess I never really thought about it but I do see why this could cause infection or more issues if not changed frequent enough.

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  26. Foley’s have been coming up a lot at work lately so the information regarding how frequently they’re changed and the reasons why they would be aren’t new to me. That they used to be changed every 30 days and were more permanent or longer lasting is somewhat new. I think this was a good reminder of how things, treatments and procedures and policies, do change in this field and how important it is to keep up on that. What we learn now may not be what we are taught to do 5 years, 10 years down the line. It will be important to keep an open mind and continue our education and listen to clinical nurse educators and managers as they guide us through new and changing concepts.

    Liked by 1 person

  27. Reading the article, I was aware that a Foley catheter get changed every month or 30 days from working in long term care. I wasn’t aware that it was as recent as 2009. This article was very interesting.

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