DQ After discussion with your preceptor, name one financial aspect, one quality aspect, and one clinical aspect that need to be taken into account for developing the evidence-based change proposal NRS 493 Topic 6 DQ 1

DQ After discussion with your preceptor, name one financial aspect, one quality aspect, and one clinical aspect that need to be taken into account for developing the evidence-based change proposal NRS 493 Topic 6 DQ 1

Over the last 2 decades there has been an undeniable rise in health care costs which has caused a shift in focus toward measuring care quality. Studies have shown that improved quality of care has been associated with lower health care costs through decreased complications and length of stay (Agarwal, Youngerman, Kaakaji, Smith, McGregor, Et. Al, 2021). In efforts to improve care quality, providers use clinical practice guidelines, which are statements that include recommendations, informed by systematic reviews of evidence, intended to optimize patient care. CAUTI caused by improper testing of urine can have financial ramifications. A urine culture can cost $80 or more. Antibiotic treatment for a UTI cost from $3 to over $300. In addition, drug-resistant infections (caused by improper treatment with antibiotics) add costs for extended lengths of stay, expensive medicines, and nursing care (ABIM Foundation, 2014).

The urine culture stewardship program included monthly 1-hour discussions with ICU house staff emphasizing avoidance of “pan-culture” for sepsis workup and obtaining urine culture only if a urinary source of sepsis is suspected. The urine culture utilization rate metric (UCUR; i.e., no. urine cultures/catheter days ×100) was utilized to measure the effect. AN INTERACTIVE QUALITY DASHBOARD REPORTED monthly UCUR, catheter utilization ratio (CUR), and CAUTI rate. Catheterized ICU patients (2015-2016) were evaluated for 30-day readmission for UTIs to ensure safety. Time-series data and relationships were analyzed using Spearman correlation coefficients and regression analysis. The urine culture stewardship program was effective and safe in reducing UC overutilization and was correlated with a decrease in CAUTIs. The addition of urine-culture stewardship to standard best practices could reduce CAUTI in ICUs.

After discussion with my preceptor, a urine culture stewardship initiative will reduce costs associated with improper testing and the treatment. Implementation of this initiative will affect clinical practice by decreasing the total number of urine cultures ordered and reducing the number of inappropriate treatments. Regarding quality, a urine culture stewardship will help identify areas where routine ordering and inappropriate practices increase costs and affect patient outcomes, as well as used to reduce excessive ordering, lower contamination rates, and decrease unnecessary antibiotic prescribing (Sinawe, Casadesus, 2022).

References

Agarwal, N., Youngerman, B., Kaakaji, W., Smith, G., McGregor, J. M., Powers, C. J., Guthikonda, B., Menger, R., Schirmer, C. M., Rosenow, J. M., Cozzens, J., & Kimmell, K. T. (2021). Optimizing Medical Care Via Practice Guidelines and Quality Improvement Initiatives. World Neurosurgery, 151, 375–379. https://doi-org.lopes.idm.oclc.org/10.1016/j.wneu.2021.02.013