Nursing Accountability in Caring Essay

Nursing Accountability in Caring Essay

Nursing Accountability in Caring Central Venous Catheter Katie Rha Grand Canyon University NRS 430V August 19, 2011 Accountability means “obligation of being answerable for one’s own judgments and actions. ” If someone gives you a job to do, you may be able to get others to carry out that task, but you are still held accountable to produce the results. In the nursing profession, a nurse is accountable for the actions towards his or her patient, even if he or she has delegated the work onto another assistant’s shoulders (Answer. com). Nursing Accountability in Caring Essay Paper

If the job is not done correctly, then it is the nurses that hold accountability for the patient’s health and safety. The American Nurses Association code of ethics emphasizes the individual nurse is to accept responsibility and accountability for individual nursing practice (Milton, 2005). A nurse is accountable to the public, clients, profession, employer, and to his or herself (Professional Accountability). Organizational structures or characteristics include interdisciplinary respect, adequate communication, and an organizational approach to management of care delivery that encourages participation in care-giving decisions. Nursing Accountability in Caring Essay Paper

RNs are accountable to comply employer job descriptions, policy and procedure legally. It is a legal obligation. This paper focuses on to address two aspects of nursing accountability in the area of infection management using central intravenous catheter. As a nurse working in chronic dialysis, I recognized that the importance of infection control related to CVC (central venous catheter). Patient usually diagnoses end stage of renal disease which needs to initiate dialysis when patient is inpatient with severe s/s of uremia. There are two types of dialysis accesses. Nursing Accountability in Caring Essay Paper

The first kind involves the creation of a permanent connection between an artery and a vein under the skin, calls Fistula. It usually takes 6-12weeks of maturation time; means can not access this fistula right away after surgery. The other type of access involves the direct placement of a tube into a central vein through the neck, chest or groin, calls CVC (central venous catheter). The central venous catheter to be placed for hemodialysis access then treatment initiated. Once patient is discharged from the hospital they transfer chronic dialysis center with CVC to continue receiving treatment.

Cannulation of CVC access site places the hemodialysis patient at risk for infection via bacterial contamination. Bacteria can be introduced directly into the patient’s bloodstream by connecting to dialysis machine through CVC leading to local infection of the access exit site and/or to bloodstream infection. Bloodstream infection increases morbidity and mortality in hemodialysis patients and must be prevented. Catheter infection can occur following transmission of hand or aerosolized bacterial contaminants. Nursing Accountability in Caring Essay Paper

Staphylococcus aureus is the leading cause of catheter exit site infection and bacteremia in hemodialysis patients. Accountability to the Client The professional nurse’s primary obligations will be to provide accurate and appropriate care to their clients. Accurate and appropriate delivery for nursing care focuses on client safety, and in order to provide safe care, the nurse must demonstrate competence. It is critical to prevent infections for nurses using sterile technique while taking care of Central intravenous catheter.

Nurse need to adhere to the policies of that employer (or participating in changing policy). Dialysis staffs and patients should wear gloves, gown, and a surgical mask or face shield during catheter connect and disconnect procedures to access the patient’s bloodstream to reduce the spread of infectious droplets and reduce contamination of the catheter site. The catheter hub caps or bloodline connectors should be disinfected per guidelines. To prevent contamination, a cap or syringe should be placed on, the lumen and tip should never remain open to the air. Nursing Accountability in Caring Essay Paper

Accountability to the Employer One area of employer accountability involves delegation to other care providers. The use of non-RN caregivers results from the recent nursing shortage and the need to the costs of care. Delegation encompasses the transfer of responsibility for performing tasks while retaining accountability for the outcomes of the client, including knowledge of the abilities of the one to whom tasks are delegated. In my past experience, I worked two different states have different regulations about licensure staff to take care of CVC patient.

In Wisconsin, they do not require RN or LPN to access to CVC for dialysis, PCT used to be trained to be a dialysis technician for 3 to 6 month program at hospital or dialysis clinic. PCT initiate hemodialysis using CVC, change dressings, and monitor during treatment. PCT who manipulating a catheter and accessing the patient’s bloodstream should be performed in a manner that minimizes contamination, but there was a higher rate of infection in hemodialysis patients. New or inexperienced PCTs seem to be difficult obtain and perform ascetic technique when manipulation CVC that place patient at risk for infection. Nursing Accountability in Caring Essay Paper

Even though they have policy says CVC dressing changes and catheter manipulations that access the patient’s bloodstream should only be performed by trained dialysis staff, I still have questions who proper trained staffs are. The nurse is accountable for the actions toward his or her patient, even if he or she has delegated the work onto PCT or LPN with many different reasons. Another state, for example, Texas, where only RN or LPN can access CVC has significant low infection rate related to hemodialysis CVC.

Upon completion of a training program, it is permissible for Licensed Practical Nurse (LPNs) working in chronic hemodialysis outpatient settings, to access and provide care to patients with CVC under the direction of a RN. This means RN supervise of LPN’s activities and responsible for the patients in the unit. Effective April 15, 2010, the Centers for Medicare and Medicaid Services (CMS), established new conditions for coverage for dialysis facilities to be certified under the Medicare program. Nursing Accountability in Caring Essay Paper

The conditions established specific standards which include the certification of Patient Care Technicians (PCTs). Facilities will be responsible for identifying the LPN and PCT candidates determined to be eligible for training. The delegation of thee activities is based on the RN’s professional judgment, the competence of the LPN and PCT, policy and procedures of the facility. Regardless of delegation, however, the RN retains the responsibility for the clinical management of dialysis care including assessment of the patient for symptoms and reactions.

The catheter exit site should be examined at each hemodialysis treatment for signs of infection by RN(Opinion). Staff and patient education should include instruction on infection control measures for hemodialysis access sites. Ongoing infection control and risk management should be in place to monitor the incidence of infection. We can delegate the responsibility to others, but we are still accountable for the outcomes. As nurses, we are accountable, to the client, profession, employer, and ourselves. References. Nursing Accountability in Caring Essay Paper

Milton, Constance L. (2005). Accountability in Nursing: Reflecting on Ethical Codes Professional Standards of Nursing Practice from a Global Perspective. from nursing. yale. edu/Centers/International/Ethics Conference/… /15_Milton. doc Professional Accountability and Nursing Classification Systems. Lecture 3. from http://angel03. gcu. edu/section/default. asp? id=1020866. http://www. cdc. gov/hicpac/pdf/guidelines/bsi-guidelines-2011. pdf http://www. op. nysed. gov/prof/nurse/dialysis-lpns-and-end-stage-care. pdf

Central Venous Catheter ( CVC ) is a catheter placed into a big vena to obtain an endovenous entree. Its usage has become indispensible in the direction of a critically sick patient. CVC is utile in hemodynamic monitoring, measuring of Central Venous Pressure ( CVP ) , uninterrupted IV extracts, hemodialysis/plasmapharesis and in puting of hard peripheral venous entree. Datas from the United States of America states a usage upto 15 million catheter yearss every twelvemonth ( 1 ) .Despite the battalion of benefits, CVCs have drawbacks every bit good. One of the most deadly complications associated with CVC is a catheter related infection. Catheter related blood watercourse infections ( CRBSI ) bears a mortality rate of 12-25 % doing it a really of import preventable health care associated infection ( 2 ) . As per CDC studies, there was a 58 % decrease in the rate of CRBSI from 2001 to 2009 ensuing in an approximative 27,000 saved lives and $ 1.8 billion disbursals in Health attention ( 3 ) . This helps in justification of the legion surveies in this field invariably updating the information sing the epidemiology every bit good as preventative schemes. Nursing Accountability in Caring Essay Paper

Over the old ages at that place has been a changeless diminution in the rate of CRBSI owing to the legion preventative schemes which are extensively implemented worldwide. Michigan State Keystone ICU Project ( 4-6 ) was a landmark enterprise launched in 2003-2004 across assorted ICUs in Michigan. This led to 70 % diminution in the rate of CRBSI in that part and is being implemented worldwide. A checklist was formulated based on the bing informations and was purely followed in all the ICUs which resulted in this positive result. The footing for the checklist was old informations from which few good proven and easy applicable intercessions were chosen. The thought of this survey is to chiefly place the attachment degrees in our infirmary to good CVC attention. The attempts taken in bar of CRBSI needs to be multidisciplinary affecting all classs of wellness attention workers and even the patient and his/her household. Nursing Accountability in Caring Essay Paper

Bacteriological profile every bit good as the incidence keeps altering from clip to clip thereby asking periodical experimental surveies.

AIM of the survey

To analyze the profile of Catheter Related Blood Stream Infection ( CRBSI ) among patients admitted in Medical wards/ICU in a third instruction infirmary in South India.

Aims

To analyze the incidence of CRBSI

To measure assorted factors associated with developing CRBSI

To analyze the bacteriological profile and antibiotic susceptibleness form among the isolates

To compare results among patients with/without CRBSI

To quantify the extra fiscal load due to CRBSI

Reappraisal of literature. Nursing Accountability in Caring Essay Paper

Epidemiology

Central venous catheters are progressively used in critically sick patients for hemodynamic monitoring, endovenous extracts, plasmapharesis / dialysis etc. They form a hub for colonisation of micro-organism. An infection ensuing from this colonisation contributes to Catheter Related Blood Stream Infection ( CRBSI ) which is one of the most preventable nosocomial infections. Harmonizing to CDC studies, yearly 15 million catheter yearss occur in the United States of America. Similar cumulative information is missing from our state. Catheter related infection ( CRI ) is a major hazard associated with them and it significantly increases morbidity and mortality in critically sick patients. The incidence of CRIs varies mostly depending on the geographic part as good assorted installations within the same part. Nursing Accountability in Caring Essay Paper

Datas from 108 ICUs in Michigan, USA ( 4-6 ) reported a baseline CRBSI incidence rate of 7.7 per 1000 catheter yearss prior to the execution of Keystone Intensive Care Unit Project by Pronovost et Al. However with the execution of this simple checklist, the incidence decreased to 1.4 per 1000 catheter yearss over the following 16-18 months and this decrease was sustained at 36 months of execution. Maki et Al ( 7 ) reported an incidence rate of 2.7 per 1000 catheter yearss in non-medicated, non-tunneled and non-cuffed cardinal venous catheters which are most normally used in ICUs. National Healthcare Safety Network 2009 ( 8 ) reported a average CRBSI rate of 1.65 per 1000 catheter yearss in ICU apparatus and 1.14 per 1000 catheter yearss in general inmate ward apparatus.

Fontela et Al ( 9 ) published a reappraisal of informations collected over 6 old ages ( 2003-2009 ) from 58 ICUs across Canada. The incidence rate of catheter related infections as expressed per 1000 catheter yearss was as follows: Nursing Accountability in Caring Essay Paper

Adult ICUs – 1.67

Pediatric ICUs – 2.26

Neonatal ICUs – 4.40

Besides, a noteworthy characteristic in this information was a important lessening in the rate of CRBSI with clip.

Similar incidence rates were reported across Europe. Tacconelli et Al ( 10 ) reviewed informations from France, Italy, Germany and the United Kingdom. The incidence rate was 1.12 – 4.2 per 1000 catheter yearss ensuing upto 14000 CRBSI episodes per twelvemonth which translated to a net extra disbursal of a‚¬ 160 million. Zingg et Al ( 11 ) reported a rate of 2 – 7 per 1000 catheter yearss from Switzerland. Nursing Accountability in Caring Essay Paper

Rosenthal et Al ( 12 ) reviewed the literature from resource limited states. All states based on their gross national per capita income were classified by the World Bank into four groups: Low, Lower-middle, Upper-middle and High income. Low and in-between income states are besides referred to as developing states or the resource limited states. 144 of the 209 states including India autumn under this class harboring over 75 % of the universe population. Merely 10 of those states reported CRBSIs utilizing standardised definition and methods. A sum of 99 surveies were identified of which 30 surveies were reviewed, including one from India. The CRBSI rate as expressed per 1000 catheter yearss ranged from 1.6 – 44.6 in grownup and paediatric ICUs, and 2.6 – 60 from neonatal ICUs. Mortality odds ratio ensuing from CRBSI ranged from 2.8 – 9.5.

Mehta et Al ( 13 ) studied the profile of health care associated infections ( HAI ) including cardinal venous catheter related infections, ventilator associated pneumonia and catheter associated urinary piece of land infection in 12 ICUs across 7 metropoliss in India. Christian Medical College, Vellore was besides a portion of this survey. The incidence rate of CRBSI was 7.92 per 1000 catheter yearss. This resulted in a important protraction of infirmary stay compared to patients without HAI – 4.4 yearss Vs 9.4 yearss. Excess mortality due to CRBSI was 4 % ( RR 1.6 ) . There were assorted other surveies across the state describing CRBSI rate. Parameshwaran et Al ( 14 ) reported a CRBSI rate of 8.75 per 1000 catheter yearss in Kasturba Medical College, Manipal. Chopdekar et Al ( 15 ) reported a CRBSI rate of 9.26 per 1000 catheter yearss in Grant Medical College, Mumbai. Patil et Al ( 16 ) from Satara, Maharashtra reported a much higher rate of catheter related infections – 47.31 per 1000 catheter yearss. Our infirmary has a nosocomial infection surveillance plan as a portion of which all ICU patients are monitored. The CRBSI rate in the twelvemonth 2010-2011 among patients in Medical ICU was 1.8 – 2 per 1000 catheter yearss ( unpublished information ) .Nursing Accountability in Caring Essay Paper

Bacteriology

The bacteriological profile in CRBSI is extremely variable. Different ICUs have a different profile. The profile may even alter within the same ICU with clip. SCOPE database ( 17 ) included 49 infirmaries in the USA and studied over 24 1000 instances of catheter related blood watercourse infections during 1995-2002. Overall 65 % of all infections were due to Gram Positive beings, 25 % due to Gram Negative beings and the staying due to fungi. Most common being isolated was Coagulase Negative Staphylococci ( CoNS ) imputing to 31 % of CRBSI. This was followed by Staphylococcus aureus doing 20 % of CRBSI. Another of import facet was the altering tendency of antibiotic susceptibleness noted from 1995 to 2001. Methicillin opposition among the Staphylococcus aureus isolates increased from 22 % to 57 % which was dismaying.

National Healthcare Safety Network, 2009 ( 3 ) information showed a important diminution in the CRBSI rate from 2001 to 2009, the major subscriber being a 73 % diminution in the rate of Staphylococcal infection ( RR = 0.27 ; 95 % assurance interval [ CI ] = 0.238 — 0.294 ) . However the diminution in the incidence of Gram negative being infection was non that marked ( 37 % decrease ; RR = 0.63 ; CI = 0.568 — 0.692 ) . Enterococcus showed 55 % decrease ( RR = 0.45 ; CI = 0.408 — 0.491 ) while there was 46 % decrease in Candida infections ( RR = 0.54 ; CI = 0.487 — 0.606 ) . Nursing Accountability in Caring Essay Paper

The bacteriological profile from India is diverse. Patil et Al ( 16 ) reported 65 % of civilizations insulating CoNS of which merely 44 % were Oxacillin sensitive. Chopdekar et Al ( 15 ) reported that 50 % of CRBSI was caused by CoNS, all of which were multidrug immune. The form of catheter colonisation was different, with Candida and Pseudomonas isolated more often than CoNS. Parameshwaran et Al ( 14 ) reported Staphylococcus aureus followed by Candida and Pseudomonas doing most infections. 26.7 % of S.aureus isolates were immune to Methicillin. However all MRSA and MRCoNS were susceptible to Vancomycin. While all these surveies reported Gram positive beings lending to the majority of CRBSI infections, Gopalakrishnan et Al ( 18 ) reported definite altering tendency noticed in India, with Gram negative beings being the predominant cause as noted over 8 old ages. MRSA contributed to merely 6 % of all CRBSI. 65 % of all E.coli and Klebsiella produced ESBL whereas 40 % and 70 % of Pseudomonas and Acinetobacter severally were immune to carbapenems. This high degree of multidrug opposition form is really alarming. Nursing Accountability in Caring Essay Paper

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