2023 Comment1 Nursing practice has changed in how nurses handle and care for central

Comment1

Nursing practice has changed in how nurses handle and care for central lines as well as how central lines are inserted specifically peripherally inserted central catheters.  The reduction of CLABSI’s (central line associated blood stream infection) and the use of an insertion bundle have greatly improved patient outcomes in the last many years.   These practice changes have reduced patient mortality and decreased the length of patient stay in the ICU.  Through these studies and by implementation of new processes brings awareness to nursing staff on what needs to be done to better care and protect our patients.  The findings have changed my overall view of central lines. When I cared for central lines I was more careful at assessing, accessing, documenting and advocating for earlier removal of these devices when no longer needed in my patient.  At the hospital where I work, dressing changes of central lines are a two person process and the use of CUROS caps to cover needless connectors or injectable ports on tubing is required to prevent infection.  The insertion bundle is utilized by our PICC team who do their part in following strict guidelines when placing the central line catheter.    

Comment2

Hospital Acquired Pressure Ulcers (HAPU) is a topic of great concern in health care delivery due health impact and complications on affected patients, as well as the cost and reimbursement issues.  The costs of pressure ulcers are extremely high.  Patients die from sepsis related to pressure ulcers that become chronic.  According to National Pressure Ulcer Advisory Panel 2017, more than 2.5 million patients develop pressure injury (PI) a year, national incidence rate of 2.5% in hospitals, and 60, 000 death a year (William Padula, John Hopkins University). PI injury cost US Health system $9-11 billion a year.  In an effort to prevent HAPU, death caused by sepsis related to pressure ulcers, Stage II and III pressure Ulcers are among the eight preventable conditions identified by Medicare and Medicaid which extra payment are eliminated. Medicare and Medicaid stop reimbursing hospitals for certain hospital-acquired conditions considered preventable in the hospital setting, private insurance also follow this step.  Pressure ulcers are a potential complication of prolonged bed rest and are included in the category of hospital-acquired conditions. Incontinent patients are especially prone to pressure ulcers if moisture is not managed adequately. The key to prevent pressure entails is to first identify patients at risk; and second implementing strategies for all patients who are identified at risk. Health care delivery has the duty to focus patient care to prevent PI by inspecting skin daily, managing moisture on skin, conducting a pressure ulcer admission assessment for all patients, minimizing pressure, optimizing nutrition and hydration, reassessing risk for all patients daily. Following these steps help improving patient care and prevent incidence of PI in my facility. Adherence to skin care protocol program is effective way to prevent pressure ulcers.

The other evidence-based practice that has improved patients’ outcome is deep vein thrombosis prophylaxis, especially in the surgical patients undergoing general anesthesia and patient undergoing orthopedic surgery for fracture hips. Fatal pulmonary embolism (PE) rates range from 0.1% to 0.8% for all patients and may be as high as 7% for patients undergoing surgery for fractured hips (Medscape medical News, 2013). The frequent causes of DVT are due to augmentation of venous stasis due to immobilization or central venous obstruction. Nurses and surgeon needs to implement early ambulation for patient who are able to get out of bed early is the most important to prevent deep vein Thrombosis. For patient who cannot be up and ambulation, early treatment of anticoagulant therapy is crucial.