Evidenced-based practice is the use of clinical research to determine the best forms of patient care. Patient safety is very important. Preventing delirium in critically ill patients in the ICU is an area of nursing practice that has required evicene-based practice to help with this problem. Delirium is very bad for patients and can increase there stay in the hospital for 10 extra days. Bundles have been created by hospitals to help prevent delirium in critically ill patients. The RASS score is important to monitor patients in the ICU setting who are intubated. This score assesses their sedation level. If a patient is too sedated they can’t see if the patient is going through delirium. In the hospital I work at we use the CAM-ICU scale to assess the presence or absence of delirium. These delirium bundles include sedation cessation for patients receiving mechanical ventilation, pain control, sensory stimulation, early mobility and sleep promotion strategies. Sensory stimulation includes visible clocks, calendars and opening the blinds during the day and closing them at night. Patients who received the delirium prevention bundle experienced 78% less incidence of delirium. Using the CAM-ICU scale helps to see if a patient is suffering from delirium.
Another area of nursing practice that evidence-based practice has improved better patient outcomes is infections from urinary catheters. In the ICU I work at we don’t leave foley catheters in. We may leave it in if the patient is receiving CRRT or for a short period after surgery. Evidence has proved during the first week of catheterization, bacteriuria develops in 8% of patients per day, and after the 10th day of catheterization, half of patient are bacteriuric. Catheter associated bacteriuria (CAB) can result in marked morbidity, mortality, and cost. The mortality rate directly from hospital acquired CAB is 12.7%. CAB can cause bacteremia in patients and they end up staying longer in the hospital. Not keeping catheters in for extended time frames can prevent these types of infections. In the hospital I work at we have bundles to keep track of foley catheters to help prevent CAUTIs and keep track of CAUTIs. Doing good perineal care is also important if a patient has a urinary catheter this needs to be done every shift and as needed. This is good for patients with a temporary urinary catheter and patients who have chronic foleys.
Conway, L.J., Liu, J, Harris, A.D., Larson, E.L. Risk Factors for Bacteremia in Patients with Urinary Catheter-Associated Bacteriuria. American Journal of Critical Care. 2017; 26:43-52.
DiSabatino Smith, C. and Grami, P. Feasibility and Effectiveness of a Delirium Prevention Bundle in Critically Ill Patients. American Journal of Critical Care. 2017; 26:19-27.