Using statistical process control charts to measure changes from a nurse-driven protocol to remove urinary catheters

Reynolds, Staci S.; Lozano, Halie; Fleurant, Monique; Bhandari, Kalpana

doi:10.1016/j.ajic.2022.03.005

Cited by 2 publications

(3 citation statements)

References 15 publications

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“…17 Contrary to popular belief, QI initiatives without inferential statistical analyses can be published and provide clinically meaningful information. For example, Reynolds and colleagues 18 used SPC charts to determine whether there was a reduction in urinary catheter device days after implementing a nurse-driven urinary catheter removal protocol. They found no signals of improvement, but rather, special cause variation was identified with a shift of 8 data points above the extended mean, indicating there was an increase in urinary catheter device days after the intervention.…”

Section: Discussionmentioning

confidence: 99%

“…Findings demonstrated a continued need to implement further tests of change to improve the catheter utilization rate. 18 In another QI initiative, Williams and colleagues 19 implemented small tests of change through PDSA cycles to improve oral care compliance. Data were plotted using SPC charts, finding a shift in oral care compliance, with data points above the upper control limit, indicating clinical improvements.…”

Section: Discussionmentioning

confidence: 99%

“…They found no signals of improvement, but rather, special cause variation was identified with a shift of 8 data points above the extended mean, indicating there was an increase in urinary catheter device days after the intervention. Findings demonstrated a continued need to implement further tests of change to improve the catheter utilization rate 18 . In another QI initiative, Williams and colleagues 19 implemented small tests of change through PDSA cycles to improve oral care compliance.…”

Section: Discussionmentioning

confidence: 99%

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Misuse of the P Value

Reynolds,

Waldrop

2024

Dimens Crit Care Nurs

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Introduction Quantitative research and quality improvement (QI) both seek to improve care provided to patients. However, clinicians often blur the lines between how to appropriately analyze data from these methodologies. Clinicians may inappropriately use statistical analyses for QI initiatives, rather than using run and statistical process control (SPC) charts to analyze improvements in outcomes. Objective The purpose of this article was to address the analytic methods used for QI initiatives in the clinical setting in an effort to show clinicians how to identify meaningful improvements in clinical practice. Methods In this article, we provide an example comparing the same evidence-based practice/QI initiative (chlorhexidine gluconate bathing in a medical intensive care unit) using a quasi-experimental pretest/posttest research design with statistical analyses completed with t tests with analyses using run and SPC charts to show the data trended over time. Using a pretest/posttest design, chlorhexidine gluconate bathing compliance improved from 63% to 65%, a nonsignificant change, P = .075. These same data plotted on run and SPC charts, however, show a shift and a trend, indicating clinically significant improvements per QI methodologies. Conclusion The example in this article highlights the pitfall of relying only on statistical analyses and P values to determine the importance of a clinical project, and provides a practical example for how run or SPC charts can be used to identify improvements over time.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Misuse of the P Value

Reynolds,

Waldrop

2024

Dimens Crit Care Nurs

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Effectiveness of Nurse-Driven Protocols in Reducing Catheter-Associated Urinary Tract Infections

2024

Journal of Nursing Care Quality

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Background: Catheter-associated urinary tract infections (CAUTIs) are common health care–associated infections linked to indwelling urinary catheters. Nurse-driven protocols (NDPs) empower nurses to direct care without physician orders, potentially enhancing patient outcomes and reducing infection rates. Purpose: This systematic review and meta-analysis aimed to evaluate the effectiveness of NDPs for preventing CAUTIs and reducing catheter utilization rates. Methods: Databases searched included Cochrane Library, PubMed, Embase, and others. Ten studies involving 27, 965 NDP-treated patients and 30, 230 controls were reviewed, examining catheter utilization rates and CAUTI incidence. Results: Use of NDPs significantly lowered catheter utilization rates (34.84% vs 49.40%) and CAUTI incidence (2.867% vs 6.503%). Risk ratio analysis revealed a 29.48% decrease in catheter utilization and a 55.91% reduced CAUTI risk with NDP implementation. Conclusions: Using NDPs demonstrate superior efficacy in reducing catheter use and CAUTI occurrence compared to traditional methods. Further research is warranted to solidify evidence-based nursing practices in this area.

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Using statistical process control charts to measure changes from a nurse-driven protocol to remove urinary catheters

Cited by 2 publications

References 15 publications

Misuse of the P Value

Misuse of the P Value

Effectiveness of Nurse-Driven Protocols in Reducing Catheter-Associated Urinary Tract Infections

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