Reducing contamination of midstream urine samples through standardized collection processes: a best practice implementation project.

OBJECTIVE: The objective of this project is to decrease the rates of midstream urine sample contamination through standardization of evidence-based techniques among nurses. INTRODUCTION: Urinary tract infection is a prevalent health problem worldwide. The diagnosis and treatment of urinary tract infection depend on a thorough physical examination and the results of an uncontaminated midstream specimen of urine. However, improper techniques used in the collection often cause sample contamination, leading to delayed diagnosis and the use of inappropriate antibiotics for treatment. As nurses are at the forefront of care delivery, they are involved in reducing the rates of midstream urine sample contamination. Thus, the use of an evidence-based approach to standardize collection of midstream urine culture is crucial for the provision of higher-quality patient care. METHODS: Education sessions were delivered to the nurses and an evidence-informed standardized patient education leaflet was crafted by the project team for implementation. With a sample size of 30 nurses and patients, the project took place in a 21-bed adult surgical ward in a hospital in Singapore. The JBI Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRiP) programs were used to implement the evidence-based project. The project was implemented in three phases from October 2018 to January 2019. A standardized audit tool devised from JBI PACES was used for the audits in this project. The rates of midstream urine specimen contamination and the knowledge of nurses were also monitored. RESULTS: The baseline audit revealed that the nursing staff required educational sessions to improve their knowledge of midstream urine sample collection. Aside from criteria 1,3 and 4, the remaining criteria achieved compliance of more than 80%. The criteria below 80% compliance became the main focus of the project interventions. At follow-up cycle 1, all criteria achieved at least 80% compliance except criteria 4 and 5, which achieved 73% and 69% compliance, respectively. At the three-month post implementation audit, all criteria achieved a compliance rate of at least 80%. Fisher's exact test was carried out, and statistical significance of the results was achieved (p < 0.001) when compared to baseline audit. The rates of midstream urine specimen contamination also significantly decreased from 40% at the baseline audit to 20% at the third-month post implementation audit. Nurses' knowledge markedly improved as measured by the three-question quiz. CONCLUSION: This evidence-based implementation project highlights the effectiveness of the JBI PACES and GRiP processes for initiating best practice within a nursing environment. The use of JBI best-practice recommendations to standardize methods for midstream urine specimen collection effectively reduced the rates of midstream urine contamination.

Improving the accuracy of fluid intake charting through patient involvement in an adult surgical ward: a best practice implementation project.

OBJECTIVES: The main objective of this evidence-based utilization project was to improve the accuracy of fluid intake charting through patient involvement. INTRODUCTION: The accurate documentation and maintenance of fluid balance charts constitute an integral part of nursing care. However, inaccuracies in fluid balance charting by nurses often occur. Inaccurate charting can result in delayed interventions, affecting the safety of patients. It has been found that fluid intake charting in an acute surgical inpatient ward is highly inaccurate. Many expressions of dissatisfaction are evident among medical healthcare professionals and patients regarding the accurate updating of the charts. Therefore, evidence-based measures need to be implemented in order to improve the safety of patient care through accurate recording of patients' fluid intake. METHODS: The project took place in a 21-bed acute surgical ward which had 30 patients. The Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI-PACES) and Getting Research into Practice (GRiP) tools were used to implement the evidence-based project. A pre- and post- audit methodology congruent with the framework was applied. The project was implemented in three phases from April to September 2016. The audit criteria obtained from JBI-PACES were used. The project's primary focus was to harness patient involvement in improving the accuracy of fluid intake charting. RESULTS: Criteria 1 and 2 revealed low levels of compliance during the pre-implementation audit, 3% and 10%, respectively. There were significant improvements one month post-implementation for both Criteria 1 and 2, 100% and 87%, also respectively. Fisher's exact test was carried out and the statistical significance of the results was achieved (p < 0.001), compared to the pre-implementation audit. At six months post-implementation, the audit found that both criteria were adequately sustained as a practice in the ward (Criterion 1: 100%, Criterion 2: 83%). CONCLUSIONS: This project has demonstrated the effectiveness of improving the accuracy of fluid intake charting through patient involvement. The use of JBI-PACES and GRiP has allowed the effective utilization of evidence in practice. It has also provided evidence that effective engagement of the ground nurses and stakeholders coupled with the commitment of change champions and ground nurses can contribute to improving practice in a highly demanding acute care setting and lead to healthcare success.