Digital Repository Doctoral Projects Spring 2023 Guidelines for the Proper Utilization of the PureWick External Female Catheter to Promote Positive Patient Outcomes and Prevent Harm Patricia Ann Weller Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Weller, P. A. (2023). Guidelines for the Proper Utilization of the PureWick External Female Catheter to Promote Positive Patient Outcomes and Prevent Harm Weber State University Doctoral Projects. https://cdm.weber.edu/digital/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact archives@weber.edu. PUREWICK GUIDELINES 1 April 28, 2023 April 28, 2023 PUREWICK GUIDELINES 2 Table of Contents Abstract………………………………………………………………………………....5 Guidelines for the Proper Management of the PureWick™………………………..…..6 Background and Problem Statement……………………………………………….....7 Diversity of Population and Project Site……………………………………………...8 Significance for Practice Reflective of Role-Specific Leadership………………..…..8 Literature Review and Framework…………………………………………………..….8 Search Methods………………………………………………………………….....…9 Reduction of CAUTI……………………………………………………………….....9 Urine Containment and Measurement…………………………………………...……9 Hazardous Urine Precautions…………………………………………………………10 Infection Control…………………………………………………………………...…11 Patient Harm………………………………………………………………………......11 Patient Satisfaction………………………………………………………………...….13 Indications…………………………………………………………………………….13 Contraindications………………………………………………………………...…...14 Application and Removal of the PureWick™…………………………………...…...14 Framework……………………………………………………………………………...15 Discussion……………………………………………………………………….…....16 Implications for Practice………………………………………………………….…..17 Project Plan………………………………………………………………………….….17 Project Design…………………………………………………………………….…..17 Needs Assessment of Project Site and Population……………………………..…..…18 PUREWICK GUIDELINES 3 Cost Analysis and Sustainability of Project…………………………………………..19 Project Outcomes……………………………………………………………………..20 Consent Procedures and Ethical Considerations………………………….……….….20 Instruments to Measure the Effectiveness of Intervention…………………….…..….20 Project Implementation…………………………………………………………………21 Project Interventions……………………………………………………………….....21 PureWick™ Training Video………………………………………………….....….22 Algorithm…………………………………………………………………...………22 NSR Unit Training…………………………………………………….………...….22 Knowledge Assessment………………………………………………..………...…23 New Hire Orientation……………………………………………...…….………….23 Project Timeline………………………………………………………………....……23 Project Evaluation…………………………………………………………………..…..24 Data Maintenance and Security………………………………………………………24 Data Collection and Analysis…………………………………………………..…….24 Findings……………………………………………………………………..………..25 Table I…………………………………………………………………..……..……25 Table II………………………………………………………………………….…..25 Strengths……………………………………………………………………….....…27 Weaknesses……………………………………………………………..…………..27 Discussion…………………………………………………………………...….....……28 Translation of Evidence into Practice………………………………….……………..28 Implications for Practice and Future Scholarship…………………………………….29 PUREWICK GUIDELINES 4 Sustainability………………………………………………………………………..30 Dissemination…………………………………………………………………….…30 Conclusion……………………………………………………………………..………..31 References………………………………………………………………………………32 Appendix A. Algorithm with Associated QR Code……………………………...……..37 Appendix B. Algorithm QR Code Unit Placement……………………………………..38 Appendix C. Observational Study Findings………………………………….…………39 Appendix D. Project Budget………………………………………...………………….41 Appendix E. Qualtrics Knowledge Check……………………………………......…….42 Appendix F. Project Implementation Power-Point………………………………….….49 Appendix G. Post-test assessment QR Code……………………………………………51 Appendix H. Project Timeline……………………………………………………...…..52 Appendix I. Pretest and Post-test Survey Results Comparison…………………...……53 PUREWICK GUIDELINES 5 Abstract The PureWick™ female external catheter is a revolutionary, non-invasive device for managing female incontinence. Nurses must meet specific criteria to initiate and maintain the PureWick™ device safely. Deficiencies in nursing staff knowledge may result in harm to patients and nurses. Purpose: This quality improvement project aimed to educate nursing staff on the evidence-based procedures to safely initiate, manage and supervise the use of the PureWick™ device. Methodology: A two-month observational study of nursing staff behaviors identified the lack of proper training and knowledge to manage the PureWick™, posing a risk for patient harm. An evidence-based educational training program was developed and delivered to nursing staff on an inpatient rehabilitation unit who incorporate the PureWick™ into their practice. Additionally, an algorithm was developed and associated with a quick response (QR) code to allow decisionmaking or troubleshooting. Results: A quasi-experimental design utilized a pretest and post-test strategy to collect quantitative data to determine intervention effectiveness. Qualtrics survey results indicate increases in learning in key safety areas. For example, one pretest question's Std deviation was 0.49, post-test Std deviation was 0.26. Implications for Practice: Implementing an evidence-based PureWick™ training program provides the education required to incorporate the device safely into practice. Safe practice behaviors reduce the risk of harm to patients and nursing staff. Keywords: Urinary incontinence, PureWick™ female external catheter, observation study, algorithm. PUREWICK GUIDELINES 6 Guidelines for the Proper Management of the PureWick™ External Female Catheter Device Urinary incontinence is involuntary urine leakage and is 2-3 times more common in adult females (Pansota et al., 2019; Testa, 2015). Incontinence of urine puts the skin's epidermal layer at risk for damage by increasing the pH level, potentially leading to infections, burning, pressure injuries, and substantial pain (Beeson & David, 2018). The only way to prevent this condition is by ensuring urine does not stay in contact with the skin for prolonged periods. Historically, urine and urinary incontinence are managed using indwelling catheters or adult disposable diapers. Urinary tract infections are consistently among the top common healthcare-associated infections or HAIs (Beeson & Davis, 2018; Grey et al., 2016; Monday et al., 2021; Uhr et al., 2021; Warren et al., 2021). Up to 75% of HAIs are associated with an indwelling urinary catheter and are considered preventable (Centers for Disease Control and Prevention, 2021; Van Decker et al., 2021, Uhr et al., 2021; Warren et al., 2021). Indwelling urinary catheters are associated with urinary tract infections (CAUTI). In 2015, there were 62,700 CAUTIs, with 13,000 directly related deaths. Several years later, similar CAUTI rates and morbidity exist (Bagley & Severud, 2021; Glover et al., 2019). For example, the fourth quarter of 2020 noted a 19% increase in CAUTIs, with the intensive care unit (ICU) settings seeing a rise of up to 30% (Centers for Disease Control and Prevention, 2021). Adult disposable diapers are associated with incontinence-associated dermatitis (IAD); this condition is often reported among adult patients (Mugita et al., 2021). The state of IAD develops by sustained exposure to urine due to infrequent changes completed by nursing staff and the occlusive nature of the product (Mugita et al., 2021). In addition, Mugita et al. (2021) PUREWICK GUIDELINES 7 also report compromised skin integrity due to these products affecting skin microclimate, disrupting barrier function, and changes to pH levels. Proper utilization and management of the PureWick™ can prevent patient injury. Literature suggests that the PureWick™ external female catheters can positively impact urine management in incontinent women while decreasing harmful effects like infection and skin breakdown (Beeson & David, 2018; Caufman et al., 2019; Glover et al., 2019). Several processes are involved in the proper utilization and management of PureWick™. Improper management can harm patients (Bagley & Severud, 2022). Pronovost and Bo-Linn (2012) remind us that although national attention has focused on reducing patient error and associated damages, patients are still experiencing preventable and often costly harm. Background and Problem Statement When used properly, the PureWick™ is an alternative, non-invasive method to manage urine incontinence in female patients; when not used properly, the device poses the risk of patient harm. This author conceived the opportunity for the project after being asked by senior leadership to develop PureWick™ protocols for implementation in the Neuro Specialty Rehabilitation Units (NSR) within Intermountain Health Care. At the time, it was unclear if the PureWick™ was being utilized correctly on female patients. In the NSR unit, the preference is mobile patients; both males and females get up and out of bed at night to use the restroom. A 2month naturalistic observational study occurred in the Saint George Regional Neuro Rehabilitation Unit to determine the utilization of the PureWick™, with field notes compiled of the nursing staff's behaviors managing the device. Direct observations concluded that the frontline nursing staff's behaviors indicated insufficient training to initiate and manage the PureWick™ device safely. Considering this new awareness, a decision was made to address PUREWICK GUIDELINES 8 concerns and advocate for the safety of patients by developing a project that addresses risky and deficient actions (Watson, 2016) of nursing staff concerning the utilization of the PureWick™ device. Diversity of Population and Project Site This project's population includes registered nurses, certified nursing assistants, and patients providing or receiving care at Saint George Regional Hospital. Saint George Regional Hospital is a 284-bed facility serving southern Utah, southeastern Nevada, northwestern Arizona, and other locations when facilities divert. Saint George Regional Hospital is a level II trauma center caring for diverse conditions and populations (Intermountain Healthcare.org). Significance for Practice Reflective of Role-Specific Leadership The nursing staff plays a vital role in managing urinary incontinence in hospitalized patients (Bradway & Hernly, 1998). The PureWick™ female external catheter is a non-invasive device that contains female incontinence, reduces skin breakdown, and measures urine output (Van Decker et al., 2021). Facilities such as Boston Medical Center report that despite the PureWick™ being a newer technological device, it is crucial to lead the movement toward the non-invasive management of urinary incontinence (Van Decker et al., 2021). While in the nurse leader and DNP student role, extensive observation and interview uncovered that the current nursing staff lacks adequate education and training on PureWick™ utilization and management. Therefore, developing and implementing a PureWick™ training program will benefit nursing staff and patients at Saint George Regional Hospital. Literature Review and Framework PUREWICK GUIDELINES 9 A literature review was conducted to find relevant information associated with the utilization and management of the PureWick™, cases of patient harm, catheter-associated urinary tract infections, and use of the PureWick™ in preventing CAUTIs. Search Methods Databases accessed were CINAHL, EBSCO, Google Scholar, and PubMed. Several search inclusion terms were attempted; however, the ones that yielded the best results were: PureWick™, female external catheters, catheter-associated urinary tract infections, CAUTI prevention, hazardous drug precautions, hazardous urine, and infection control. Excluded were journal articles older than ten years, except four pieces. Articles were selected if they reported using PureWick, which contained information about catheter-associated urinary tract infections, statistics, measures to prevent patient harm, hazardous drug precautions, and infection control. Reduction of CAUTI CAUTIs are consistently at the top of all hospital-acquired infections and result in increased healthcare costs, increased lengths of stay, drug resistance, increased suffering, and mortality (Beeson & Davis, 2018; Grey et al., 2016; Monday et al., 2021; Uhr et al., 2021; Warren et al., 2021). Some estimates put the yearly costs of CAUTIs at five billion dollars in direct and indirect expenses (Bagley & Severud, 2021). In addition, females are more likely to have an indwelling catheter and 3x more likely to develop a CAUTI (Warren et al., 2020). The use of an external female catheter is shown to be a feasible alternative to indwelling catheters aiding in the prevention of CAUTI (Beeson & David, 2018; Eckert et al., 2020; Glover et al., 2019 Grey et al., 2016; Monday et al., 2021; Van Decker et al., 2021; Warren et al., 2021). Urine Containment and Measurement The PureWick™ allows urine to be evacuated through controlled suction from the PUREWICK GUIDELINES 10 vaginal opening, collected, and stored in a collection canister (Eckert et al., 2020; Uhr et al., 2021). The PureWick™ has a 99% urine capture efficiency when used correctly (The PureWick™ female external catheter (FEC)-bardcare.uk, 2020; Tran & Rodrigue, 2018). In addition, in situations where the accounting of intake and output is essential, the collection canister allows for the accurate measurement of urine (Bagley & Severud, 2021; Beeson & Davis, 2018; Grey et al., 2016; Tran & Rodigue, 2018; Van Decker et al., 2021; Warren et al., 2021). Hazardous Urine Precautions Many hazardous drugs are excreted through a patient's urine (Polovich, 2004; Sessink & Bos, 1999). Cytostatic drugs, antineoplastic, and other hazardous drugs used to treat conditions such as cancer, infections, and immune deficiencies are occupational hazards (Friese et al., 2019; Sessink & Bos, 1999; Walton et al., 2012). Hazardous drugs are being administered with increased frequency outside the typical oncology setting with their approval for use in conditions such as organ transplantation, rheumatoid arthritis, and psoriasis (Friese et al., 2019). It is not uncommon to find these drugs in various departments in the hospital setting, such as the rehabilitation unit. Hazardous drug exposure poses significant health risks to nursing staff, such as reproductive problems, spontaneous abortions and miscarriages, menstrual dysfunctions, malformation in offspring, preterm and low birth weights, rare cancers, skin disorders, and significant respiratory issues (Friese et al., 2019; Sessink & Bos, 1999; Walton et al., 2012). Urine output from patients receiving dangerous drugs must be handled as contaminated for up to seven days after receiving drug therapy (Section 15-waste handling and patient excreta, 2007). After using the PureWick™, the device may be a potential biohazard and must be disposed of PUREWICK GUIDELINES 11 according to specific organization policies (The PureWick™ female external catheter (FEC)bardcare.uk, 2020). The National Institute of Occupational Safety and Health and other organizations recommend using personal protective equipment (PPE) when handling hazardous drug material and waste (Friese et al., 2019; Polovich, 2004; Sessink & Bos, 1999; Walton et al., 2012). PPE includes chemo-rated gloves, protective gowns, masks, and goggles. Infection Control Bodily fluids such as urine should be treated as potential sources of infections (Hamasuna et al., 2011). Urine management requires special care due to the bacteria in watery environments, such as Pseudomonas aeruginosa, Tuberculosis bacilli, and E faecalis, which can cross-infect patients and staff (Flores,2007; Hamasuna et al., 2011). Through standard precautions, the risk of transmission is reduced (Flores, 2007; Hamasuna et al., 2011). Standard precautions include appropriate hand hygiene, PPE use, and gloves. During direct observations of patients and nursing staff handling the PureWick™, concerning behaviors that led to infection control concerns were noted. One such behavior was a patient using the device intermittently by removing after urination, draping it over a garbage can placed at the bedside, and reapplying at the next urge to void. Hand hygiene was not noted inbetween uses. Another behavior of concern is the draping of a soiled PureWick™ over the suction canister close to other medical equipment. Patient Harm As with any medical device, misuse and mismanagement of PureWick™ can cause patient harm (Bagley & Severud, 2021). Every year in the United States, there are close to five hundred thousand patient deaths, with innumerable more patients harmed directly resulting from PUREWICK GUIDELINES 12 human error (Watson, 2016). Otherwise known as patient safety events, they often do not occur for complex reasons but from simple and preventable human errors (Watson, 2016). Therefore, the education provided to nursing staff is crucial to patient safety, including appropriate indications and contraindications for use, proper application, approved suction controls, skin assessments, and peritoneal care requirements (Bagley & Severud, 2021). High suction control settings can result in skin breakdown that can progress to localized necrosis and gangrene (Bagley & Severud, 2021). A manufacturer and user facility device experience (MAUDE) adverse event report described friction burns and abrasions discovered on a female patient that resembled suction marks and required the care of a wound ostomy nurse to heal. Upon further investigation, it was found that the suction was turned up to 200 mmHg or 160 mmHg higher than the recommended suction setting (FDA, 2017). A recent shift huddle at Saint George Regional Hospital discussed a similar incident. Due to inappropriate suction settings and periodic device checks, a female patient suffered severe friction burns resulting in a higher level of wound care management to heal (S. Martinez, R.N., personal communication, 2022). Bagley and Severud (2021) present a case in which a 64-year-old woman hospitalized for thirty days was discharged to a rehabilitation facility. Two days later, she was readmitted to the hospital with a urinary tract infection (UTI) and a fungal infection encompassing the vagina and perineum. This patient had a PureWick™ in place during her thirty-day hospital stay and, unfortunately, suffered a life-threatening complication from its use. Ensuring patient safety generally comes from developing and sustaining simple safety habits among nurses and all healthcare workers who affect the lives of their patients daily (Lawati et al., 2018; Watson, 2016). Patient safety is achieved when employees know and understand what behaviors and attitudes are appropriate and expected by the healthcare PUREWICK GUIDELINES 13 organization in which they are employed (Lawati et al., 2018). Without knowledge of the elements required for the proper utilization of the PureWick™, patient safety is compromised. Patient Satisfaction The benefit(s) of using PureWick™, thus adding to patient satisfaction, includes utilizing the device on patients with various mobility constraints, such as bedrest (Beeson & David, 2018; Urh et al., 2021; Van Decker et al., 2021). Using the device promotes cleanliness and increases patient satisfaction (Beeson & Davis, 2018; Caufman et al., 2019). One institution reported that patients and nurses find the device easy to use and comfortable (Urh et al., 2021). Research indicates that PureWick™ promotes better sleep (Beeson & Davis, 2018; Bleeker et al., 2019; Glover et al., 2019). Increased patient satisfaction also results from decreased pain one experiences from being turned and repositioned during brief and linen changes (Beeson & Davis, 2018; T. Hertzberg, RN, personal communication, 2022). Hospital-acquired infections such as CAUTI can increase hospital lengths of stay and may decrease patient satisfaction scores, as patients are responsible for paying most or all costs incurred (Bagley & Severud, 2021). In addition to increased patient satisfaction, nurses utilizing the PureWick™ report satisfaction. Applying the PureWick™ is not invasive and therefore does not require a physician's order (Eckert et al., 2020; Dr. B. Hatch, personal communication, 2021; Warren et al., 2021). The device decreases the workload of toileting and linen changes; it allows for the containment and measurement of urine. When used correctly, the device is a safe alternative for keeping patients free from skin injury and infection (Beeson & Davis, 2018; The PureWick™ female external catheter (FEC)-bardcare.uk, 2020; Tran & Rodrigue, 2018). Indications PUREWICK GUIDELINES 14 The PureWick™ is indicated for use in female patients (Eckert et al., 2020; Tran & Rodigue, 2018). Other indications for use include: the bedbound patient, incontinence of urine, post-surgical procedures which limit mobility, other mobility issues, accurate urine measurement requirements, prevention of skin breakdown due to incontinence, difficulty using a bedpan (Eckert et al., 2020; Glover et al., 2019; Tran & Rodigue, 2018; Van Decker et al., 2021). Contraindications The PureWick™ is contraindicated in patients with urinary retention (Bagley & Severud, 2021; Eckert et al., 2020; Tran & Rodrigue, 2018) and in menstruating patients who cannot use a tampon (Bagley & Severud, 2021; Eckert et al., Tran & Rodrigue, 2018). The PureWick™ is not recommended for patients with frequent bowel incontinence unless a fecal management system exists (Bagley & Severud, 2021; Tran & Rodrigue, 2018). The device is not recommended in patients with recent urogenital surgery (Bagley & Severud, 2021; Tran & Rodrigue, 2018). The device should not be used on altered or combative patients (Bagley & Severud, 2021; Eckert et al., 2020; Tran & Rodigue, 2018). The PureWick™ is contraindicated in patients with male genitalia and postpartum patients with vaginal discharge. It is not to be used with a bedpan or materials which obstruct airflow, and those who are mobile and can ambulate safely to the bathroom (Eckert et al., 2020; The PureWick™ female external catheter (FEC)-bardcare.uk, 2020; Uhr et al., 2021). During the 2-month observation completed before approval of the project, several ambulatory patients requested the use of the device purely out of personal convenience reasons. Application and Removal of the PureWick™ Before applying the PureWick™, cleanse the peritoneum area with soap, water, or another approved cleanser and perform a skin assessment to check for compromised skin PUREWICK GUIDELINES 15 integrity (Bagley & Severud, 2021; Uhr et al., 2021). Next, align the device with the perineum, palpating the pubic bone as an anatomical landmark. Position between the labia and against the urethral opening, with the top end aligned with the pubic bone and the bottom tucked gently between the gluteus muscles. Ensure the wicking material touches the skin (Bagley & Severud, 2021; Beeson & Davis, 2018; The PureWick™ female external catheter (FEC)-bardcare.uk, 2020; Uhr et al., 2021). Connect the tubing to low continuous suction greater than or equal to 40mmHg but never on a high setting (Bagley & Severud, 2021; The PureWick™ female external catheter (FEC)-bardcare.uk, 2020). Ensure suction is turned on and extension tubing is free of twists (Bagley & Severud, 2021). Do not insert the device into the vagina, anal canal, or other body cavities (Bagley & Severud, 2021; Beeson & Davis, 2018; The PureWick™ female external catheter (FEC)-bardcare.uk, 2020). To remove the PureWick™, separate the patient's legs, gluteus, and labia to remove the device and gently pull directly outward. Never push or pull the apparatus against the skin during placement or removal (Uhr et al., 2021). To avoid urine backflow, keep the suction on during removal. To ensure patient safety, replace every 8-12 hours or if soiled with stool (The PureWick™ female external catheter (FEC)-bardcare.uk, 2020; Uhr et al., 2021). Always change out the device if dropped onto the floor or otherwise compromised. Framework The PureWick™ project aims to foster the adoption of proper use and management of the PureWick™ device. Everett Rogers' Innovation-Diffusion Model will be the framework this project utilizes. Roger's model works better for adopting behaviors instead of cessation or preventing behaviors (LaMorte, 2016). The model's four stages include awareness, the decision to adopt, initial use, and continued use. The project's awareness stage includes validating the need PUREWICK GUIDELINES 16 for PureWick™, a newer innovation in the healthcare industry. Awareness consists of the actualization and realization that the PureWick™ device must be utilized according to specific standards of care. The decision to adopt stage and initial use stage is where the education and training video occur. The continued use phase is where the learned information becomes the standard when nursing staff utilizes the device on female patients. According to Roger's theory, five main influencing factors lead to adopting an innovation (LaMorte, 2016). The first two are relative advantage and compatibility. The project aims to reveal the benefits and compatibility of using the PureWick™ device to manage urine safely in adult females. The third influencing factor is complexity. Many innovations fail at adoption due to complexities. The project addresses perceived complexities of the PureWick™, such as suction settings and infection control, in a manner that is easy to understand, remember and apply. The final two influencing factors are tribality and observability. The project will address both through easy access to the training video through a barcode scanning system that anyone with a smartphone can use. An expert panel discussion found a reluctance of nursing staff to use external collection devices due to concerns that included application, indication, and management questions (Gray et al., 2016). Eckert et al. (2020) find that educating registered nurses and nursing assistants contributes to intended project outcomes. It is the hope that the PureWick™ project will do just that. Discussion Emerging research indicates that using the use of the PureWick™ external female catheter is an appropriate alternative to managing female incontinence (Beeson & David, 2018; Caufman et al., 2019; Glover et al., 2019). Improper use of PureWick™ can put patients and nursing staff at risk for injury (Bagley & Severud, 2021). However, deficiencies in nursing staff knowledge can PUREWICK GUIDELINES 17 result in device misuse. Addressing deficiencies in learning by developing a comprehensive training program that is easily understandable and accessible can promote the safe use of PureWick™ for patients and nurses alike. Implications for Practice The utilization and management of PureWick™ in a consistent and approved manner will reduce CAUTIs and the significant costs associated with treating these HAIs. The PureWick™ increases patient satisfaction through sleep promotion, skin protection, cleanliness, decreased pain from mobility constraints, and cost reduction by preventing HAIs. The PureWick™ accurately measures and monitors urine output when measurements are crucial to patient outcomes. Using PureWick™ leads to nursing satisfaction by reducing the workload of frequent linen changes and adult disposable diaper changes, which can lead to workplace injuries when caring for overweight, obese, or mobility-limited patients. Developing a training program will increase nursing knowledge and confidence when initiating and maintaining the device. Project Plan This project plan includes developing a PureWick™ external female catheter training program delivered to the Neuro Rehabilitation Specialty Unit nursing staff at Saint George Regional Hospital. A pretest and post-test strategy will measure baseline and learning competencies. The project includes the development of an algorithm with an associated QR (quick response) code (see Appendix A). The algorithm will enable nursing staff quick access (via their smart device) to instructions for utilizing and managing the PureWick™ external female catheter competently and safely. Project Design PUREWICK GUIDELINES 18 The quality improvement project aims to train nursing staff to safely incorporate the PureWick™ female external catheter into practice. The project designed an evidence-based training program for nursing staff using the PureWick™ device. Included in the training curriculum was a video produced by the manufacturer of the PureWick™ and targeted to clinical personnel. In addition to the training program, the principal investigator developed an algorithm to provide a visual tool with step-by-step directions on how to use the device. The algorithm has an assigned scannable QR code and was placed next to the PureWicks to allow quick and easy access to information and troubleshooting (see Appendix B). Increasing understanding and knowledge of the PureWick™ will reduce the risk of harm to patients and nurse staff who use the device. In addition, increased awareness and knowledge will aid in continuous quality improvement. Needs Assessment of Project Site and Population With the support from key stakeholders, including the medical director, this project was initially targeted at the nursing staff utilizing the PureWick™ within the NSR unit(s). Before the project plan and design, a need for further training of the nursing staff working on the NSR unit was identified through findings of an observational study requested by Jaime D'Ausilio, Nursing Director of Rehabilitation Services Intermountain Healthcare (see Appendix C). Following the project's inception, similar needs have been identified in other departments throughout the hospital, such as W4, resulting in the need to incorporate the BD PureWick™ Female External Catheter Acute Care training video into the new nursing staff orientation process. Additionally, it was identified that Nursing staff who have not received this orientation training would benefit from easy access to a reference guide, such as an algorithm, to help them safely implement the PureWick™ into their patient care. Along with the nursing director, other key stakeholders PUREWICK GUIDELINES 19 contributing to the success of this project include the educator and manager of the NSR unit at SGRH. Key stakeholders responsible for new hire education have written the B.D. video into the orientation curriculum providing this vital education to all new hires at SGRH. The project will rely on the leadership of other units to encourage the use of the algorithm. Supporters of the Institute of Medicine (IOM) understand that one of the six primary goals developed by the IOM is to avoid patient harm during a patient's medical treatment (Six Domains of Health Care Quality, 2018). This project promotes patient safety through the B.D. Medical training video used in the training session, new hire orientation, and the development of the PureWick™ External Female Catheter Algorithm for Inpatient Adult Female Use. Cost Analysis and Sustainability of Project Costs associated with implementing the project were discussed and approved with project consultants. The investigator is responsible for any cost incurred to associate the Q.R. code with the PureWick™ algorithm, incentives, and gratitude gifts given to project consultants. Initial project costs are as follows: ● One training session for 18 registered nurses and 16 certified nursing assistants at the average hourly wage of $28.00= $952. ● Algorithm QR code printed and laminated for each supply room containing the PureWick™ device at SGR at $1.50 X 15= $22.50. ● Cost to generate the Q.R. code for algorithm =$112.66 ● Post-test incentives at $10=$400.00 ● Final budget costs are included in (Appendix D). The sustainability plan incorporates the five-minute BD PureWick™ Female External Catheter Acute Care training video into newly hired nursing staff orientation at SRH. The PUREWICK GUIDELINES 20 sustainability of the algorithm's scannable Q.R. code will depend on the subscription management. Currently, the investigator has paid for the Q.R. code for a year. Intermountain HealthCare owns the intellectual rights of the algorithm, and how the key stakeholders decide to manage it is left to be determined. Maintaining the laminated Q.R. codes will be designated for individual unit educators and managers. Project Outcomes The intended project outcomes will be evaluated through the measurement of the following goals: ● After training, there will be an increase in knowledge from the pretest to the post-test. ●Nursing staff will utilize the Q.R. code to seek answers to their PureWick™ questions, as evidenced by the future number of "hits" the Q.R. gets. ●The BD PureWick™ Female External Catheter Acute Care training video will be a continued part of the new hire orientation curriculum. ●There will be zero incidents of harm related to using the PureWick™ female external catheter, as evidenced by future audits. Consent Procedures and Ethical Considerations Weber State University's Institutional Review Board (IRB) and Intermountain Healthcare's IRB both determined that this project meets the requirements for quality improvement and, thus, does not need formal IRB approval. Tests and associated results are assured to be anonymous, aggregated, and protected. Instruments to Measure the Effectiveness of Intervention The PureWick™ External Female Catheter Application & Maintenance Knowledge Check was created in Qualtrics to measure knowledge before and after the training program's PUREWICK GUIDELINES 21 completion (see Appendix E). The tool collected aggregate data on knowledge of appropriate utilization and management of the PureWick™ device. Participation in both the pretest and posttest was voluntary; responses were anonymous. Creation of the knowledge check questions utilized findings from the PureWick™ Observation Report. Results that posed the most significant risk of harm to patients and nursing staff, such as suction settings, were turned into questions that, when answered correctly, would demonstrate staff competence in managing the device safely. Consultation with Tamika Richardson MSN, PureWick Marketing Lead, BD Interventional, and Wanfei Yang MHS, Associate Director Care Continuum Solutions Urology and Critical Care, BD Interventional, provided content validity of the questions in the knowledge check. Ms. Richardson and Ms. Yang are subject experts on the PureWick™ external female catheter. Project Implementation The project was fully implemented when the following aims were met. First, PureWick™ training material(s) have been incorporated into new hire orientation at SGRH. Second, the PureWick™ External Female Catheter Algorithm for Inpatient Adult Female Use with its associated QR code was placed next to the PureWick™ on all units at SGRH whose nursing staff use the device. The training material and algorithm instructed nursing staff on the safe and appropriate utilization of the PureWick™ device. Finally, the NSR staff training session was delivered, and data were collected and analyzed. Project Intervention An early intervention completed to facilitate the successful implementation of the PureWick™ project was the accomplishment of a 2-month naturalistic observation study on the PUREWICK GUIDELINES 22 NSR Unit. The results identified unit-specific concerns about nursing staff management of the PureWick™ and validated the need for further interventions. As the project progressed, similar behaviors were noted throughout the various units at SGRH, including an incident involving patient harm witnessed by this author while floating in the Orthopedics Unit. PureWick™ Training Video The project's initial plan was to develop and film a 2-minute training video demonstrating how to safely and correctly use the PureWick device. The footage would have then been utilized in the broader training program. Additionally, the plan included associating a QR code linking the trainees to the training video. Despite collaborative efforts between this author and Liberator Medical and Bard Inc (BD) representatives, written legal permission to develop the video was not obtained, resulting in an inability to proceed with filming. Fortunately, newly found mentors at Bard provided this author with the information necessary to establish credentials, gaining access to a 5-minute training video already developed with all rights reserved by BD. Algorithm The PureWick™ External Female Catheter Algorithm for Inpatient Adult Female Use was developed and presented to key stakeholders. This algorithm will guide nursing staff who utilize the PureWick™ with step-by-step clinical decision support instructions. A QR code was established and associated with the algorithm. Once the algorithm was edited and final revisions completed, a new QR code was associated, printed, laminated, and placed next to the PureWick™ devices for staff development and sustainability. In addition, unit managers and educators were sent emails detailing the algorithm. NSR Unit Training PUREWICK GUIDELINES 23 The results of the observation study established a need for PureWick™ training to address the deficiencies. A PowerPoint presentation (see Appendix F) was developed and delivered during a mandatory training implemented on September 20, 2022. Two weeks before the training, flyers were posted around the NSR unit with the date and time of the mandatory meeting. A week before the meeting, reminder emails were sent to all staff members. Knowledge Assessment At the start of the training session, a pretest was given utilizing the questions in the PureWick™ External Female Catheter Application & Maintenance Knowledge Check created in Qualtrics. The pretest, initially in paper form, gathered baseline knowledge regarding the utilization and management of the PureWick™ device before the training. Participants were given access to a QR code to scan via their smart device and completed the post-test in the Qualtrics system (see Appendix G). Both instruments collected anonymous aggregate knowledge data for comparison purposes. New Hire Orientation The PureWick™ training video produced by Bard and used in the project was adopted into the new hire orientation curriculum at SGRH. All new hires who work in nursing are required to view this video during their orientation process. The NSR unit educator and a project consultant assisted with incorporating the Bard video into new hire orientation, aiding in sustainability. Project Timeline The implementation of the PureWick™ project began in 2020 at the request and under the direction of senior leadership at the inpatient rehabilitation executive level. This request PUREWICK GUIDELINES 24 resulted in the observation study and the beginning of the project. The project, with its associated interventions, timeline, and deadlines, since developed, are in (Appendix H). Project Evaluation Evaluation of the PureWick™ quality improvement project began with administering the pretest before starting the educational training program provided to nursing and other direct support staff working with patients on the NSR unit. Upon delivery of the training, a post-test in the same question format was administered. The results of tests were compared and analyzed to determine if knowledge increased after the intervention and if the project could be considered generalizable and sustainable. Data Maintenance and Security The PureWick™ project utilized a pretest and a post-test to measure the learning before and after the project implementation. Neither test contained personal or identifiable information, including names and IP addresses, to ensure the security of the data. The primary investigator collected original pretest documents, stored them in a secured office, and shredded them immediately after analysis. Principle investigator ensured data security. Data Collection and Analysis Quantitative data for this quasi-experimental design was collected from participants after the conclusion of the educational intervention. A pretest and post-test were developed using Qualtricsᵡᵐ online survey software. Conversely, there was no control group. Participants in the intervention took the pretest before the educational training and the post-test upon completion. Questions were the same for both tests. Initially, participants completed the pretest on paper. Then, participants accessed the post-test using an anonymous link provided to them. Descriptive PUREWICK GUIDELINES 25 data from the survey results were analyzed using the data analysis and results feature within Qualtricsᵡᵐ. Findings The results of the PureWick™ educational training suggest that the intervention increased staff knowledge on how to initiate and manage the female external catheter safely. The results of questions considered significant and pose the greatest risk to patient safety are displayed in the following tables. Table 1 Pre-Post Measures of PureWick™ Survey Variable PureWick™ can be used on a male or female. Pre-Assessment M 1.62 SD .49 Post-Assessment M 1.93 SD .26 Appropriate initial suction setting. 1.48 .50 1.11 .31 PureWick™ reusable? 2.09 0.55 2.00 0.00 This table demonstrates participant responses to the PureWick™ survey before and after the educational intervention. Note: Pretest results in N=36. Post-test results N=44. Table 2 Pre-Post Measures of PureWick™ Survey in percentages PUREWICK GUIDELINES 26 The PureWick™ device can be used on a male or female. Answer Pretest Post-test Percent True 41.67 False* 58.33 True 0 False* 100 What is the most appropriate initial suction setting? Answer Pretest Post-test Percent 40mmHg* 47.22 120mmHg 52.78 200mmHg 0 40mmHg* 95.83 120mmHg 4.17 200mmHg 0 Is the PureWick™ reusable? Answer Pretest Yes, rinse & dry between uses or when Percent 11.43 soiled No, it is a single-use device that should be 68.57 replaced minimally every 8-12 hours or soiled* No, it is a single-use device that should be 20.00 replaced every 24 hours or soiled Post-test Yes, rinse & dry between uses or when soiled 0 PUREWICK GUIDELINES 27 No, it is a single-use device that should be 100 replaced minimally every 8-12 hours or soiled* No, it is a single-use device that should be 0 replaced every 24 hours or soiled Note: * Indicates correct answers. The PureWick™ female external catheter was developed for female use only. The question asked if the device could be used on males and females, 41.67 % of pretest respondents answered true, compared to zero post-test. Possibly, the most critical question in the survey addressed suction settings. Respondents answered this question correctly 68.57% pretest compared to 100% correctly post-test. Respondents answered correctly on 47.22% pretest compared to 95.83% post-test. Reducing the risk of infection is critical when utilizing the device. Re-using, rinsing, or prolonged use of the device is contraindicated. See the results of all questions and answers in (Appendix I). Strengths Participation in the education training intervention was considered mandatory, but the pretest and post-test were voluntary and anonymous. The PureWick™ External Female Catheter Application & Maintenance Knowledge tool used in the pretest and post-test was developed using results from the observational study. The questions were specific to behaviors that posed the risk of patient harm and were validated by content experts. Results of the post-test demonstrated an increase in knowledge which will contribute to patient safety. In addition, findings may be generalized to other nursing units throughout the hospital. Weaknesses Limitations to the study include fewer than anticipated participants in the training session. Despite mandatory training, approximately 20 nursing staff were absent. Additionally, present PUREWICK GUIDELINES 28 during the training were physical and occupational therapists who do not directly apply or monitor the PureWick™ while the device is in use. During the pretest and post-test surveys, discussion was noted among participants, which may have influenced individual responses. There were unequal responses between the pretest and post-test, with eight more completing the post-test. Survey results were anonymous, resulting in the inability to demonstrate individual learning outcomes. Discussion Guidelines for adequately utilizing the proper operation of PureWick™ external female catheter to promote positive patient outcomes and prevent harm were successfully incorporated into an educational training program and implemented in the Neuro Specialty Rehabilitation Unit at Saint George Regional Hospital. The project's overarching goal was to increase nursing staff knowledge on safely incorporating the PureWick™ into practice. Translation of Evidence into Practice The PureWick™ female external catheter is an innovative device to manage female urinary incontinence. Nursing staff, including registered nurses and certified nurse assistants, are responsible for implementing and managing the PureWick™ within Saint George Regional Hospital units. A literature review established the knowledge requirements for nursing staff to safely initiate, operate, and supervise the operation of the device. Additionally, the observational study conducted on the Neuro Specialty Rehabilitation Unit identified gaps in nursing knowledge posing risks to patient safety, including, among other behaviors, inappropriate suction settings. The literature indicates that high suction control settings can cause patient harm by skin breakdown, friction burns, and abrasions. The literature review and observational study findings directed the curriculum development of the educational training intervention. Additionally, both results led to the PUREWICK GUIDELINES 29 development of instruments that measured the effectiveness of the intervention. Furthermore, these findings governed the development of the PureWick™ External Female Catheter Algorithm for Inpatient Female Use. Results of the pretest administered before the intervention demonstrated gaps in staff knowledge consistent with findings of the observational study, including but not limited to inappropriate suction settings. The post-test results after the educational training showed an overall increase in staff knowledge. For example, when asked what the most appropriate initial suction setting is, 52.78 % of participants answered incorrectly during the pretest compared to 4.17 % post-test. Implications for Practice and Future Scholarship When used appropriately, the PureWick™ external female catheter is a safe, non-invasive way to manage female urine incontinence. Clinical implications include risk reduction of patient harm associated with the mismanagement of the PureWick™ device as a direct result of unknowingness. Reductions in patient safety events resulting in injury have the potential for significant financial savings and increased patient satisfaction scores. Identified knowledge gaps in the Neuro Specialty Rehabilitation Unit employing approximately 23 registered nurses and 40 certified nursing assistants, raise concerns that similar gaps in knowledge exist in other departments throughout the hospital, risking patient harm. This issue can be addressed through a future scholarship provided by the PureWick™ training video and algorithm. Facility educators can support future scholarship through this project. Future scholarship should include research surrounding the use of PureWick™ and reducing catheter-associated urinary tract infections. Whereas the training video used in the educational training intervention is currently part of the new-hire orientation, it is suggested that educators incorporate it into yearly competency training. PUREWICK GUIDELINES 30 Sustainability New and innovative medical equipment such as the PureWick™ requires formal staff training to ensure safe utilization. For this reason, PureWick™ training has become a part of the new-hire orientation process at Saint George Regional Hospital. The co-project consultant for this project is a lead clinical educator for the hospital and a motivating factor for sustainability. Results of the observation study led to revisions to the Lippincott procedures found and accessed by nursing staff in the Intermountain Health E-resources. One such revision was the addition of hazardous drug considerations when handling the urine of a patient receiving hazardous drugs and on a PureWick™. Lippincott procedures are vital to direct nursing staff in the decision-making process, with this database maintained by the corporation aiding sustainability. The algorithm with the associated QR code was presented to the Saint George Regional Hospital practice council. The algorithm will serve as a guide for nursing staff who utilize the PureWick™. The algorithm provides step-by-step instructions, indications, and contraindications and is a clinical decision-support tool. The QR code has a year subscription purchased. The practice council will become instrumental in the sustainability of the QR code when the subscription expires. The co-project consultant has expressed the desire to seek the economic sustainability of the QR code. Dissemination Findings of the observation study were presented to Jaime D'Ausilio, Nursing Director of Rehabilitation Services Intermountain Healthcare, which led to Lippincott procedure revisions and is published within the E-resources easily accessible to employees. In addition, the algorithm was presented to Saint George Regional Hospital stakeholders for further dissemination. PUREWICK GUIDELINES 31 This quality improvement project is scheduled to be presented on April 4, 2023, to faculty and peers in the Weber State University DNP program. Intermountain Healthcare owns the project's intellectual rights. Still, other dissemination opportunities are under investigation, including an upcoming Inpatient Rehabilitation Facility (IRF) education meeting and a Utah Association of Rehabilitation Nurses (UARN) meeting. In addition, the application for dissemination at the Nursing World Conference planned for October 2023 will be submitted pending approval. Conclusion When utilized correctly, the PureWick™ external female catheter is a safe alternative for managing female incontinence; however, the device can pose the risk of patient harm without adequate staff training. The PureWick™ educational training provided to the Neuro Specialty Rehabilitation Unit staff demonstrated the intervention's effectiveness in increasing staff knowledge on the safe utilization and management of the device. Facilities that provide evidenced-based staff education opportunities, such as this training, will promote patient safety and satisfaction. 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Agency for Healthcare Research and Quality. https://www.ahrq.gov/talkingquality/measures/six-domains.html Testa, A. (2015). Understanding urinary incontinence in adults. Urologic Nursing, 35(2), 82-86. https://doi.org/10.7257/1053-816X.2015.35.2.82 Tran, C., & Rodrigue, D. (2018). An alternative to the indwelling foley-nacns.org. https://nacns.org/wp-content/uploads/2018/01/Poster-58-Tran.pdf Urh, A., Glick, L., Barron, S., Zavodnick, J., Mark, J. R., Shenot, P., & Murphy, A. (2021). How I do it: PureWick female external catheter: A non-invasive urine management system for incontinent women. The Canadian Journal of Urology, 28(3), 10669-10672. U. S. Food and Drug Administration. (2017). Maude adverse event report: PUREWICK corporation 3012224959 PUREWICK female external catheter. accessdata.fda.gov. https://www.accessdata.fda.gov/scripts.cdrh/cfdocs/cfMAUDE/detail.cfm?mdrfoi_id=69 82581&pc=NNW Van Decker, S. G., Bosch, N., & Murphy, J. (2021). Catheter-associated urinary tract infection reduction in critical care units: A bundled care model. BMJ Open Quality, 10(4), e001534. https://doi.org/10.1136/bmjoq-2021-001534 PUREWICK GUIDELINES 36 Walton, A., Mason, S., Busshart, M., Spruill, A., Cheek, S., & Lane, A. (2012). Safe handling: Implementing hazardous drug precautions. Clinical Journal of Oncology Nursing, 16(3), 251-254. doi:10.1188/12.CJON.251-254 Warren, C., Fosnacht, J. D., & Tremblay, E. (2021). Implementation of an external female urinary catheter as an alternative to an indwelling urinary catheter. American Journal of Infection Control, 49(6), 764-768. https://doi.org/10.1016/J.ajic.2020.10.023 Watson, G. (2016). The hospital safety crisis. Society, 53(4), 339-347. https://doi.org/10.1007/s12115-016-0028-2 PUREWICK GUIDELINES 37 Appendix A PUREWICK GUIDELINES 38 Appendix B PUREWICK™ GUIDELINES 39 Appendix C PureWick Observation Report & Findings 1- Suction to PureWick was not turned on. Patient was discovered with soiled brief & bedding, PureWick device was saturated in urine and remained placed between patient's legs. 2- Suction to PureWick turned on, however the connection between device and suction tubing wasn't properly attached. Patient discovered with soiled brief (unknown how long patient was with wet brief) 3- Suction turned to highest setting Manufacturer directions state suction to be set to > or = to 40mmHg, but not 180200mmHg 4- Improper or no perineum cares provided to patient prior to application of PureWick The PureWick package comes with 3 Provon wipes for patient cleansing. Cleansing should occur in the same procedural manner as the cleansing completed before catheterizations. **I suggest normal perineum cares before cleansing with the Provon wipes** 5- Bowel movement noted on PureWick after the patient was cleansed of stool. PCT attempted to re-insert soiled PureWick without obtaining a new one. 6- PureWick fell onto the floor during a brief change. PCT picked up PureWick and attempted to re-insert without obtaining a new one. 7- PureWick utilized on an ambulatory, continent patient who requested its use to promote better sleep. 8- PureWick utilized on a stand-pivot patient for what seemed to be staff convenience 9- PureWick noted to be draped over patient's trash can. Patient was selfusing the PureWick intermittently to void (hip fx able to stand-pivot) PUREWICK™ GUIDELINES 40 **Tremendous infection control issue** 10- PureWick appeared to have not been assessed entire shift. Current recommendations are to assess PureWick every rounding or 2 hours while the PureWick is in use. Ensure assessment after patient turns 11- PureWick applied at the start of the 18L shift. 06 nurse reports PureWick in place during morning assessment. Manufacturer direction state PureWick utilization is 8-12 hours. **I suggest we utilize the PureWick for no longer than 10 hours. Shorter periods of time with foul smelling or cloudy urine** 12- PureWick utilized on patient with PSA stationed in the room. **I suggest the PureWick not be utilized on patients who have 1:1 nursing care who can stand pivot or are ambulatory** 13- Urine collection device not emptied after utilization of PureWick Empty at the end of shift & record output. PUREWICK™ GUIDELINES 41 Appendix D Project Budget Implementation Expenses Items Cost per Unit Number Staff Training $28.00 34.00 $952.00 Training Materials + post-assess $5.00 34.00 $170.00 $112.66 1.00 $112.66 Algorithm QR Code printed/lami $1.50 15.00 $22.50 Post-test incentives $10.00 40.00 $400.00 Thank-you gifts for Roxanne, Kari, & Sandy. $20.00 3.00 $60.00 Algorithm QR Code Total $ 177.16 $ 127.00 Total Cost $1,717.16 Ongoing Expenses Items QR Code Annual Renewal Cost per Unit $ 112.66 Number $1.00 Total Cost $112.66 $0.00 $0.00 Total $ 112.66 Funding Items Amount Private Grant $ 225.00 Out of pocket $ 550.00 Staff Training paid by facility $ 952.00 Total $ 1,727.00 $112.66 PUREWICK™ GUIDELINES 42 Appendix E PureWick™ External Female Catheter Application & Maintenance Knowledge Check Start of Block: Default Question Block Q1 The following is an online survey that takes approximately 5 minutes to complete. The survey questions will be about ______. By participating in this survey, you are giving your consent. The results of this survey are reported using aggregated data, keeping responses anonymous and confidential. Data will be used for educational or quality improvement purposes to improve outcomes. If you have any questions, please contact Patricia 435.592.5731 ________________________________________________________________ Q2 The PureWick ™ device can be used on a male or female o True (1) o False (2) PUREWICK GUIDELINES 43 Q3 Is the PureWick™ reusable? o Yes, rinse and dry between uses or when soiled (1) o No, it is a single-use device that should be replaced minimally every 8-12 hours or soiled (2) o No, it is a single-use device that should be replaced every 24 hours or soiled (3) PUREWICK™ GUIDELINES Q4 What is the most appropriate initial suction setting? o 40mmHg (1) o 120mmHg (2) o 200mmHg (3) Q5 Who should not use the PureWick™ (select all that apply) ▢ ▢ ▢ ▢ Patients with urinary retention (1) Patients with urinary incontinence (2) Patients with perineum breakdown (3) Patients with frequent episodes of bowel incontinence (4) 44 PUREWICK GUIDELINES 45 Q6 Urine collected & discarded from patients receiving hazardous drugs require special PPE? o True (1) o False (2) o Depends on the drug (3) PUREWICK™ GUIDELINES Q7 Common hazardous drugs administered on our NSR unit include (select all that apply) ▢ ▢ ▢ ▢ ▢ Finasteride (1) Warfarin (2) Lisinopril (3) Methotrexate (4) Tacrolimus (5) Q8 Barrier cream can be applied to the perineum area prior to application of the PureWick™ o True (1) o False (2) Q9 The PureWick™ has no allergy concerns associated with the product. o True (2) o False (4) 46 PUREWICK GUIDELINES 47 Q10 The PureWick ™ can be secured to the patient using a securement device such as tape. o True (1) o False (2) PUREWICK™ GUIDELINES Q11 Assessment of device placement and skin condition must be completed at a minimum every? o 2 hours (1) o 4 hours (2) o 6 hours (3) o At least once per shift (4) End of Block: Default Question Block 48 PUREWICK™ GUIDELINES 49 Appendix F PUREWICK™ GUIDELINES 50 PUREWICK™ GUIDELINES 51 Appendix G PUREWICK™ GUIDELINES 52 Appendix H Task Start Date Days to Complete Literature 14-Jan 70 IRB Approv 16-May 70 27-Jun 25 Write Script 1 3-Aug Meeting wit 4-Aug 1 Schedule Si 4-Aug 1 Deliver Scrip 8-Aug 6 Practice scri 15-Aug 13 Film PureWi 31-Aug 4 Establish an 5-Sep 1 Meeting wit 5-Sep 12 Preparation 31-Aug 15 Purchase inc 25-Oct 1 Set-up & Ho 8-Nov 1 Collection o Distribute Q 10-Nov 1 Email Unit M 10-Nov 1 Review Data 20-Nov 20 27-Jun Literature Review IRB Approval Write Script for Training Video Meeting with project leads to review video script Schedule Simulation lab times Deliver Script to Sandy PCT Practice script with Sandy in simulation lab Film PureWick™ training video Establish and associate QR code to video Meeting with project lead to establish staff training date Preparations for staff training Purchase incentives for completion of post-tests Set-up & Hold staff training, administer pre-test via Qaltrics Collection of post-tests completed Distribute QR code to units Email Unit Managers Review Data 5-Oct 13-Jan 23-Apr 1-Aug PUREWICK GUIDELINES 53 Appendix I Pretest Survey Results The PureWick ™ device can be used on a male or female. 10 0 True False Post-test Survey Results The PureWick™ device can be used on a male or female. 20 10 0 True False Pretest Survey Results Is the PureWick™ reusable? 20 10 0 Yes, rinse and dry between uses or when soiled No, it is a single-use device that should be replaced minimally ... No, it is a single-use device that should be replaced every 24 ... PUREWICK GUIDELINES 54 Post-test Survey Results Is the PureWick™ reusable? 20 10 0 Yes, rinse and dry between uses or when soiled No, it is a single-use device that should be replaced minimally ... No, it is a single-use device that should be replaced every 24 ... Pretest Survey Results What is the most appropriate initial suction setting? 10 0 40mmHg 120mmHg 200mmHg Post-test Survey Results What is the most appropriate initial suction setting? 20 10 0 40mmHg 120mmHg 200mmHg PUREWICK GUIDELINES 55 Pretest Survey Results Who should not use the PureWick™ (select all that apply) 20 10 0 Patients with urinary retention Patients with urinary incontinence Patients with perineum breakdown Patients with frequent episodes of bowel Post-test Survey Results Who should not use the PureWick™(select all that apply) 20 10 0 Patients with urinary retention Patients with urinary incontinence Patients with perineum breakdown Patients with frequent episodes of bowel ... Pretest Survey Results Urine collected & discarded from patients receiving hazardous drugs require special handling & PPE. 20 0 True False Depends on the drug PUREWICK GUIDELINES 56 Post-test Survey Results Urine collected & discarded from patients receiving hazardous drugs require special handling & PPE. 20 0 False True Depends on the drug Pretest Survey Results Common hazardous drugs administered on our NSR unit include (select all that apply) 20 0 Finasteride Warfarin Lisinopril Methotrexate Tacrolimus Post-test Survey Results Common hazardous drugs administered on our NSR unit include (select all that apply) 20 0 Finasteride Warfarin Lisinopril Methotrexate Tacrolimus PUREWICK GUIDELINES 57 Pretest Survey Results Barrier cream can be applied to the perineum area prior to application of the PureWick™ 0 True False Post-test Survey Results Barrier cream can be applied to the perineum prior to the application of the PureWick™. 0 True False Pretest Survey Results The PureWick™ has no allergy concerns associated with the product. 20 0 True False Post-test Survey Results The PureWick™ has no allergy concerns associated with the product. 20 0 True PUREWICK GUIDELINES 58 Pretest Survey Results The PureWick ™ can be secured to the patient using a securement device such as tape. 20 0 True Post-test Survey Results The PureWick ™ can be secured to the patient using a securement device such as tape. 20 0 True False Pretest Survey Results Assessment of device placement and skin condition must be completed at a minimum every? 10 0 2 hours 4 hours 6 hours At least once per shift PUREWICK GUIDELINES 59 Post-test Survey Results Assessment of device placement and skin condition must be completed at a minimum every? 0 2 hours 4 hours 6 hours At least once per shift