Enhancing patient safety through enhanced clinical practices

Prof Sandy Middleton and Dr Oyebola Fasugba NRI

When people come to the hospital, they usually expect to get better. Unfortunately, hospital-acquired complications sometimes get in the way of that, which is why they are taken very seriously.

In fact, in mid-2018, the National Safety and Quality Health Service (NSQHS) established financial penalties for hospitals where patients suffer from preventable hospital-acquired infections.

To help tackle the issue, Prof Sandy Middleton and Dr Oyebola Fasugba, working at the Nursing Research Institute, received funding from the St Vincent’s Clinic Foundation for a study that aims to improve prevention practices for hospital-acquired urinary tract infections (UTI). As it is one of the most common complications, the study findings will be instrumental in informing clinical care to enhance patient safety.

We often picture medical researchers gearing up with lab goggles and white coats, but sometimes what they need is a detective hat. Such is the case for this research project, carried out at the St Joseph’s Hospital by a group of seven investigators, comprising of researchers and clinicians: Prof Elizabeth McInnes, Ms Joyce Baye, Dr John Shephard, Ms Rose Gordon, Ms Anila Ali, are working together with Prof Sandy Middleton and Dr Oyebola Fasugba.

Bridging the evidence gap

Despite hospital-acquired UTI prevention being a priority of the Australian Safety and Quality Goals for Healthcare, there has been little data collection or report about the prevalence of this infection. Yet for successful prevention of an infection, its surveillance is essential.

This is the knowledge gap that Prof Middleton and Dr Fasugba’s team aims to address, looking more particularly at catheter-associated UTIs, the most prevalent of hospital-acquired UTIs.

The research project is twofold: first, an analysis of St Joseph’s Hospital’s medical records over the past five years to quantify the disease burden; second, qualitative interviews with medical and nursing staff at various levels to better understand the barriers and enablers to implementing existing hospital-acquired UTI prevention practices.

Thanks to the mixed methods study, the team of investigators will be able to shed some light on the hospital-acquired UTI mysteries.

Future-proofing prevention practices

While the quantitative part of the study will provide baseline prevalence data, the qualitative interviews will enable the researchers to pinpoint what is needed to successfully implement hospital-acquired UTI prevention practices. For example: is the local clinical practice guideline for urethral catheter insertion and maintenance adhered to, and if not, why?

The goal for this study is also to leverage the experience of doctors and nurses at the St Joseph’s Hospital, and capture their observations and knowledge on this type of infection to further prevent it.

Based on the results, the team will provide policy makers in the hospital with evidence for decision-making. However, the intention is to disseminate the insights and influence decision-making on clinical practice at a national scale.

‘’This is the first-ever study in Australia that will interview clinicians on this issue. Their views are only a sample, but they will provide an excellent snapshot of the wider clinical care community,’’ said Dr Oyebola Fasugba. ‘’At the conclusion of this study, we will have important evidence to inform clinical practice and ensure better outcomes for our patients. Our study may be focusing on one hospital, but hospital-acquired UTI is a national issue, and as such our research could have wide-reaching impact for other hospitals in Australia towards implementing prevention practices.’’

Empowering nurses

The beauty of this project is that it relies on a very collaborative research approach. Unlike the majority of research projects, nurses are involved – both as investigators and as interviewees.

It only makes sense: nurses are the frontline of patient care. Their input will help translate the findings into practical recommendations and actions, based on the interviews but also based on their experience in managing patients day in, day out. In addition, involving nurses will contribute to successful implementation of the study and the outcomes that will stem from it. Their buy-in is particularly important, since nurses are usually the ones involved in care management of catheters. Finally, this type of research work also helps nurses build their research skills and knowledge.

‘’We're very keen to be part of this collaborative research work, with the hope that it will open opportunities for more research at the hospital, especially with the nurses.’’ said Dr Oyebola Fasugba.