A Safety Score Improvement Plan for Shalom Intensive Care Unit

Developing hospital safety scores was aimed at enlightening the public on the best healthcare facilities to receive the best quality and safe care available in the market. However, many people are not aware of the relevance of such safety scores and they do not apply them appropriately. A high safety performance score implies poor safety measures practiced in such a healthcare facility and patients are advised against obtaining services from such a facility. Many determinants of hospital safety scores have been described, but hospital-acquired infections (HAIs) stand out as a potential safety threat in most healthcare facilities. The fact that medical insurance plans do not cover such infections makes it a safety threat that requires the development of an appropriate safety improvement plan. An example of serious HAIs that require special attention in safety improvement plans is the Catheter-acquired Urinary Tract Infection (CAUTI). These are the commonest HAIs leading to increased medical expenses associated with an increase in hospital stays. The Shalom Intensive Care Unit (not the real name for confidentiality purposes) reported high hospital scores due to CAUTI, explaining the need for developing a safety score improvement plan. The purpose of this paper is to develop a safety score improvement plan to reduce the incidence rate of CAUTI in Shalom Intensive Care Unit.

Factors behind the Patient Safety Issue

The standard policies intended to reduce the incidence of CAUTI require healthcare providers to ensure that sterile techniques are applied during the placement of catheters. Existing policies must utilize closed systems and revise the daily plan of care to enhance the safety of patients in the Intensive Care Unit (ICU) (Ceballos, Waterman, Hulett, and Makic, 2013). Even after adhering to all these policies, Shalom Intensive Care Unit continues to report high incidence rates of CAUTI. However, it was noted that about 90% of the patients in the ICU are on urinary catheters yet there lacks adequate evidence-based interventions designed to reduce the prevalence of CAUTIs.

Furthermore, there is a lack of clear guidelines on how to properly insert a urinary catheter to reduce the risk of developing CAUTIs. All these aspects cannot be implemented without developing an effective patient culture whose development is guided by the nurse manager. Conducting a Hospital Survey of Patient Safety Culture (HSOPSC) is the first step in determining the current safety culture and factors leading to the high prevalence rates of CAUTIs in Shalom ICU. It is also likely that the lack of a strong reporting system in the ICU deters the efforts to improve the safety scores in the facility.

Influence of Leadership in Changes for Safety

Transformational leadership exercised by the nurse leader will aid in changing the mindsets of the patients and other nurses to report new cases of CAUTIs. Transformational leadership involves setting an example for other nurses to follow during practice. The nurse leader demonstrates values of self-sacrifice and goodwill and involves all nurses in the process of decision making aimed at improving the patient safety. Since all the nurses participate in the process of decision-making, all recommendations made to improve patient safety can be adopted without resistance (Wong, Cummings & Ducharme, 2013). The lack of good leadership explains why the facility continues to use outdated policies that are inefficient and negatively affect the quality and safety of care.

The Effects of Policies and Procedures on Safety Issues

The management of hospital staff, effective delivery of care and the management of material resources is facilitated by the implementation of policies and procedures in the workplace. The systems theory guides the nurse managers to assess the competencies of all nursing staff and prevent incidences of work overload, which may lead to ineffectiveness (Csikszentmihalyi & Wolfe, 2014). A specific model applied in the nursing sector to monitor and assess the relevance of existing policies is the dynamic systems theory. This model emphasizes on the importance of training nurses to provide transparent care without engaging in risk behavior. The model also provides a framework for embracing teamwork, monitoring fellow nurses and embracing creativity and technology for delivery safe care. As such, the nurses are encouraged to engage in research on the safest mechanisms of delivering care by implementing evidence-based practice.

Recommendations to Ensure Patient Safety

The safety improvement plan in the management of increased incidence rates of CAUTIs should incorporate an interconnected network of the aspects of teamwork, evidence-based practice, information sharing, and good governance.  A good safety improvement plan can only be based on addressing the mentioned factors that increase the risk of developing CAUTIs in catheterized patients. However, the nurse manager must engage other nurses in the development of the safety improvement plan to encourage ownership of the plan and ease the process of implementation. A nurse manager who tries to develop the improvement plan solely and attempts to force it on the other nurses faces much resistance and may not achieve the desired policy change (Ceballos et al., 2013). As such, the safety improvement plan must be based on the contribution of all or a majority of the nurses if it is to make an impact in the facility.

Evidence-based Strategy to Improve Patient Safety

The strategy will involve creating awareness among all the critical care nurses on the EBP procedures of removing catheters through adequate training (Dolansky & Moore, 2013). The awareness creation plan will be communicated under the directions of the Institute of Medicine (IOM) report highlighting that man is to error in an attempt to discourage self-righteousness. Doing so will encourage accountability and the development of feasible tools and procedures used to monitor and evaluate errors that occur during catheterization. Such a plan of care is expected to improve the safety of catheterized patients by elevating the performance standards and enhancing the quality of care delivery.

The nurse manager has to spearhead efforts to enhance the safety of patients in the hospital. As such, the improvement plan requires the nurse manager to mobilize all the subordinates to participate in identifying the factors that jeopardize the safety of catheterized patients (Dolansky & Moore, 2013). From the risk factors, the team of nurses will be advised to remove catheters that are not needed as a way of reducing the risks of developing CAUTIs. A chart indicating the safest protocol of evaluating the need for catheters among patients in the ICU will be conspicuously placed in the facility and nurses will be encouraged to read and internalize it. Since all nurses will be involved in the development of such a chart, including all necessary improvements, it will be easy to implement changes aimed at improving the safety scores. According to Ceballos et al. (2013), the feeling of ownership and complacency is crucial in ensuring the sustainability of the improvement plan through continuous monitoring and evaluation to improve the efficiency of the safety plan. The quality indicators for the improvement plan will include monitoring and recording the duration of the indwelling catheters, the rate of catheter insertions, the incidence rate of CAUTIs, and the length of hospital stay among catheterized patients. Limitations of this strategy include additional expenses involved in training and resistance from expert nurses who desire to use old techniques in achieving their objectives.

Plan to Implement Safety Recommendation and Monitor Outcomes

All the above action points require financing, and the nurse manager is expected to lobby intensively for the higher management of the facility to see the need for funding the safety improvement plan. The top management must be convinced that the safety improvement plan can guarantee a continuous influx of patients and funding from medical insurance agencies. Therefore, the management will develop a tracking system that will ensure that all the catheters are tracked on a daily basis (Dolansky & Moore, 2013). Each nurse leader will be accountable for all decisions made and justify the utilization of resources in implementing the strategy. The system will provide feedback from nurses and patients to guide the evaluation of the quality of care and determine whether the strategy is worth pursuing. Significant improvements in patient safety will inform EBP in the facility and suffice the process of implementing evidence-based policies in healthcare.


The provision of safe and cost-effective care requires the implantation of a safety improvement plan. Hospital-acquired infections like CAUTIs form a major contribution to safety issues in healthcare and can be addressed by implementing such safety score improvement plans. An education-based plan of action in Shalom ICU involving the creation of awareness and development of a monitoring system will be implemented to solve the CAUTIs safety problem.


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