Chapter 10 Case Study upload link - 50 pts Read the Case Study found on page 200

Question

Chapter 10 Case Study upload link - 50 pts

Read the Case Study found on page 200 in your textbook.

The case study for this chapter is a continuation of Marilyn Nelson’s investigation of the UTI issue in the ambulatory clinics of the Western States University Hospital.

After flowcharting the process for collecting urine specimens (depicted in figures 10.2 through 10.6), Marilyn and her colleagues recognized how complex the issue was within their organization. They decided to collect data from all process paths evident in the flow chart. Because so many people were involved in the processes and because significant delays could be involved, they also began to wonder what role contaminated specimens played in the situation.

Although it was an expensive project, the team designed an investigative study to collect data. Urine specimens were routinely tested by nursing personnel or house staff in the clinic to determine each specimen’s pH and specific gravity and to classify each specimen according to its color, clarity, and presence of gross hematuria. Each specimen was then tested with Multistix to determine whether microscopic bacteria, red blood cells, or WBCs were present. When a specimen failed any of the Multistix screens, it was referred to Clinical Laboratory Services for microscopic analysis, culture, and sensitivity analysis by a laboratory technician.

First, the team collected data regarding time elapsed between collection of the specimen, point-of-care testing with Multistix, and receipt of the specimen in Clinical Laboratory Services. In addition, the team investigated the sequence of events that occurred in the interim. A summary of the data collected is provided in table 10.1.

Second, on a temporary and random basis, the team obtained urine specimens from each clinic immediately following collection and had a complete analysis performed STAT in the clinic labs. This analysis identified pH, specific gravity, color, clarity, cell counts, and bacterial counts almost immediately after the specimen was delivered by the patient or collecting clinician. All specimens that showed microscopic bacteria either on Multistix or on microscopic analysis were cultured. A summary of the data collected is provided in table 10.2.

Third, the team compared the incidence of UTI identified in the randomly collected specimens with the incidence identified in specimens going through the usual process. A summary of the data collected is provided in table 10.3.

QUESTIONS FOR CASE STUDY

1.Upon examination of the data sets, Marilyn Nelson and her colleagues identified several areas where the analysis revealed situations that were probably contributing to the clinic’s high UTI rate. Look at the UTI rate for children whose parents had collected the specimen versus the rate for children who had been catheterized by nursing personnel to collect the specimen. What might be the reason for the higher rate in children whose parents had collected the specimen?

2.Are there any other areas in the data that reveal important aspects that may be contributing to the high UTI rates? What might be the reasons for these higher rates?

3.Upon discussion of the findings and examination of the flowcharted processes, the laboratory manager noted a subtle change in clinic processes that probably was contributing to the problem. House staff had begun at some point to Multistix the specimens in the original collection containers. Thus, what had been a clean-catch specimen could become a contaminated one when staff opened the container to perform the Multistix. What really should have been done was to pour off a small amount or aliquot of the specimen into another container, reseal the original container for the laboratory, and perform the Multistix on the aliquot container. This process would minimize the possibility of contaminating the original specimen. How would this change in process be represented in the flow charts presented in the case study?

You will be doing the assignment individually using a Word document. Put your name on the upper right hand corner. Upload the completed assignment on Moodle using the link provided.

Explanation / Answer

1.the higher rate of UTI is more in children whose data was collected by parents is because the method used by parents to collect the urine was not hygienic. They did not use any methods of sterilization, hand gloves and clean and sterile containers for urine collection. This all led to contamination if urine.

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