Overcoming Challenges to Reduce CAUTI and Improve Safety Culture

1. Overcoming Challenges to Reduce CAUTI and Improve Safety Culture National Content Series for All Staff Current as of August 2015

2. Learning Objectives Upon completion of this training, participants will be able to: • Describe common challenges to implementing the clinical and cultural interventions that reduce HAIs/CAUTIs and improve safety culture in LTC facilities • Identify strategies and tools to address challenges in your LTC facility • Review how you can help achieve success in the program goals

3. Reducing CAUTI and Improving Safety Culture: Challenges CLINICAL CULTURAL • Physician buy-in • Knowledge and skills (e.g., remove catheters as soon as clinically indicated, not routinely changing catheters) • Understanding CAUTI definition • Data collection • Reduce unnecessary urine culture orders • Antibiotic stewardship • Prioritization (time management) • Lack of champions • Workload and workflow • Lack of leadership • Poor communication • Staff turnover

4. TeamSTEPPS Communication Strategies • SBAR • CUS • Check-Back

5. SBAR • Situation • Explain the current situation • Background • Brief history with only the important information • Assessment • Summarize the facts and what you think is going on • Recommendation • Explain what actions you think should take place

6. CUS Please use CUS Wordsbut only when appropriate!

7. Check-Back is…

8. TeamSTEPPS: Using SBAR • Situation—What is happening? • Background—What is the background? • Assessment—What do I think the problem is? • Recommendation—What would I recommend? Mr. Belding is an 82-year-old resident of your facility. He has an indwelling catheter due to acute urinary retention. Yesterday his urine was clear and yellow. Today he is more tired than normal and his urine is definitely pink and smells bad. You need to communicate what you’ve observed with a nurse or prescribing clinician.

9. CAUTI Definitions and Data Collection Resources • Definition check-lists • Pocket Cards

10. NHSN CAUTI Criteria YES YES YES YES then the resident has a CAUTI!

11. What are the Signs and Symptoms of CAUTI? ONE or MORE of the following: See Onboarding 2: CAUTI Definitions and Reporting video for all LTC staff for further details

12. Antibiotic Stewardship: The Challenge • Antibiotic overuse is common in LTCFs as a result of : • Positive urine dipstick • Positive urine culture • Lack of communication among all team members can result in antibiotic overuse

13. Antibiotic Stewardship: Solutions • Educate all team members, including residents and families • Ask staff and residents /family to look for signs and symptoms • Explain the appropriate use of an indwelling catheter, urine culture or antibiotics • Promote shared decision-making

14. Overcoming Challenges • Identify the challenge • Recognize and engage champion(s) • Use teams to tackle the challenge • Collect data and communicate progress • Empower staff to be part of the solutions • Celebrate success

15. Stay Updated with Useful Resources NHSN Criteria—CAUTI Definition Pocket Cards Antibiotic Stewardship Brochure