Today’s webinar will begin in a few minutes.

1. Today’s webinar will begin in a few minutes. Please press *6 to mute your line or use the “mute” button on your phone. If you have questions for the presenter or need to contact TCPS staff, type your comments into the chat box. Lines will be opened during the call, so attendees may ask questions. Please do not put the conference on hold. Thank you for your patience.

2. Catheter-Associated Urinary Tract Infections (CAUTI)Tennessee Performance Trends

3. Key Percentiles for Facility-Specific Catheter-Associated Urinary Tract Infection (CAUTI) Standardized Infection Ratios (SIRs) in Adult and Pediatric Intensive Care Units (ICUs) by Reporting Year, Tennessee, 01/01/2012 - 12/31/2013 Data reported as of September 4, 2014 No. = number of facilities; UC Days = urinary catheter days; OBS = observed number of CAUTI PRED = statistically 'predicted' number of CAUTI; SIR = standardized infection ratio (observed/predicted number of CAUTI) Key percentiles include facilities with at least one predicted infection Red highlighting indicates SIR for reporting period is significantly higher than national 2009 SIR of 1.0 Green highlighting indicates SIR for reporting period is significantly lower than national 2009 SIR of 1.0

4. CAUTI Performance January – June 2014 • 403 CAUTI events January – June 2014 • Of the 18 hospital “outliers” for 2013 • 11 showing some improvement • 4 hospitals showing over 50% reduction • 3 getting worse • 4 no change in performance

6. CAUTI Recommendations – Call to Action from Deep Dive Session Fall 2013 with CMO’s • Focused leadership attention and accountability. • Include CAUTI performance on organizational scorecards and in performance evaluations of leaders/staff. • Make hospital and unit level data visible to staff and physicians by posting on units. • Utilize communication strategies such as daily staff huddles, communication boards and bedside shift reports to identify, share and discuss patient safety risks and mitigation plans. • Define clinical protocols for indications for catheter placement to decrease utilization. • Develop and utilize nurse-driven protocols for prompt removal of catheters when criteria for use are no longer met. • Utilize daily multi-disciplinary rounds to assess continued need for any device including urinary catheters.

7. Tennessee Center for Patient Safety The THA Board accepted the recommendations from the THA Quality Committee to address CAUTI performance: • THA board set a specific goal for a 40percent reduction in CAUTI within next 12 months (by July 2015) • 371 fewer events July 2014-June 2015 compared to 2013 • THA staff focus on outlier hospitals to show clinical and financial impact of poor performance and provide targeted resources • Hospitals share data on MRSA, C-difficile and healthcare worker vaccinations with THA to include in TCPS summary reports and hospital scorecards • No new data collection required by hospitals. Hospitals would confer rights to access in CDC reporting system • THA collect and monitor hospital performance for long-term acute care (LTAC) and rehabilitation facilities using publicly reported metrics for CAUTI, CLABSI, MRSA, C-difficile and healthcare worker vaccinations

8. Chris Edwards, MD, FHM Chief Medical Officer Maury Regional Medical Center Lynnelle Murrell, RN,BSN,CIC Director, Infection Prevention Maury Regional Medical Center

9. ON THE CUSP: A CAUTIPreventionProject September26, 2014

11. Project Kickoff oInvolvedthe wholefacility oIdentified Champions: multidisciplinaryand housewide oPresented datain apersonal form oDeclaredZero Infections Tolerated oA culture changeregardinghow we think abouturinarycatheters

12. Measures • ScienceofSafetyvideomandatoryforstaff • AddedPatientSafetyRoundingforinpatientand • outpatientareasand • DailyMultidisciplinaryRounds • Includedhowmanypatientshaveurinary catheters • Whatistheplanforremoval? • Doyoufeelcomfortableusingthenurse drivenprotocol forremoval?

13. Policy Changes • AddedobserverwheninsertingUC • ImplementedNurseDrivenRemovalProtocol • Tightenedthe indicationsforinsertion,maintenance, • andremovaltomirror the 2009HICPAC guidelines • UpdatedGU Shiftassessment to includea hard stopwherestaff wouldassesswhether UCstill appropriate • Withroundinglearnedsomestaffwerenot comfortableusingprotocolforremoval withoutphysician’sorder • havetokeepcheckingback with,educatingstaff

14. Measures • MaintenanceBundle • MonthlyPointPrevalenceStudywith feedback • Changedour ED to stock onlyurimeter kitsso admissionstoCC wouldalreadyhaveurimeter in place • Beds donothavean appropriatehangerfor • catheter bagwhileinthelowposition • CT Tableno placeto hangcatheter bag • Catheter Carecharting not being doneinEMR • –EducatedNurseTechsandaddedtocharting

15. Measures • Educationand competencies • Every area thathadthepotentialtotouchaUC- Nsg,Nurse techs, Radiology, Transportation, PT/OT • Developedachecklistandstandard work relatedto • urinarycatheter insertion • Requireddemonstrationforalllicensedstaffthatwill insert and care for urinary catheters • We knowthatpractices changeover theyears • Puts allstaffon same page(standard work) whenobservinginsertions

16. Measures • CHGbathingforcriticalcarepatients • Surveyaboutbathingpracticesbeforeandafterimplementation • People’smindsetschangedabouttheneedfora dailysoapand • waterbath • Hasbranchedouttootherareasofthehospitalafterseeing outcomes • PhysicianIPEducation– containsHICPAC indications for UC placementtoput everyoneon thesame page

17. Measures • Statusboardbuilt inMeditech–PCS chartingtoquicklyaccessUC relateddata • Usedbyleadchargenursefor roundingonall • patientseachshift • Toensureinterventionsinplace:Isithanging intherightplace?Securedtoleg?Isitstill needed?

18. Internal Reporting • EventAnalysis presentationsatIPCouncil • AllHAIdeviceinfectionsandC.difficileare reviewedbyfrontlinestaffinvolvedinthepatient’scare. • Frontlinestaff bringopportunitiestomeeting • tobediscussed • Frontlineengagementandbuy-inforIP measures • Leadershipbuy-inneededtomakesureFLS • cangettothemeeting

19. Internal Reporting • Helpstaffconnectthedots • Standingagendaitemonstaffnurse,charge nursemeetings • EventanalysissenttoNurseManagerin • real time • Monthlyscorecardtoindividual units • DatareportedtoInfectionControl Committee,PatientSafetyCommittee and QualityCouncil

20. Real Time Reporting Leaninitiative:Visual ManagementBoards postedontheunitscontain numberofdaysinfection free

21. Attachments • HospitalistMultidisciplinaryRoundGuide.doc • UrinaryCatheter Insertion Care andRemoval.pdf • UrinaryCatheter RemovalNurse ClinicalPractice Guideline.pdf • MRH UrinaryCatheter Insertion Assessment.doc • CAUTI PreventionPocket Card.doc • Female Foley(insertion)Checklist.doc • PhysicianIPEducation.doc

22. Questions?

23. West Tennessee HealthcareSherri McAlexander, RN, IP

24. 635-bed tertiary care center Serves 17-county area of rural West Tennessee 5 adult intensive care units as well as a neonatal intensive care unit Not-for-profit organization Jackson Madison County General Hospital

25. CAUTI Prevention Initiative We began in September 2012 Started out with a CAUTI Bundle following the HICPAC recommendations for CAUTI Prevention: appropriate catheter usage, proper insertion and maintenance, and prompt removal interventions Rolled out education to the staff CHG usage in ICUs Bard Stat-lock Rochester Medical Spirit condom catheters

29. CAUTI Core Prevention Strategies • Catheter Use • Insert only for appropriate indications • Leave in place only as long as needed • Catheter Insertion • Ensure only properly trained persons insert and maintain catheters • Insert using aseptic technique and sterile equipment • Catheter Maintenance • Maintain a closed drainage system • Maintain unobstructed urine flow

30. Non-ICU area’s DUR went from 0.28 in Jan 2014 to 0.19 in April 2014 and 0.13 by June 2014 Medical ICU’s DUR went from 0.79 in Jan 2014 to 0.68 in April 2014 Coronary ICU’s DUR went from 0.87 in Jan 2014 to 0.55 in April 2014 Medical ICU had no CAUTI the first 7 months of 2014! Pilot Areas

31. IN SUMMARY House-wide, our device utilization ratio has dropped from 0.36 in June of 2012 to 0.27 in April 2014 In our ICUs we have dropped our CAUTI rate from 7.03 in December 2013 to 1.51 as of August 2014!

32. Upcoming Events • OB Monthly Team Webinar- September 29, 2014; 10:00am CST • TCPS October Monthly Webinar- October 17, 2014; 9:00am CST • OB Monthly Team Webinar- October 27, 2014; 10:00am CST • 2014 THA Leadership Summit • Wednesday November 5th at the Gaylord Opryland Hotel and Convention Center in conjunction with THA’s Annual Meeting. Make plans to showcase your improvement work by submitting a poster for presentation. Contact Chris Clarke at cclarke@tha.com for details

33. Other Reminders • Webinar Evaluation: Earn contact hours for webinar participation after completing • TCPS Newsletter: Sent every Tuesday afternoon • IHI Open School: THA is providing free access to the IHI Open School curriculum for 2014 to employees and trustees of our safety partner hospitals. • AHRQ Hospital Survey on Patient Safety (HSOPS): The Tennessee Center for Patient Safety offers the survey to all safety partners at NO COST. Go to www.tnpatientsafety.comTools and Resources AHRQ Culture Survey for more information.

34. IHI Open School 2014 • THA is providing free access to the IHI Open School curriculum to employees and trustees of our safety partner hospitals. • 21 online, self-paced courses including 72 lessons and corresponding resources—videos, case studies, podcasts, featured articles, exercises, networking • Free app for the iPhone and iPad by logging onto iTunes • Over 25 contact hours available for CME, CNE, CPHQ and ACPE credit • Certificate of completion • Register using instructions. Type “Tennessee Hospital Association” as your facility to receive free membership. • Once registered, go to the course page: www.ihi.org/lms • Click the online learning tab and choose a lesson • Click Begin Lesson

35. Questions