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CAUTI Content Call #6 A Hospital’s Perspective

CAUTI Content Call #6 A Hospital’s Perspective. CAUTI Prevention: Implementation in a Community Hospital. CAUTI Content Call Schedule. CAUTI Prevention Implementation in a Community Hospital. Mary Jo Skiba RN BSN Project Manager QI/Research January 2011. Community Hospital.

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CAUTI Content Call #6 A Hospital’s Perspective

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  1. CAUTI Content Call #6A Hospital’s Perspective CAUTI Prevention: Implementation in a Community Hospital

  2. CAUTI Content Call Schedule

  3. CAUTI PreventionImplementation in a Community Hospital Mary Jo Skiba RN BSN Project Manager QI/Research January 2011

  4. Community Hospital 146 Licensed Beds Med Surg (2 Units) ICU (8 Bed) Women’s Health Inpatient Rehab Inpatient Psych Non-Profit Sole Community Provider

  5. Objectives • Remove barriers and identify steps towards successful CAUTI project initiation • Demonstrate educational strategies • Maintain success

  6. Have a Plan Plan, Plan, Plan… then Plan some more…

  7. Project Planning • CAUTI Team • Policies • Awareness Campaign • Data Collection Plan • Project Start Date • Education • Plan for Follow-Up

  8. Project Planning • Establish CAUTI Team Members • Involve frontline staff • Have a physician champion • Include charge nurses • Include staff development • Determine the scope of your initial project • Policy - Urinary Catheterization • Review/Revise • Use policy in toolkit • Don’t re-create the wheel • Consolidate into one policy if possible • Automatic Catheter Stop Policy

  9. Project Awareness KEYSTONE HAI (Hospital Associated Infections) “Bladder Bundle Project” Preventing Catheter Associated Urinary Tract Infections Hospital Newsletter Flyers Screen Savers

  10. Data Collection • Data collectors • Data forms – • Add qualifiers specific to your hospital • Assure understanding of project requirements • 5 days week = Mon thru Fri (not W/E) • Data entry web-based program

  11. Project Start Date • Use calendar or Gantt chart to plot activities • Check vacation schedules of key staff • Watch out for major holidays Be Flexible

  12. Planning Education • Nursing • Who will be trained • Who will train • How will we train • When will we train • How will we do make-ups • How much ongoing training or re-training needed • Physicians • Who will train • How will we train • When will we train

  13. Two Fold Approach • Didactic • CAUTI Face to Face Inservice • All Nursing/Aides • Guideline For Prevention of CAUTI • Physician CME • Dept Meetings 2. Demonstration of Insertion Competency

  14. Developing CAUTI Education • Don’t Re-create The Wheel • Use Other Hospitals PowerPoint Slides • Update/Revise to Fit Jerri’s Story North Carolina Prevent CAUTI Toolkit http://www.ncqualitycenter.org/resources.lasso

  15. Trained the trainers

  16. Urinary Catheter Insertion Competency • Traveling Mannequin • 100% Aides and all nurse frequent inserters (ED, OR, WHU, IP Rehab, ICU) • Read Policy • Take Quiz • Perform Procedure • Instant Remediation and Repeat Demonstration

  17. 167 Competencies Avg 15 min/staff member 41 Aides, 126 Nurses

  18. Outcome Improper Cleaning 26 Improper Gloving 24 Contaminated field 45 Didn’t know needleless cath port for specimens 30

  19. Urinary Catheter Insertion Competency Improvement Plan • Require Field Competency all Aides within 2 months - supervised by RN’s • Newly hired Aides trained by RN’s • Yearly Aide hands on demonstration of competency

  20. Strategies • Caths flagged with date of insertion • Secured to legs • Specimen collection for culture - Don’t use first urine drained from catheter - ED patients – prior to collection, change catheter unless known change within 7 days - Inpatients… If catheter in for 7 days must change prior to specimen collection • Perineal hygiene prior to caths • “John Door” educational posters

  21. Foley Catheter Prevalence

  22. 1/1/08 –4/30/08 ARMC Michigan

  23. OutcomesARMC Monthly Urinary Cath Related UTI’s 2008 28 CAUTI’s Avg 2.3 mo 2006 46 CAUTI’s Avg 3.8 mo 2007 32 CAUTI’s Avg 2.7 mo 2009 6 CAUTI’s Avg 0.5 mo

  24. OutcomesARMC Monthly Urinary Cath Related UTI’s 2006 46 CAUTI’s Avg 3.8 mo 2007 32 CAUTI’s Avg 2.7 mo 2008 28 CAUTI’s Avg 2.3 mo 2009 6 CAUTI’s Avg 0.5 mo

  25. Investigation • Cath competency plan not followed • Focus was on hospital EMR implementation • Daily cath patrol not consistent • Prevalence rates up

  26. New Plan • Annual competency aide and ED/OR nurses • Competency imbedded in orientation/annual skills evaluation • Agenda item every leadership/staff mtg • Charge nurses do daily Cath Patrol- Med Surg • Metric reports monthly to staff and physicians • Cath necessity built into EMR documentation • Decrease size standard cath from #16 to #14

  27. ZERO!!

  28. Questions Be vigilant…Plan for and carry out follow-up interventions Don’t worry alone… “Courage is being scared to death, but saddling up anyway” (John Wayne) Questions? mjskiba@agh.org

  29. Your Feedback is Important http://www.surveymonkey.com/s/FN9BJKB

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