Catheter Associated Urinary Tract Infection (CAUTI): A Prevention Plan

1. Catheter Associated Urinary Tract Infection (CAUTI):A Prevention Plan Utilize the Electronic Health Record (EHR) to improve nursing process and patient outcomes. Education created by Kristi Noble MSN RN OCN Clinical EHR educator September 2014

2. Goal of CAUTIGoal of CAUTI Prevention Educate RN/LPN’s to prevent and reduce the incidence of a CAUTI by: • Using the EHR to standardize documentation • Use instructions and indications when inserting and removing an indwelling urinary catheter • Assessing the need for a urinary catheter daily

3. Objectives for CAUTI Prevention • Recall the importance of standardizing documentation for in and out times and line days. • Identify instructions and indications for placing and removing an indwelling urinary catheter. • Recall the of use and function of the daily needs assessment form. • Identify where to locate policies and protocols for an indwelling urinary catheter within the electronic health record.

4. Regulations and ReportingDid you know? Since 2008 The Centers for Medicaid and Medicare Services have not reimbursed the cost of Hospital Acquired infections, such as CAUTI. Since January of 2013 Munson has been manually reporting the instances of patients developing a CAUTI while in the hospital. The estimated cost of treating a CAUTI that develops while in the hospital ranges from $1,200 to $2,800.

5. Importance of documenting indwelling urinary catheters in the EHR • Improve patient outcomes • Increase patient safety • Better tracking of patients with an indwelling urinary catheter • Able to generate reports for reimbursement • Standardize documentation across the multiple departments and organizations within Munson Healthcare • Standardize order and discontinue process for indwelling urinary catheter • Able to utilize a daily needs assessment form for removal of urinary catheter as soon as possible

6. Current Foley documentation will be moved to I-view Will move to I-view

7. Ordering indwelling urinary catheter: old to new Indwelling is new key word. Foley can still be used. • Nursing must verifying the presence of an active order. If no order present the nurse must obtain one from the provider.

8. New requirements for indwelling urinary catheter orders: Instructions and Indications You may multi-select by holding down the control key • Instructions and indications are mandatory to complete order. • If a provider enters DO NOT REMOVE as instruction or certain indications the daily Needs Assessment form will not fire to the PAL every 24 hours. • Ensure the instructions and indications are as accurate as possible. • If the patient does not meet the criteria, they don’t need a urinary catheter.

9. The next step after the order is placedGo to PAL Once the order is placed two tasks will generate on the PAL for the nurse: Insertion task, will take nurse directly to I-view to create the dynamic group. A daily needs assessment task, used to determine if the urinary catheter is still appropriate for the patient, will occur at 8am the day following catheter insertion. By right clicking and selecting Chart Details the system will take you to I-view for documentation of insertion or daily needs assessment form.

10. Creating the Dynamic Groupfor Indwelling Urinary Catheter Mandatory fields when creating dynamic group. The insertion date is crucial, allows tracking of line days to begin. Place cursor in date box, press T, date and time will pull in. Date will default forward on subsequent days. The functionality of the charting is the same as other I-view charting.

11. Genitourinary Assessment moving to I view The GU assessment will be removed from the nursing launcher. In the vacated area a reminder will be in red to have the documentation be completed in I-view. In an effort to streamline documentation the GU assessment is moving to I-view. It will have its own band on the navigator.

12. Nursing Assistants Twice a Day PAL Task for Peri and Catheter Care Nursing assistants will receive a twice daily task on the PAL for documenting peri and catheter care. RNs will not receive this task on their PAL, but will need to ensure that the care and documentation was completed in I-view.

13. Nurse Driven Protocol (070.P037)for Removal of Urinary Catheter When an order is placed for a urinary catheter the provider can have the removal based on a Nurse Driven Protocol/RN assessment. The Nurse Driven Protocol can be located by right clicking on the order. Policies and procedures are to help guide the RN for care and removal of the urinary catheter.

14. Bladder Scan Protocol Bladder Protocol (070.P035) is available for nursing to use. It does not need a physician order. It is a standing order that is approved by the Medical Executive Committee. If a nurse has to straight cath a patient two times, upon the second insertion place a urinary catheter and page the provider for an indwelling catheter order.

15. Indwelling Urinary Catheter (Foley) Needs Assessment Once a urinary catheter has been inserted, a daily needs assessment form must be completed. This will come daily task on the PAL, starting at 8am the day after insertion. If the patient does not meet criteria forthe urinary catheter at any other pointduring the day the needs assessment form can be found in Ad Hoc forms to complete.

16. Needs Assessment form In this area the last two indications will be viewable The form brings in the current order allowing the RN to see when and why the catheter was ordered

17. Needs Assessment Form Form will be tasked daily at 8am. If the patient still meets the criteria to keep catheter RN will select the indication and the form will be complete.

18. Needs Assessment Form By selecting does not meet criteria the system will auto DC the order and send a task to the PAL for catheter removal. When the patient no longer meets criteria for catheter RN will select option to have the catheter discontinued.

19. Reference Text Policies and Protocols Protocol Reference Text found by right clicking inside the window

20. When Indwelling Urinary Catheter discontinued or no longer needed The RN may discontinue the urinary catheter either through the order or the needs assessment form. Providers can right click on the order and Cancel/DC or Modify the catheter order. Providers can DC or Modify the catheter order. RNs will DC the catheter via the needs assessment form or by right clicking on the order and Cancel/DC

21. When Indwelling Urinary Catheter discontinued or no longer needed Once the provider or RN discontinuesthe urinary catheter the RN will get a task on the PAL to remove the catheter. Right clicking and Chart Details will take the RN to I-view to complete the documentation

22. When Indwelling Urinary Catheter is discontinued or no longer needed The date and time of removal is captured from time stamp of the column. Remember to chart at the time of removal or back chart the correct time. Removal Date/Time Once charting completeRN must inactivate the dynamic group

23. Straight/Intermittent Catheterization For patients who require intermittent straight catheterization, a separate dynamic group needs to be created. The same group may be used for each instance of catheterization during the patients stay. Documentation occurs the same as all other charting in I-view

24. Viewing Urinary Catheter Assessment The best place to view the urinary catheter assessment is in Results Review on the Patient Assessment tab in a group format.

25. Preventing a CAUTI • Verify there is an active order for the indwelling urinary catheter with indications and instructions. • Assess the need for indwelling urinary catheter daily. • Utilize the Nurse Driven/Bladder Scan protocol to remove the indwelling urinary catheter as soon as possible. • Seek alternatives to using an indwelling urinary catheter whenever necessary.

26. Preventing a CAUTI • Empty the catheter drainage bag every 8 hours, if 2/3 full, and prior to transporting a patient. • Verify that peri and catheter care is performed and documented twice a day in I-view. • Arrange the catheter drainage bag so it is placed below the patients bladder at all times. • Assess for the presence of a securement device, i.e. Stat lock, on the patients upper thigh, right or left. • Document catheter output in I-view.

27. ABC’s of CAUTI prevention Adherence to an infection prevention plan Bladder scan per protocol when urinary catheter removed Condom catheter, access to commode chairs Do not use catheters unless necessary Early removal of catheter using the electronic health record as a guide

28. Your involvement in ensuring that our patients are safe and free from catheter associated urinary tract infections is appreciated, and your care to our patients is invaluable.