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Journey to Reducing CAUTI

Journey to Reducing CAUTI. Where we started What we’ve accomplished What our vision is for the future. Objectives. August 2008- Munroe joined a VHA Rapid Adoption Network (RAN) Initiative to reduce CAUTI With a specific goal to reduce device days Organized a multidisciplinary team.

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Journey to Reducing CAUTI

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  1. Journey to Reducing CAUTI

  2. Where we started What we’ve accomplished What our vision is for the future Objectives

  3. August 2008- Munroe joined a VHA Rapid Adoption Network (RAN) Initiative to reduce CAUTI With a specific goal to reduce device days Organized a multidisciplinary team In the beginning…

  4. The Stream Team • Educators • Infection Prevention Coordinators • Front line nurses • Senior nursing administrator • Physicians • Quality Coordinator

  5. Why so many device days? • Catheters were being placed in the emergency room and forgotten • No clear rationales for catheter insertion/continuation • Catheters weren’t addressed until ready for discharge- prolonged length of stay

  6. Addressed unnecessary placement by developing specific criteria for insertion/continuation First Steps…Avoid Catheterization

  7. Condom Catheters Urinals/female urinals Cloth Chux Frequent toileting Bladder scanning Consider alternatives…

  8. Developed a nurse driven policy allowing nursing to remove catheters when no longer meeting criteria Set a goal to reduce device days by removing catheters within 3 days Next Step…Timely Removal

  9. Examples

  10. Physician Reminder Tool

  11. Document: Date of insertion # of days (pop-up warning) Catheter size Continue catheter reason Computer charting altered to match our policy

  12. Late 2010 we learned of future SCIP measures Changed to “Cut the rate by 48” Goal to remove catheters by Day #2 SCIP Measure Conflict

  13. Assist with physician documentation • Reminder became permanent part of record • Reminded surgeons to document why the patient required prolonged catheterization

  14. Updated Insertion skills checklist Catheter care (patient care techs) Proper transporting techniques for patients with catheters Transporters Physical therapy Volunteers House wide Education

  15. House Wide EducationExamples…

  16. In Feb 2011 we joined the FHA CAUTI Initiative

  17. Invited all staff to preview the science of safety video Promoted a culture of safety on our unit Science of Safety

  18. Added Catheters to our PI Plan Audit quarterly: Date/Time of bags Securement device use Catheter reminder tool on chart Electronic charting compliance Nursing Quality Council

  19. Further defined criteria for catheter insertion/continuation

  20. We removed all 16F catheters and replaced with 14F Making it easier for staff to choose the smallest appropriate catheter Changed stocked items in Pyxis

  21. New Signage on our supply Pyxis

  22. Computer based learning Update computerized charting Updated Policy Updated Staff Education

  23. Focused on proper specimen collection for RNs and PCTs

  24. Physician champion educated MDs on proper criteria for urinalysis Avoid routine urinalysis on asymptomatic patients Discourage unnecessary antibiotic therapy Physician Education

  25. Utilized On-the-Cusp Tool Kit

  26. Reviewed each CAUTI Where the catheter was inserted Duration of catheter Reason for insertion/continuation Looked for trends Discussed findings with staff involved CAUTI Case Analysis

  27. Daily catheter audits by charge RNs

  28. Utilization Trends

  29. Incorporating more education into orientation house wide Include Science of Safety video during general orientation Continue to track and trend CAUTIs house wide to improve quality Looking ahead…

  30. Center for Disease Control (2009). Guideline for prevention of catheter-associated urinary tract infections 2009. Retrieved December 28, 2011 from, http://www.cdc.gov/hicpac/pdf/CAUTI/CAUTIguideline2009final.pdf  Gokula, R., Hickner, J., and Smith, M. (2004). Inappropriate use of urinary catheters in elderly patients at a midwestern community teaching hospital. American Journal of Infection Control, 32 (4), 196-199. Mosby’s Nursing Skills (2010). Specimen collection: sterile urine from a catheter. Excerpted and adapted from Perry AG, Potter PA: Clinical nursing skills & techniques, ed 7, St. Louis, 2010, Mosby. Michigan Health and Hospital Association (2011). Care Counts Account. Retrieved from, http://mhacarecounts.org/UserLogin.aspx?Url=/ Pronovost, P. (2005). Improving patient safety. Johns Hopkins University. Retrieved from, http://www.safercare.net/OTCSBSI/Staff_Training/Entries/2009/9/6_1._The_Science_of_Improving_Patient_Safety.html References Robinson, S., Allen, L., Barnes, M., Berry, T., Foster, T., Foster, T., Friedrich, L., et al. (June 2007). Development of an evidence-based protocol for reduction of indwelling urinary catheter usage. MEDSURGE Nursing, 16(3), 157-161.

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