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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 Prevention Implementation in a Community Hospital. Mary Jo Skiba RN BSN Project Manager QI/Research January 2011. Community Hospital. 146 Licensed Beds Med Surg (2 Units)

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

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

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

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

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

  7. 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

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

  9. 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

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

  11. 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

  12. 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

  13. 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

  14. Trained the trainers

  15. 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

  16. 167 Competencies • Avg 15 min/staff member • 41 Aides, 126 Nurses

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

  18. 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

  19. 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

  20. Foley Catheter Prevalence

  21. 1/1/08 –4/30/08 ARMC Michigan

  22. Outcomes ARMC 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

  23. Outcomes ARMC 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

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

  25. 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

  26. Outcomes ARMC Monthly Urinary Cath Related UTI’s ZERO!!

  27. 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

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