Journey to Reducing CAUTI

Munroe Regional Medical Center

Journey to Reducing

CAUTI


Objectives

• Where we started

• What we’ve accomplished

• What our vision is for the future


In the beginning…

• 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


The Stream Team

• Educators• Infection Prevention

Coordinators• Front line nurses• Senior nursing

administrator • Physicians• Quality Coordinator


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


First Steps…Avoid Catheterization• Addressed unnecessary placement by

developing specific criteria for insertion/continuation


Consider alternatives…

• Condom Catheters

• Urinals/female urinals

• Cloth Chux

• Frequent toileting

• Bladder scanning


Next Step…Timely Removal

• 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




Computer charting altered to match our policy

Document:

• Date of insertion

• # of days (pop-up warning)

• Catheter size

• Continue catheter reason


SCIP Measure Conflict

• Late 2010 we learned of future SCIP measures

• Changed to “Cut the rate by 48”– Goal to remove catheters by Day #2


Assist with physician documentation

• Reminder became permanent part of record

• Reminded surgeons to document why the patient required prolonged catheterization


House wide Education

• Updated Insertion skills checklist

• Catheter care (patient care techs)

• Proper transporting techniques for patients with catheters – Transporters– Physical therapy– Volunteers


House Wide EducationExamples…


In Feb 2011 we joined the FHA CAUTI Initiative


Science of Safety

• Invited all staff to preview the science of safety video

• Promoted a culture of safety on our unit


Nursing Quality Council

• Added Catheters to our PI Plan

– Audit quarterly:• Date/Time of bags• Securement device use• Catheter reminder tool on chart• Electronic charting compliance


Further defined criteria for catheter insertion/continuation


Changed stocked items in Pyxis

• We removed all 16F catheters and replaced with 14F

– Making it easier for staff to choose the smallest appropriate catheter


New Signage on our supply Pyxis


Updated Staff Education

• Computer based learning

• Update computerized charting

• Updated Policy


Focused on proper specimen collection for RNs and PCTs


Physician Education • Physician champion educated MDs on

proper criteria for urinalysis

– Avoid routine urinalysis on asymptomatic patients

– Discourage unnecessary antibiotic therapy


Utilized On-the-Cusp Tool Kit


CAUTI Case Analysis

• Reviewed each CAUTI– Where the catheter was inserted– Duration of catheter– Reason for insertion/continuation – Looked for trends – Discussed findings with staff involved


Daily catheter audits by charge RNs


Utilization Trends


Looking ahead…• 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


ReferencesCenter 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

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.

Documents

Journey to Reducing CAUTI