NYSPFP CAUTI Educational Session: CAUTI Guide to … · Educational Session: CAUTI Guide to Patient Safety (GPS) Results Part II Tuesday, ... Bladder scanner was purchased and training

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Educational Session: CAUTI Guide to Patient Safety (GPS) Results Part II Tuesday, June 24, 2014


Agenda

2


Overview of CAUTI GPS Questions o Questions 1 through 10

o Higher percentage is better

o Questions 11A through D o Lower percentage is better

4


Brookdale University Hospital and Medical Center: CAUTI GPS Results

5

TAKE EVERY PRECAUTION

Cortland Regional Medical Center provides quality healthcare with skill and compassion, meeting the lifelong healthcare needs of all citizens of Cortland and the surrounding communities.

Services include: Inpatient Community Hospital with 162 Licensed beds including medical,

surgical, telemetry, ICU, mental health, maternity, & transitional care services Emergency & Urgent/Prompt Care Services Outpatient surgery, endoscopy, lab, cardiology, physical medicine and rehab,

& radiology services Long Term Home Health Services Rehabilitation Care Facility Adult Day Care Services


Goal 2012: Develop guidelines and tools needed to

implement Joint Commission’s NPSG 07.06.01 by 1/1/13 and establish a baseline internal benchmark rate.

2013: Obtain an internal benchmark rate below

1.6/1000 catheter days (the 2012 baseline) We achieved a rate of 0.6/1000 catheter days in

2013.

What is our current rate for 2014? We achieved at rate of 0/1000 catheter days in 2014.


Background 5-10% of all hospitalized patients in the US will

develop a health care associated infection (HAI). 40% of all HAIs are urinary tract infections. 80% of UTIs are attributable to indwelling urinary

catheters. In 2012, the preventing catheter associated

urinary tract infections (CAUTI) was added as a National Patient Safety Goal.

CAUTI is the most frequent HAI in hospitals and long term care.


Standard Strategies Conduct a risk assessment. Do not insert an indwelling urinary

catheter unless it is absolutely necessary. Use appropriate technique when placing

and maintaining indwelling urinary catheters.

Remove indwelling urinary catheter as soon as possible.

Evaluate efforts to reduce CAUTI.


Risk Assessment Electronic Admission Assessment

Screen for chronic foley and when placed Evaluate if chronic foley meets criteria If meets criteria—new catheter is placed

Electronic Shift Assessment Assess need based on CDC criteria listed in screen Documentation includes:

Whether they have a catheter or not Insertion date Foley day Whether they meet criteria or not Following maintenance bundle (listed on the screen for the

nurse as a reminder).


Meditech Shift Assessment


Insertion Only inserted when absolutely necessary. Urinary catheterization is not routine. CDC criteria is used to guide appropriate use. Consider alternatives:

Condom catheter Toileting Assessing voiding residuals with bladder scan Straight catheterization Suprapubic catheter

Engaged providers and nursing staff who have changed the culture to more seriously consider the impact and risk of catheterization before insertion.


Maintenance Securement device --Cath-secure

stickers less catheter movement therefore

decreasing the opportunity for biofilm to make its way into the urinary tract system.

Maintenance bundle: hand hygiene, catheter and peri-

care, securement, maintaining a closed system, and where the bag/urometer should be positioned (not the floor) at rest and during transport.


Removal Shift assessment determines

if patient NO longer meets criteria.

If patient does not meet criteria, the provider is called for order for removal.

We have developed and will soon be implementing a nurse-driven protocol for providers to order a urinary catheter with removal per protocol allowing the nurse to automatically remove the catheter when CDC criteria is not met.


Evaluation Root Cause analysis is completed on every HAIs A sub-committee of the Infection Control Committee

was formed to institute CAUTI prevention program. CAUTI rates are reported monthly at Nursing

Leadership/QI and Patient Safety meetings. Evaluation of practices in 2012 generated the following

other changes: Bladder scanner was purchased and training on use was

provided. New securement device selected New Orientation and Annual Education Modified specimen collection policy to decrease impact

of biofilm


Specimen Collection Chronic indwelling catheters present on admit are

changed if patient meets criteria PRIOR to obtaining a specimen.

If a urine sample is needed from a patient at any point during hospitalization and the foley is greater than 48 hours old, it must be replaced with a clean foley (entire system) prior to obtaining a urine specimen.

If in doubt, place a new catheter philosophy. Scrub the hub technique is stressed when obtaining a

specimen from the catheter.


Training Orientation training for RNs, NA, &

techs Annual skills day training Training includes the following:

CAUTI definition, stats, significance Insertion technique and CDC criteria Maintenance bundle Principles of correct specimen

collection Impact on the patient Impact on reimbursement and quality

Medical Staff Newsletter reinforcing criteria for catheter use and removal


Outcome


Lessons Learned Technique Technology Training Patience Persistence Medical Staff support Administrative support


References Trautner, B. & Darouiche, R. (2004). The role of biofilm in catheter associated urinary tract infections. American Journal of Infection Control, 32 (3), 177-183. The Joint Commission (2013). 5 Sure-fire methods for complying with NPSG.07.06.01. The Joint Commission:The Source, January, 2013.


Hospital Questions and Discussion Facilitated by Maria Sacco


Next Steps o Next CAUTI Web conference:

o September 30, 2014, 10:00 to 11:00 a.m.

June 23, 2014 23

Documents

NYSPFP CAUTI Educational Session: CAUTI Guide to … · Educational Session: CAUTI Guide to Patient Safety (GPS) Results Part II Tuesday, ... Bladder scanner was purchased and training