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Utilize the Electronic Health Record (EHR) to improve
nursing process and patient outcomes.
CATHETER ASSOCIATED URINARY TRACT INFECTION (CAUTI):A PREVENTION PLAN
Education created byKristi Noble MSN RN OCNClinical EHR educatorSeptember 2014
Goal of CAUTI
Goal 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
Objectives for CAUTI Prevention
1. Recall the importance of standardizing documentation for in and out times and line days.
2. Identify instructions and indications for placing and removing an indwelling urinary catheter.
3. Recall the of use and function of the daily needs assessment form.
4. Identify where to locate policies and protocols for an indwelling urinary catheter within the electronic health record.
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.
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
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.
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.
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:
1. Insertion task, will take nurse directly to I-view to create the dynamic group.
2. 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.
Creating the Dynamic Group for Indwelling Urinary Catheter
Mandatory fields when
creating dynamic group.
The functionality of the charting is the same as other I-view charting.
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.
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 documentationbe 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.
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.
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.
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.
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 for the urinary catheter at any other point during the day the needs assessment form can be found in Ad Hoc forms to complete.
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
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.
Needs Assessment Form
When the patient no longer meets criteria for catheter RN will
select option to have the catheter discontinued.
By selecting does not meet criteria the system will auto DC the order and send a
task to the PAL for catheter removal.
Reference Text Policies and Protocols
Protocol Reference Text found
by right clicking
inside the window
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
When Indwelling Urinary Catheter discontinued or no longer needed
Once the provider or RN discontinues the 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
When Indwelling Urinary Catheter is discontinued or no longer needed
Removal Date/Time
Once charting complet
eRN must
inactivate the
dynamic group
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.
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
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.
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.
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.
Adherence to an infection prevention planBladder scan per protocol when urinary catheter removedCondom catheter, access to commode chairsDo not use catheters unless necessaryEarly removal of catheter using the electronic health record as a guide
ABC’S OF CAUTI PREVENTION