An Evidence-Based Practice Project

Amanda Wesson, MSN, MHA, RN

Catheter associated urinary tract infections (CAUTI) are the

most common hospital-acquired infection

CAUTI increases cost, length of stay, morbidity and mortality

Hospitals no longer receive reimbursement for CAUTI not present on admission from CMS

Roughly 13,000 people die annually from CAUTI

The risk of CAUTI increases by 5% per day for every day a catheter stays in place

Background

Create and implement a comprehensive tool for

nurses to evaluate the need of a urinary catheter and empower them to remove urinary catheters when clinically indicated

Purpose

Decrease catheter days

Decrease device utilization rate (catheter days/patient days)

Decrease catheter associated urinary tract infections (CAUTI)

Goals

Indwelling Catheter Days (FY16) Davenport – 11940

Silvis – 2209

Device Utilization Rate (FY16) Davenport – 16.99

Silvis – 18.52

Infections- Urinary Catheter (FY16) Davenport - 14

Silvis - 3

Initial State

Iowa Model

Team:

Infection Prevention Specialists

Infection Prevention Coordinator

Infectious Disease Specialist (Physician Champion)

Project Design

Received approval through Med Exec committees,

Protocol committee, Forms committee, and the Nursing Partnership Council

Edited catheter discontinuation documentation

Involved Clinical Education Specialist

Project Design

4 Departments

W ICU, ICU/CCU, Rehab, Med-Tele

Pre-survey

Current processes

Knowledge of indwelling catheter criteria

Comfort using a bladder scanner

1 Month

Pilot

Initial State

0

5

10

15

20

January February March April May

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Rehab

0

20

40

60

80

100

January February March April May

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ICU - W

65

70

75

80

85

January February March April MayDe

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ICU/CCU

0

5

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15

20

January February March April May

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Med/Tele

Post-pilot survey

Care of patients with indwelling catheter

Use of protocol

Barriers

Data discrepancies

Not enough information

Pilot extended for 2 more months

CSU added to pilot

Pilot Outcomes

4 CAUTIs in 5 months

CSU Initial State

0

5

10

15

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25

30

January February March April May June July

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CSU

Appropriate documentation

Decreased device utilization rate in 4/5 departments

Plan to expand system-wide in December 2016

Pilot Outcomes

CSU- 0 CAUTIs

since August

Pilot Outcomes

Outcomes

Indwelling Catheter Days (FY16) Davenport – 11940 Silvis – 2209

Device Utilization Rate (FY16) Davenport – 16.99 Silvis – 18.52

Infections- Urinary Catheter (FY16) Davenport - 14 Silvis - 3

Indwelling Catheter Days (FY17 through May) Davenport - 10889 Silvis – 1785

Catheter Device Utilization Rate Davenport – 20.07 Silvis – 18.4

Infections- Urinary Catheter (FY17 through May) Davenport - 12 Silvis - 0

Outcomes

Silvis- 0 CAUTIs since February 2016

Outcomes

5 fewer CAUTIs in FY17 thus far

Increased nurse autonomy

Decreased catheter days thus far

Decreased device utilization rate in Silvis and several Davenport departments

Impact on Patient Care

Electronic documentation

Competing initiatives

Clarification of “I & O critical for patient management”

Pure-wick- hope to have pilot started by end of June

On-Going

Committees coming out of the woodwork

Pilots are not fool-proof

Stay in touch!

Lessons Learned

Questions?