CAUTI Talk: The Conversation That Never Ends Jenny Tuttle, RN, MSNEd, CNRN.
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Transcript of CAUTI Talk: The Conversation That Never Ends Jenny Tuttle, RN, MSNEd, CNRN.
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CAUTI Talk:The Conversation That Never
Ends
Jenny Tuttle, RN, MSNEd, CNRN
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![Page 3: CAUTI Talk: The Conversation That Never Ends Jenny Tuttle, RN, MSNEd, CNRN.](https://reader030.fdocuments.us/reader030/viewer/2022032600/56649d955503460f94a7e113/html5/thumbnails/3.jpg)
VERKLEMPT
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Tucson Medical Center - CAUTI Project
• Identified as a quality initiative in 2012• Joined ON the CUSP: STOP CAUTI project
through AzHA – Cohort #5• Unit 450 – 16 bed Adult ICU– Neuro/neurosurgery– Vascular Surgery– General Surgery– Medical
Implementation of CAUTI project in ICUApril 1st, 2013
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So What…. it is just a UTI ?!• Not a glamorous problem• 40% of Hospital Acquired infections are a UTI
with 80% being catheter associated• 13,000 deaths are associated with CAUTI annually• Estimated 65-70% preventable• 3 – 10% daily incidence of bacteriuria occurring from catheter use• Treatment no longer reimbursed by CMS
Medscape.com., 2013. ; OntheCUSPStopHAI.org., 2013.
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ICU impact• Prolonged catheterization is the major risk factor for CAUTIs• Twenty-five percent of inpatients and up to 90% of patients in an ICU have a urinary catheter during hospitalization, often without an appropriate indication.• Indwelling urinary catheters are placed without sufficient rationale, and/or remain in place after indications expire.
• CAUTIs can be decreased by interventions that facilitate removal of unnecessary catheters.
• Most hospitals have not implemented effective strategies for preventing CAUTIs. American Association of Critical Care Nurses. (2011). Catheter associated urinary
tract infections. Retrieved from http://www.aacn.org
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Challenges
• Worst rate in the hospital• Average device utilization rate – 91%• Infection Control based• Building the right team• Identifying realistic goals• How to get staff involved• Changing the culture• How to sustain improvements
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EMR Based – Infection Control ToolBefore After
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Building the Right Team for Change • Team dynamics• Team Work
- Monthly Team Meetings- Data review
- RCA on each CAUTI• Identifying problem patients/Making
recommendations- Brainstorming- Revised audit tool- Developed• Ventilator guidelines• Patient/family pamphlet
• Auditing
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Auditing
• Not just another audit - modifying audit tool to identify barriers – Bundle assessment • Stat lock use• ER catheter kits – breaking the system
• Influence of the auditor
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Revised Audit Tool
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Staff Involvement
• Wicking pads
• Scales
• Condom catheters• External Male collection
devices
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Changing the Culture
• Team evaluation of nursing practice/process• Listening during audits– “but they are vented”– “but they are on Lasix”– “but they will be incontinent and get a pressure
sore”• Challenging/ Engaging the staff – Everyday• Providing the tools to measure output
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Ventilator GuidelineConditions that require a foley:
SEPSIS (24 HRS)CRRTARFPressors with titrationTherapeutic HypothermiaIABPSAH with CSW/SIADH/DISAH with triple H therapyLasix- acute and/or continual IV infusion
Conditions that do not require a foley: MIV Tube feeding Pressors with minimal titration Chronic Lasix Mildly sedated or drowsy
patient Respiratory failure pts not
chemically paralyzed and/or sedated
Case dependant situations
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Culture Change at Work
42 yr. old, FemalePulmonary FibrosisVentedParalyzed/sedated x 5
days
23 yr. old, male S/P Craniectomy for
Temporal lobectomy due to chronic seizures
Post op - Seizures
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How to Sustain Improvements?(The Conversation Continues……)
• One unit improves another gets worse• When convenience becomes a complication• Consistent message with physicians• Added back the audit
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Making Realistic Goals
• Reduced our utilization goal of < 70 %– Lowest month utilization was 32 %
• Reduced our rates by 82% on pilot unit– 12 months before Implementation - 24 CAUTI’s– 12 months after implementation - 4 CAUTI’s
• 3 Months with NO CAUTI’s on both
ICU/CCU
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Lessons Learned
• We all own this: Infection Control, Nursing..• Physician buy-in• Bringing all the stakeholders• Don’t give up – keep at it
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Thank You !!!