Catheter Apathy: The Link Between Hospital

Culture And Clinical Practice

Background NSQIP Data has identified a Care Improvement

Opportunity for VIHA in the South Island

-1.0%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12

Percentage of Patients with

Post-operative UTI

Postoperative Urinary Tract Infection (UTI) Trend Over Time - Cross Comparison: VGH, RJH, NRGH

NSQIP Overall Mean

VGH

RJH

NRGH

We are working at transforming the way in which we think about catheters.

Another day,

another foley…

Infection is bound

to happen

Perpetuating The Culture Of “Catheter Apathy”.

Foley Catheters don’t get none

Living On The Edge

What mindset influences Catheter Acquired Urinary Tract Prevention?

Compassion Knowledge Respect Caring Empathy

Will to do the right

thing Best Practice

1. 40% of nosocomial infections are UTIs

2. 80% UTIs from catheters

3. Catheters increase falls risk.

4. 100% increase in CAUTIS after 2 days

5. 1 – 4 days extended in hospital leading to

increased costs.

6. promote immobility and the subsequent health

challenges related to immobility.

Catheter Acquired UTI

48/6 and CDMR originated with Mrs.G. CAUTI being a root cause of her debilitation.

Why do you work in health care? What is the primary motivator? If slight changes in the way you do things would prevent harm would you do them?

It is time to do the right thing by doing things right.

The timing is right It’s time to be practice perfect. Our vulnerable patients need catheter care done right.

The timing is now Potential harm is being done so let’s work to prevent this now.

The timing is right now We can elevate our practice and prevent sometimes life changing adverse events right now.

For some it’s now or never.

It is easier to Act your way into a new way of Thinking, than Think your way into a new

way of Acting

Foley Catheter Tracking Sheet

Name Room # MRN# Admit date

Foley insertion date

Inserted on which unit?

Does patient meet Foley criteria?

Foley D/C Date

Reinsertion date

Foley D/C date

Daily total insitu Date/#

Foley Catheters are not indicated for:

• Incontinence • Immobility • Obtaining urine specimens • Pt. request/convenience

• Stage III/IV decubitus • Diuresis / Mass hydration • Comfort Care/Palliative Care

Foley Indicators: • Obstruction relief • Neurogenic bladder • Strict I&O • GU related Surgery/Procedure

Catheter in place?

NO

YES

This is the best

alternative

Does patient meet

criteriaNO

YES

Obtain remove foley

order

Foley Catheters are not indicated for:• Incontinence• Immobility• Obtaining urine specimens• Pt. request/convenience

Foley Indicators Obstruction relief Neurogenic bladder Strict I&O GU related Surgery/Procedure Stage III/IV decubitus Diuresis / Mass hydration Comfort Care/Palliative CareConsider alternatives

Maintain foleyand review daily

Catheter Usage Decision Support

Catheters are the number one cause of UTIs and 40% of hospital infections are UTIs. First thing to do is to promote the dialogue between patient, nurse and the CNL to ensure practice is elevated and supported. The unit is initiating a tracking document to ensure that we elevate our practice to the benefit of our patients. The data it provides will be invaluable as time passes.

The CNL will be here to support the effort to optimize catheter care. She will be a key to helping resolve gaps in appropriate catheter care. One infection is one too many.

0

1

2

3

4

5

6

7

8

week 1 week 2 week 3 week 4 week 5 week 6 week 7 week 8

vgh 5

rjh 6

Number of Patients In Care With Catheters > One Day

Relax, we will be introducing tools to help elevate practice and to help bring catheter care to the forefront

of the clinician’s mind.

Patient Empowerment Through Knowledge

Its time to recognize that the patient is a key player in the provision of care.

Patient inclusion and education will help to elevate the care we provide.

• The patient is better informed about urinary catheters including maintenance. •The patient becomes a partner in care. •The patient becomes another voice in the dialogue of catheter necessity.

Patient as an empowered member of the team

Tew L, Pomfret I, King D. Infection risks associated with urinary catheters. Nurs Stand 2005;20:55-61 http://www.medscape.com/viewarticle/587464_4 Lo E, Lindsay N, Classen D, et al. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29:S41-S50 http://www.aacn.org/wd/practice/content/practicealerts/cathassocuti-nov11.pcms?menu=practice Saint S, Kowalski CP, Kaufman SR, et al. Preventing hospital-acquired urinary tract infection in the United States: a national study. Clin Infect Dis. 2008;46:251-253. Lambert VA, Lambert CE. Nurses' workplace stressors and coping strategies. Indian J Palliat Care 2008;14:38-44

Contact Information

• John Kristiansen • AKA: Johnny Lightning Bolt • VIHA Consultant NSQIP • (250) 727-4000 ext. 15569 • (250) 686-8681 Mobile • John.Kristiansen@viha.ca • N542 Victoria General Hospital

Questions???