Journey to Reducing CAUTI
description
Transcript of Journey to Reducing CAUTI
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Munroe Regional Medical Center
Journey to Reducing
CAUTI
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Munroe Regional Medical Center
Objectives
• Where we started
• What we’ve accomplished
• What our vision is for the future
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Munroe Regional Medical Center
In the beginning…
• August 2008- Munroe joined a VHA Rapid Adoption Network (RAN) Initiative to reduce CAUTI
– With a specific goal to reduce device days
• Organized a multidisciplinary team
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Munroe Regional Medical Center
The Stream Team
• Educators• Infection Prevention
Coordinators• Front line nurses• Senior nursing
administrator • Physicians• Quality Coordinator
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Munroe Regional Medical Center
Why so many device days?
• Catheters were being placed in the emergency room and forgotten
• No clear rationales for catheter insertion/continuation
• Catheters weren’t addressed until ready for discharge- prolonged length of stay
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Munroe Regional Medical Center
First Steps…Avoid Catheterization• Addressed unnecessary placement by
developing specific criteria for insertion/continuation
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Munroe Regional Medical Center
Consider alternatives…
• Condom Catheters
• Urinals/female urinals
• Cloth Chux
• Frequent toileting
• Bladder scanning
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Munroe Regional Medical Center
Next Step…Timely Removal
• Developed a nurse driven policy allowing nursing to remove catheters when no longer meeting criteria
• Set a goal to reduce device days by removing catheters within 3 days
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Munroe Regional Medical Center
Computer charting altered to match our policy
Document:
• Date of insertion
• # of days (pop-up warning)
• Catheter size
• Continue catheter reason
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Munroe Regional Medical Center
SCIP Measure Conflict
• Late 2010 we learned of future SCIP measures
• Changed to “Cut the rate by 48”– Goal to remove catheters by Day #2
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Assist with physician documentation
• Reminder became permanent part of record
• Reminded surgeons to document why the patient required prolonged catheterization
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Munroe Regional Medical Center
House wide Education
• Updated Insertion skills checklist
• Catheter care (patient care techs)
• Proper transporting techniques for patients with catheters – Transporters– Physical therapy– Volunteers
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Munroe Regional Medical Center
House Wide EducationExamples…
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Munroe Regional Medical Center
In Feb 2011 we joined the FHA CAUTI Initiative
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Munroe Regional Medical Center
Science of Safety
• Invited all staff to preview the science of safety video
• Promoted a culture of safety on our unit
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Munroe Regional Medical Center
Nursing Quality Council
• Added Catheters to our PI Plan
– Audit quarterly:• Date/Time of bags• Securement device use• Catheter reminder tool on chart• Electronic charting compliance
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Further defined criteria for catheter insertion/continuation
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Munroe Regional Medical Center
Changed stocked items in Pyxis
• We removed all 16F catheters and replaced with 14F
– Making it easier for staff to choose the smallest appropriate catheter
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Munroe Regional Medical Center
New Signage on our supply Pyxis
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Munroe Regional Medical Center
Updated Staff Education
• Computer based learning
• Update computerized charting
• Updated Policy
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Focused on proper specimen collection for RNs and PCTs
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Physician Education • Physician champion educated MDs on
proper criteria for urinalysis
– Avoid routine urinalysis on asymptomatic patients
– Discourage unnecessary antibiotic therapy
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Munroe Regional Medical Center
Utilized On-the-Cusp Tool Kit
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Munroe Regional Medical Center
CAUTI Case Analysis
• Reviewed each CAUTI– Where the catheter was inserted– Duration of catheter– Reason for insertion/continuation – Looked for trends – Discussed findings with staff involved
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Munroe Regional Medical Center
Daily catheter audits by charge RNs
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Munroe Regional Medical Center
Utilization Trends
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Munroe Regional Medical Center
Looking ahead…• Incorporating more education into
orientation house wide
• Include Science of Safety video during general orientation
• Continue to track and trend CAUTIs house wide to improve quality
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Munroe Regional Medical Center
ReferencesCenter for Disease Control (2009). Guideline for prevention of catheter-associated urinary tract infections 2009. Retrieved December 28, 2011 from,
http://www.cdc.gov/hicpac/pdf/CAUTI/CAUTIguideline2009final.pdf
Gokula, R., Hickner, J., and Smith, M. (2004). Inappropriate use of urinary catheters in elderly patients at a midwestern community teaching hospital. American Journal of Infection Control, 32 (4), 196-199.
Mosby’s Nursing Skills (2010). Specimen collection: sterile urine from a catheter. Excerpted and adapted from Perry AG, Potter PA: Clinical nursing skills & techniques, ed 7, St.
Louis, 2010, Mosby.
Michigan Health and Hospital Association (2011). Care Counts Account. Retrieved from, http://mhacarecounts.org/UserLogin.aspx?Url=/
Pronovost, P. (2005). Improving patient safety. Johns Hopkins University. Retrieved from, http://www.safercare.net/OTCSBSI/Staff_Training/Entries/2009/9/6_1._The_Science_of_Improving_Patient_Safety.html
Robinson, S., Allen, L., Barnes, M., Berry, T., Foster, T., Foster, T., Friedrich, L., et al. (June 2007). Development of an evidence-based protocol for reduction of indwelling urinary
catheter usage. MEDSURGE Nursing, 16(3), 157-161.