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 • [email protected] • N542 Victoria General Hospital
Questions???
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