CAUTI Content Call 6 A Hospitals Perspective CAUTI

CAUTI Content Call #6 A Hospital’s Perspective CAUTI Prevention: Implementation in a Community Hospital 1

CAUTI Content Call Schedule CUSP/CAUTI Content Call #1 – CUSP Moderator – Sam Watson; Speaker – Sean Berenholtz 03/07/11 2 ET/1 CT/12 MT/11 PT Attendee: (866) 256 -9295 CUSP/CAUTI Content Call #2 - The Science of Safety Moderator – Sam Watson; Speaker – Sean Berenholtz 03/22/11 2 ET/1 CT/12 MT/11 PT Attendee: (866) 256 -9295 CUSP/CAUTI Content Call #3 - Care and Removal Intervention Moderator – Sam Watson; Speaker – Mohamad Fakih 04/05/11 2 ET/1 CT/12 MT/11 PT Attendee: (866) 256 -9295 CUSP/CAUTI Content Call #4 - Data Collection Moderator – Sam Watson; Speaker – Sam Watson 04/19/11 2 ET/1 CT/12 MT/11 PT Attendee: (866) 256 -9295 CUSP/CAUTI Content Call #5 - The View from the Bedside Moderator – Sam Watson; Speaker – Russ Olmsted 05/03/11 2 ET/1 CT/12 MT/11 PT Attendee: (866) 256 -9295 CUSP/CAUTI Content Call #6 - Implementation in a Community Hospital Moderator – Sam Watson; Speaker – Mary Jo Skiba 05/17/11 2 ET/1 CT/12 MT/11 PT Attendee: (866) 256 -9295 2 60 Min.

CAUTI Prevention Implementation in a Community Hospital Mary Jo Skiba RN BSN Project Manager QI/Research January 2011 3

Community Hospital 146 Licensed Beds Med Surg (2 Units) ICU (8 Bed) Women’s Health Inpatient Rehab Inpatient Psych Non-Profit Sole Community Provider 4

Objectives • Remove barriers and identify steps towards successful CAUTI project initiation • Demonstrate educational strategies • Maintain success 5

Have a Plan Plan, Plan… then Plan some more… 6

Project Planning • • CAUTI Team Policies Awareness Campaign Data Collection Plan Project Start Date Education Plan for Follow-Up 7

Project Planning • Establish CAUTI Team Members • Involve frontline staff • Have a physician champion • Include charge nurses • Include staff development • Determine the scope of your initial project • Policy - Urinary Catheterization • Review/Revise • Use policy in toolkit • Don’t re-create the wheel • Consolidate into one policy if possible • Automatic Catheter Stop Policy 8

Project Awareness KEYSTONE HAI (Hospital Associated Infections) Hospital Newsletter “Bladder Bundle Project” Flyers Preventing Catheter Associated Urinary Tract Infections Screen Savers 9

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Data Collection • Data collectors • Data forms – Add qualifiers specific to your hospital • Assure understanding of project requirements • 5 days week =Mon thru Fri (not W/E) • Data entry web-based program 12

Project Start Date • Use calendar or Gantt chart to plot activities • Check vacation schedules of key staff • Watch out for major holidays Be Flexible 13

Planning Education • Nursing • Physicians • Who will be trained • Who will train • How will we train • When will we train • How will we do make-ups • How much ongoing training or re-training needed 14 • Who will train • How will we train • When will we train

Two Fold Approach 1. Didactic • • • CAUTI Face to Face Inservice All Nursing/Aides Guideline For Prevention of CAUTI Physician CME Dept Meetings 2. Demonstration of Insertion Competency 15

Developing CAUTI Education • Don’t Re-create The Wheel • Use Other Hospitals Power. Point Slides • Update/Revise to Fit Jerri’s Story North Carolina Prevent CAUTI Toolkit http: //www. ncqualitycenter. org/resources. lasso 16

Tr tra e th d ne ai in s er 17

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Urinary Catheter Insertion Competency • Traveling Mannequin • 100% Aides and all nurse frequent inserters (ED, OR, WHU, IP Rehab, ICU) • • Read Policy Take Quiz Perform Procedure Instant Remediation and Repeat Demonstration 19

• 167 Competencies • Avg 15 min/staff member • 41 Aides, 126 Nurses 20

Outcome Improper Cleaning 26 Improper Gloving 24 Contaminated field 45 Didn’t know needleless cath port for specimens 30 21

Urinary Catheter Insertion Competency Improvement Plan • Require Field Competency all Aides within 2 months - supervised by RN’s • Newly hired Aides trained by RN’s • Yearly Aide hands on demonstration of competency 22

Strategies • Caths flagged with date of insertion • Secured to legs • Specimen collection for culture - Don’t use first urine drained from catheter - ED patients – prior to collection, change catheter unless known change within 7 days - Inpatients… If catheter in for 7 days must change prior to specimen collection • Perineal hygiene prior to caths • “John Door” educational posters 23

Foley Catheter Prevalence 24

1/1/08 – 4/30/08 ARMC Michigan 1/1/2008 - 4/30/2008 ARMC Units Reporting Prevelance Rate 56 233 Int 1 54 239 Int 2 27 Post 1 34 Comparative Data Den Keystone Center for Patient Safety and Quality Num Data Point Num Den Prevelance Rate 24. 03 29 775 3, 912 19. 81 22. 59 26 697 3, 400 20. 50 169 15. 98 27 650 3, 709 17. 52 187 18. 18 26 569 3, 262 17. 44 171 828 25 20. 65 2, 691 14, 283 18. 84

Outcomes ARMC Monthly Urinary Cath Related UTI’s 2006 46 CAUTI’s Avg 3. 8 mo 2008 28 CAUTI’s Avg 2. 3 mo 2007 32 CAUTI’s Avg 2. 7 mo 26 2009 6 CAUTI’s Avg 0. 5 mo

Outcomes ARMC Monthly Urinary Cath Related UTI’s 2006 46 CAUTI’s Avg 3. 8 mo 2007 32 CAUTI’s Avg 2. 7 mo 2008 28 CAUTI’s Avg 2. 3 mo 27 2009 6 CAUTI’s Avg 0. 5 mo

Investigation • • Cath competency plan not followed Focus was on hospital EMR implementation Daily cath patrol not consistent Prevalence rates up No Indicated Reason for Catheter 60 50 40 30 20 10 0 n Ja 9 -0 9 9 -0 -0 b Fe M ar 9 r-0 Ap 9 -0 M ay 09 nu J 9 l-0 Ju 9 -0 g Au 9 9 -0 p Se O -0 ct 9 0 v. No 28 9 0 c. De 0 1 n. Ja 0 1 b. Fe 0 -1 M ar 0 r-1 Ap M ay 0 -1 n Ju 0 l-1 Ju

New Plan • Annual competency aide and ED/OR nurses • Competency imbedded in orientation/annual skills evaluation • Agenda item every leadership/staff mtg • Charge nurses do daily Cath Patrol- Med Surg • Metric reports monthly to staff and physicians • Cath necessity built into EMR documentation • Decrease size standard cath from #16 to #14 29

Outcomes ARMC Monthly Urinary Cath Related UTI’s ZERO!! 30

Questions Be vigilant…Plan for and carry out follow-up interventions Don’t worry alone… “Courage is being scared to death, but saddling up anyway” (John Wayne) Questions? mjskiba@agh. org 31

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