2014 performance improvement project kevin pham, huy tran, lawrence kim, tiffany nguyen, fady...
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2014 Performance Improvement Project
Kevin Pham, Huy Tran, Lawrence Kim, Tiffany Nguyen, Fady Youssef (And Aceela Muqri) | September 9, 2014
CAUTI and VA Nursing Documentation
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FOCUS
F – finding the problem
O – organize resources
C – clarify goals
U – understand objectives
S – select a plan
Department of Medicine| September 9, 2014
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Problem
•Benefits vs risks
•Personal experiences
•Documentation
Department of Medicine| September 9, 2014
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2009 International Clinical Practice Guidelines from IDSA
“Institution should consider nurse-based or electronic physician reminder systems to reduce inappropriate urinary catheterization (A-II) and CA-UTI (A-II).”
IDSA Guidelines
Department of Medicine| September 9, 2014
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•Computer documentation
•Decreased duration
•No change in re-cath rate
Cornia PB, Amory JK, Fraser S, et al. Computer-based order entry decreases duration of indwelling urinary catheterization in hospital- ized patients. Am J Med 2003;114:404-407.
Department of Medicine| September 9, 2014
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Our Resources
•Long Beach Veteran Affairs Medical Records (CPRS)
•Nursing management staff
•Residents
•Attendings
Department of Medicine| September 9, 2014
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Goals and Objectives
Objective:
To improve the rate of catheter-associated urinary tract infections
Primary Outcome:
The rate of Foley insertion documentation of pre-intervention compared to post-intervention samples.
Department of Medicine| September 9, 2014
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Project Challenges
•Compliance from nursing staff
•Accuracy of documentation• Multiple insertions
Department of Medicine| September 9, 2014
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Opportunity Statement
•An opportunity exists to improve:•Documentation of Foley’s
•Why?•Reduces UTI
•Goal?•increases by 10% or greater
Department Name | Month X, 201X
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PDCA
• Plan
• Do
• Check
• Act
Department Name | Month X, 201X
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Pre-Intervention (PLAN)
• Team members collected rates of documentation of Foley placement once a month for 5 months
• Documentation consisted of a Foley insertion note entered by the patient’s RN
• Spreading out the data collection was intended to eliminate possible variations
Department of Medicine| September 9, 2014
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Intervention (DO)
Department of Medicine| September 9, 2014
• Poster Design
• Nursing huddle
13 Department of Medicine| September 9, 2014
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Post-Intervention (CHECK)
• Team members collect rates of documentation of Foley placement
• Multiple Sample Days
Department of Medicine| September 9, 2014
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Outcome
Pre-intervention sample: N= 25
Post-intervention sample: N= 23
Department of Medicine| September 9, 2014
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Pre Vs Post Data
Department of Medicine| September 9, 2014
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Data Analysis
•The sample size is too small to demonstrate statistical significance.
•The raw data suggests an improvement in the rate of documentation of Foley insertion note after our intervention.
•Additional data collection may enhance the effect of our observed outcome.
•However, additional data collection requires a longer period of investigation, which is not feasible for this current project.
Department of Medicine| September 9, 2014
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Data Analysis
•The sample size is too small to demonstrate statistical significance.
•The raw data suggests an improvement in the rate of documentation of Foley insertion note after our intervention.
•Additional data collection may enhance the effect of our observed outcome.
•However, additional data collection requires a longer period of investigation, which is not feasible for this current project.
Department of Medicine| September 9, 2014
19
Data Analysis
•The sample size is too small to demonstrate statistical significance.
•The raw data suggests an improvement in the rate of documentation of Foley insertion note after our intervention.
•Additional data collection may enhance the effect of our observed outcome.
•However, additional data collection requires a longer period of investigation, which is not feasible for this current project.
Department of Medicine| September 9, 2014
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Outcome
Department of Medicine| September 9, 2014
We improved nursing documentation for Foley catheter placement with a simple educational intervention with the hope
of reducing the rate of CAUTI at the VA.
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Thank You!
Department of Medicine| September 9, 2014
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