CAUTI Content Call #6A Hospital’s Perspective

CAUTI Prevention:Implementation in a Community Hospital

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CUSP/CAUTI Content Call #2 - The Science of SafetyModerator – Sam Watson; Speaker – Sean Berenholtz03/22/11 2 ET/1 CT/12 MT/11 PT Attendee: (866) 256-9295 60 Min.CUSP/CAUTI Content Call #3 - Care and Removal InterventionModerator – Sam Watson; Speaker – Mohamad Fakih04/05/11 2 ET/1 CT/12 MT/11 PT Attendee: (866) 256-9295 60 Min.CUSP/CAUTI Content Call #4 - Data CollectionModerator – Sam Watson; Speaker – Sam Watson04/19/11 2 ET/1 CT/12 MT/11 PT Attendee: (866) 256-9295 60 Min.CUSP/CAUTI Content Call #5 - The View from the BedsideModerator – Sam Watson; Speaker – Russ Olmsted05/03/11 2 ET/1 CT/12 MT/11 PT Attendee: (866) 256-9295 60 Min.CUSP/CAUTI Content Call #6 - Implementation in a Community HospitalModerator – Sam Watson; Speaker – Mary Jo Skiba05/17/11 2 ET/1 CT/12 MT/11 PT Attendee: (866) 256-9295 60 Min.

CUSP/CAUTI Content Call #1 – CUSP Moderator – Sam Watson; Speaker – Sean Berenholtz03/07/11 2 ET/1 CT/12 MT/11 PT Attendee: (866) 256-9295 60 Min.

CAUTI Content Call Schedule

CAUTI PreventionImplementation in a Community Hospital

Mary Jo Skiba RN BSNProject Manager QI/Research

January 2011

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146 Licensed Beds

Med Surg (2 Units) ICU (8 Bed) Women’s Health Inpatient Rehab Inpatient Psych

Non-ProfitSole Community Provider

Community Hospital

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• Remove barriers and identify steps towards successful CAUTI project initiation

• Demonstrate educational strategies

• Maintain success

Objectives

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Plan, Plan, Plan…

then Plan some more…

Have a Plan

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

Project Planning

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•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

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Project Planning

Hospital Newsletter

Flyers

Screen Savers

KEYSTONE HAI(Hospital Associated Infections)

“Bladder Bundle

Project”

Preventing Catheter

Associated Urinary Tract Infections

A Focus On

Patient Safety

Infection Control Initiative

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Project Awareness

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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

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Project Start Date

• Use calendar or Gantt chart to plot activities• Check vacation schedules of key staff• Watch out for major holidays

Be Be FlexibleFlexible

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Planning Education

• Nursing• 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

• Physicians•Who will train•How will we train•When will we train

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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

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Developing CAUTI Education

• Don’t Re-create The Wheel

• Use Other Hospitals PowerPoint Slides

• Update/Revise to Fit

Jerri’s Story North Carolina Prevent CAUTI Toolkithttp://www.ncqualitycenter.org/resources.lasso

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Trained the trainers

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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

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

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Improper Cleaning 26

Improper Gloving 24

Contaminated field 45

Didn’t know needleless cath port for specimens 30

Outcome

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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

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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

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Foley Catheter PrevalenceCatheters Per Patient

0%

5%

10%

15%

20%

25%

30%

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0

4

8

12

16

20

24

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@Unit Rate@Vendor RateR

ate

 

1/1/2008 - 4/30/2008

ARMC Keystone Center for Patient Safety and Quality

Comparative Data

Units

Data Point Num Den Prevelance Rate Reporting Num Den Prevelance Rate

Pre 56 233 24.03 29 775 3,912 19.81

Int 1 54 239 22.59 26 697 3,400 20.50

Int 2 27 169 15.98 27 650 3,709 17.52

Post 1 34 187 18.18 26 569 3,262 17.44

171 828 20.65 2,691 14,283 18.84

1/1/08 –4/30/08

ARMC

Michigan

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OutcomesARMC Monthly Urinary Cath Related UTI’s

2006 46

CAUTI’sAvg 3.8

mo

2007 32

CAUTI’sAvg 2.7

mo

2008 28

CAUTI’sAvg 2.3

mo

2009 6 CAUTI’s

Avg 0.5 mo

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OutcomesARMC Monthly Urinary Cath Related UTI’s

2006 46

CAUTI’sAvg 3.8

mo

2007 32

CAUTI’sAvg 2.7

mo

2008 28

CAUTI’sAvg 2.3

mo

2009 6 CAUTI’s

Avg 0.5 mo

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Investigation

• Cath competency plan not followed

• Focus was on hospital EMR implementation

• Daily cath patrol not consistent

• Prevalence rates up

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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

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OutcomesARMC Monthly Urinary Cath Related UTI’s

ARMC Monthly Urinary Cath Related UTI's

-4

-2

0

2

4

6

8

10

Jan-

06

Mar-0

6

May-0

6

Jul-0

6

Sep-

06

Nov-0

6

Jan-

07

Mar-0

7

May-0

7

Jul-0

7

Sep-

07

Nov-0

7

Jan-

08

Mar-0

8

May-0

8

Jul-0

8

Sep-

08

Nov-0

8

Jan-

09

Mar-0

9

May-0

9

Jul-0

9

Sep-

09

Nov-0

9

Jan-

10

Mar-1

0

May-1

0

Jul-1

0

Sep-

10

Nov-1

0

Jan-

11

Mar-1

1

May-1

1

ZERO!!

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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

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Questions

Your Feedback is Important

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