Holey Moley! What About That

Foley?!Kathleen Steinmann

Hennepin County Medical CenterSeptember 7, 2012

HCMC CAUTI Team Assessment

• Documentation • Visual audits

– poor securement – poor pericares

• Education: minimal to none• Provider - RN relationship• Evaluate

products/convenience

Plan• Improve EPIC documentation• Develop education tools• Implement trial protocol ICU’s• Convert to Bard Lubricath Tray

– integrated Castile soap, – hand sanitizer and – Statlock stabilizing device

Collaboration• SCIP Team– foley removal by end of POD 2

• LEAN Event– Widened the net and IP recommended protocol– Implement changes housewide– Align report tools

Protocol

Protocol

Education• NURSING– Leadership approval for mandatory RN training– 20 minute lecture– 15 minute insertion skills training– Skills checklist (insertion/cares/stabilization/documentation)– 30 minute skill session during new nursing orientation (new)– Develop standard work for health care assistants– Education alternatives to foleys– Collaborated with skin team

• PROVIDER– All new residents receive insertion training– Presented to Provider Staff Meetings– Found provider champions and to gain one on one support– Emails

Device UtilizationLOOKING GOOD!

0.44 0.41 0.39

0.00.10.20.30.40.50.60.70.80.91.0

2011 2012Q1 2012Q2

HCMC House Urinary Catheter Device Utilization

0.00.10.20.30.40.50.60.70.80.91.0

2011 2012Q1 2012Q2

HCMC ICU (MISIPI) Urinary Catheter Device Utilization

0.94 0.94

0.5

0.6

0.7

0.8

0.9

1.0

Jan-12

Feb-12

Mar-12

Ap

r-12

May-12

Jun-12

Jul-12

MICU Device Utilization

Or maybe not yet?

Success

• Protocol implemented• Improved urine catheter kit• Improved awareness/education• SCIP process measure significant

improvement• CAUTI infection rates: too soon to tell

Challenges

• Implementation Costs– Product – Education

• Accountability Dynamic Issues– Infection vs Prevention measures – Owner

• Someone to “ride herd” until it becomes a habit• Process measure auditing responsibility • Who should manage nursing process in alignment over time

with all training and monitoring

• Audit Fatigue

Challenges• Mixed Messages for Foley– Message can vary depending on “messenger”• Example: SCIP repeated messages on the process; but none

addressing the outcome – need to collaborate!– Who wore out their welcome first?• SCIP measure already in place; focus was only on removal• Difficult now to have staff focus on cares and outcome for all

patient population

• Provider Behaviors– Foley changing “vodoo”– Inventive culture collection techniques

What Next ??

• Defect management (root cause)• Bladder scan benefit• MUST HAVE provider champions – – External push that this is valued and not a burr

• Auditing, auditing, auditing…….