mary a. petersen, msn, rn: director of professional nursing practice betsy demarest, bba, rn, cnor:...
TRANSCRIPT
Urine-8 Project: Next Step
Mary A. Petersen, MSN, RN: Director of Professional Nursing Practice
Betsy Demarest, BBA, RN, CNOR: Director of Surgical Services
Trinity Medical Center – Quad Cities
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Urine-8 Committee MembersMichelle Blackmer, MSN, FNP-BC, RNStan Buck, RN, RNFAPam Elliott, MBA, BFAChris Hansen, MS, RNDiane Laake, RN, CMSRNPaula Maddox, MSN, RN, CCRNKathryn Marhoefer, MBA, RNMichelle Mathias, BSN, RNMary A. Petersen, MSN, RN (Committee Chair)
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CAUTI Statistics Nationwide
80% of HA UTIs are caused by urinary
catheters5% deaths from HAIs are urinary
catheter associatedCost of a CAUTI is estimated at
$500-1000, $2800 if bacteremiaSource: Michigan Keystone Project, 2008
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Trinity CAUTI Rates
CAUTIs 2006-2009Year
Raw #
Rate /1000 pt days Rate / 1000 Foley days
2006 103 1.1
2007 77 0.87
2008 89 0.86
2009 69 0.82 4.25
First Step
Determine specific nursing opportunities to decrease foley related UTI’s
Conducted a one-day prevalence study Primary aims of the study included1. Quantify the level of use of indwelling
urinary catheters2. Determine the level of adherence to
guidelines
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Methods
2007, 2008 & 2010 all units on each campus surveyed
List obtained identifying all patients with Foley and RN providing direct care
Data collector directly observed the catheterized patients and interviewed RN
Data was collected on a standardized form2011 & 2012 implemented Adaptive Design
methodology
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Foley Practice Areas Reviewed
Presence of a Foley catheter Catheter secured to the pt’s abdomen or leg Tamper Evident Seal intact (TES) Tubing extended to prevent the development of
dependent loops of drainage tubing Tubing secured to patient bed or chair to prevent
pulling on system Drainage system not touching the floor Urine bag not over filled with urine
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Catheter Associated Urinary Tract Infection (CAUTI) Prevention URINE-8
1 Good hand hygiene
2 Inserted by qualified staff Sterile technique when inserting catheter
3 Proper peri care: Daily with bath, fecal incontinence, presence of
discharge or drainage and at bedtime Document peri-care
4 Secure catheter to patient with a Stat Lock Change Stat Lock every 7 days Do not use Stat Lock on edematous patient
5 U/A upon catheter insertion when symptoms present▪ Document symptoms in Care cast
6 Do not break the red seal
7 Unobstructed urine flow No kinks, bends, or dependent loops Keep urine bag off the floor
8 Remove as soon as medically able *SCIP – Remove by the end of post-op day 2
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Trinity CAUTI Rates
CAUTIs 2006-2011Year
Raw #
Rate /1000 pt days Rate / 1000 Foley days
2006 103 1.1
2007 77 0.87
2008 89 0.86
2009 69 0.82 4.25
2010 18 0.18 0.97
2011 18 0.19 0.9
Lessons Learned
Nurse to Nurse Collaboration is a practiced skill
Physician collaboration is keyPhysician and Nurse communication /
education is paramountAdaptive Design and daily monitoring
drives successful implementation
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Conclusion:HAI’s represent a direct threat to patient
safety, healthcare quality and they are costly.The Urine-8 project has consistently decreased
the infection rate and identified the positive financial impact directly attributed to evidence-based nursing practice.
The next step of adding the nurse driven catheter removal protocol will continue to decrease unnecessary Foley days and serve as a tool to meet SCIP criteria and avoid CAUTI.
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