Progress with Urinary Catheter Care Bundles Cardiff and Vale University Health Board Helen Bonello & Vince Saunders

Aims and Objectives: Cardiff and Vale UHB aims to reduce the incidence of CAUTI by 20% by December 2011 by introducing Catheter Care Bundles which put best evidence and practice at the forefront. Essentially, it aims for the right thing to do, to be the easiest thing to do!

To recap... We have 3 pilot sites: An Acute Stroke Unit (18 beds,C7 North, UHW) An Orthopaedic ward (West 5, UHL) One theatre (UHL)

Prior to rollout… November – February We re-devised our staff letter and distributed it to all staff (nursing and MDT). We used a PDSA style approach to design paperwork staff were happy with. Insertion, Maintenance, CSU, Urinalysis. The specialist continence nurses redesigned the CSU guide. Equipment checked and ordered.

We devised an educational programme and carried out informal teaching sessions with small groups of nursing and MDT staff. Educational notice board for staff and patients displayed and PowerPoint presentation put on ward computer for staff to access and printed copy made available. Agreed to trial different data collection forms.

Roll out C7... With such enthusiasm for the project we rolled out to all 5 patients straight away! However, over the first week we noticed an ‘all or nothing’ pattern with compliance, with both completion of the bundles and data collection elements. Lack of ward ownership for the project.

C7... Person or persons (few!) dependent, despite 100% of staff receiving letters and over 50% receiving education. This has improved over the weeks and staff have lots of ideas about improving compliance.

West 5 Fire/Environmental challenges! Found the definition of CAUTI difficult to communicate and understand. Challenges with using the safety cross to display meaningful data. Person dependent.

Over the period there is a new Days between Cauti's event every 42.7 days on average (Mean value). The next event could happen anywhere between 0.0 to days in the future if nothing changes.

Theatres Information made available to staff. Struggled to engage. Lack of senior support and leadership highlighted. No data collection.

Challenges... Positives Education Raised awareness New equipment available, e.g. Flip flow valves / Fixation devices Negatives Data collection. (Data needed on how long urinary catheters are staying in-situ.) Junior Dr’s staffing levels to support the project. Person dependent (NOT team lead) Effective leadership and senior support Insertion bundle to comprehensive.

Going forward... Re-work the insertion bundle to promote ease of use Screensaver (VTE project in Birmingham used this technique to raise awareness of the VTE risk assessment) Formal staff feedback – qualitative method

Quiz – to keep momentum of the project going and check knowledge. Algorithm / flow chart to help define CAUTI to improve data collection/analysis.

How to overcome challenges? Any ideas welcomed!

If we can improve care for one patient, then we can do it for ten. If we can do it for ten, then we can do it for a 100. If we can do it for a 100, we can do it for a 1000 And if we can do it for a 1000, we can do it for everyone in Wales.