Invasive Devices WebEx 18th January 2011 Invasive Devices WebEx

Already in Place? Step 1 URINARY CATHETERS Goal - December 2010 Step 2 Organising a team Identifying pilot sites (3 areas) Already in Place? URINARY CATHETERS Step 2 Baseline Data Agree care bundle for local use Goal - December 2010 Step 3 Organisations should have tested the care bundle in the pilot sites and be moving to full implementation in the pilot sites with the collection of process and outcome measures Goal - February 2011 Step 4 Organisations should be able to demonstrate reliable implementation of urinary catheter care bundles in their pilot sites and are spreading to the rest of the organisation Goal - August 2011 ongoing

Pilot Sites Three areas High use of urinary catheters/PVCs Interested in taking part / engaged Good leaders / champions for later work.

Baseline Data (UC) (minimum requirement) Numbers of urinary catheters being placed

Baseline Data (UC) Number of avoidable catheterisations List of indications Audit process retrospectively Collect prospectively as catheters are placed

Baseline Data (UC) Numbers of Catheter Associated Urinary Tract Infections (CAUTI) Use definitions provided Assessment of numbers of secondary blood stream infections (UC) Unit / hospital/organisational Seek advice from local microbiology departments

Process Measures Appropriateness of urinary catheter placement – monthly audit % compliance with insertion bundle % compliance with maintenance bundle

Outcome Measures Numbers of urinary catheters inserted Urinary Catheter Associated Infections (CAUTI): Incidence (using infection definition and numbers of UC days as denominator) Time between events (each day of CAUTI and counting days between) Hospital/organisational level monitoring secondary blood stream infections related to UC.

Month: Ward acquired: : Admitted with: X CAUTI 1 2   3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 No new CAUTI New CAUTI found Admitted with CAUTI

Peripheral Vascular Cannulae (PVC)

PVC Goal - January 2011 Step 1 Goal - March 2011 (LS3) Step 2 Organising a team Identifying pilot sites (3 areas) Goal - January 2011 PVC Goal - March 2011 (LS3) Step 2 Baseline Data Agree care bundle for local use Step 3 Testing of care bundle in pilot sites Implementation in pilot sites Goal - October 2011 Goal - June 2012 ongoing Step 4 Demonstrate reliable implementation Spread beyond pilot sites

PVC Timeline Step 1 – January 2011 Organisations should have put together a team to take forward the work on PVC within their organisations and chosen three pilot sites. Step 2 – March 2011 Organisations should have established the use of Visual Infusion Phlebitis (VIP) scoring when checking PVC sites, collecting baseline data in the three pilot areas and agreed a care bundle for use. Step 3 – October 2011 Organisations should have tested the care bundle in the pilot sites and be moving towards full implementation in the pilot sites with collection of process and outcome measures.

Step 4 – June 2012 Organisations should be able to demonstrate reliable implementation in the pilot areas and have developed and started to implement a spread plan for the rest of the organisation. October 2012 Organisations should be able to demonstrate effective spread of PVC care bundles across their organisation with sustainability of practice.

Baseline Data (PVC) (minimum requirement) Number of PVCs being placed Establish a system for monitoring the PVCs and assessing them using the Visual Infusion Phlebitis Score (VIP): Document numbers of PVCs with a VIP score of ≥2

Baseline Data (PVC) How many per day require removal / replacement on the basis of their VIP (removed appropriately - Y/N)

Baseline Data (PVC) NHS Tayside (Safer Patient Network): MRSA/MSSA infections Hand hygiene compliance Consider monitoring 20 Blood Stream Infections related to PVCs MRSA / MSSA, but also other organisms Most useful at Unit / Hospital / Organisation level.

Process Measures % Compliance with the Insertion bundle % Compliance with the Maintenance bundle

Outcome Measures Number of PVCs used

Outcome Measures Incidence of local phlebitis/infection: -Incidence – note each case of VIP ≥ 2 or documented local infection (red inflamed site with positive cultures), using number of PVC days as denominator. -Time between event, monitoring of each case of VIP ≥ 2 for local infection (as above), counting days between each event.

Outcome Measures At hospital/organisation level monitoring of secondary blood stream infections related to PVCs.

Devices Safety Briefing PVCs 1. How many patients have a cannula in situ? 2. How many can be removed? 3. How many cannulae need to be inserted? 4. Of those cannulae inserted, how many were completely compliant with the insertion bundle? 5. Of those cannulae in situ, how many have been compliant with the maintenance bundle today? 6.How many newly confirmed VIP scores of ≥ 2 today?

PVC How To Guide Driver Diagram Clarity – data collection/measures Care bundles

Criteria Yes No Clinical Exception Avoid unnecessary cannulation! Hand hygiene performed before collecting sundries, including gloves (consider using aseptic non-touch technique) Small gauge cannula selected where possible Site prepared and allowed to dry using antisepsis pre-placement of cannula Cannula sited where it can be seen, where possible. Insertion site kept covered, with an intact sterile IV designated dressing and checked. Sharps discarded immediately/safely. Gloves removed and hand hygiene performed

Criteria Yes No Clinical Exception Cannula procedures performed aseptically, with hand hygiene before & after Reviewed daily and any continuing need for the cannula documented Cannula removed as soon as the patient’s clinical condition allows, or if there is insertion site swelling/extravasation/ discharge (VIP score ≥ 2) The use of filters for long-term infusions made up in-house has been considered