CAUTI Immersion Project Washington County Memorial Hospital

Why Work on CAUTIs? Washington County was seeing Foleys inserted without proper reason Foley usage remained high Bladder scans were obsolete Infections occurred due to unnecessary and extended use of catheters Nurses were not consistent in their maintenance or charting of catheters

What Barriers Were Identified? Staff education on multiple fronts Criteria for insertion Maintenance Timely removal Bladder scans were never done Poor charting Physician support of nurse driven protocol

Washington County Memorial Hospital Statistics Washington County Memorial Hospital is a 25 bed Critical Access Hospital that owns & operates 4 rural health clinics WCMH’s ED treats over 13,000 people each year WCMH’s Swingbed program provides skilled nursing care and therapy services to approximately 120 people each year

Quarterly Tasks Completed 100% of first quarter tasks were completed. Focus on educating ED staff on insertion criteria and use of bladder scan for urinary retention 100% of second quarter tasks were completed Physicians still want to be notified before catheter removal 100% of third quarter tasks were completed Implemented checklist for charge nurse to ensure criteria is met on every catheter daily , maintained appropriately, & removed timely

Changes That Made a Difference! Education, Education, Education! Added a catheter section to the EHR for charting to ensure all important data is documented at each shift Daily rounding with charge nurse and primary care nurse

What Did We Learn? ED staff inserted catheters too frequently Educating those nurses drastically reduced the number of catheters that made it the nursing unit Straight catheters were not being used for urinary retention WCMH received Foley catheters that did not have a red seal on them. A new type of Foley is now ordered Charting was inconsistent Staff did not follow the same practice for catheter maintenance

Catheter Maintenance Compliance Makes a Difference & Prevents HAIs

Did All This Work Make a Difference? YES! It was worth it! Compared to baseline data the changes in our workflow made a difference We prevented 3 people from having a CAUTI! These people did not have an increased length of stay, did not have to undergo additional testing, & did not have to take additional meds We also saved $3,000!

Big Wins! Fewer CAUTIs Fewer catheter days Improved charting in ED and nursing unit Nurses are more engaged with their patients Nurses are more aware of the catheter protocols

How Can We Keep This Up? Checklists are in place for charge nurse to complete daily audits Does the catheter still meet criteria for use? Is the appropriate charting done? Has the catheter been maintained appropriately? Qualaris is in place and will continue to be our method for audits

Now What? Charge nurses will be taking on more audits Infection Preventionist will continue to do spot checks We will continue to track catheter days Physicians still require contact before removing catheters, even if they do not meet criteria for ongoing usage 