Northwest Medical Center Our CAUTI Journey Moving Forward Through Looking Back Lori Bishop, RN IP/EE Health Specialist-Quality/Risk

Northwest Medical Center 25 Bed Critical Access Hospital Serving 4 Communities Acute And Swing Bed Services Dynamic Outpatient Department Home Health Agency 4 Physician Clinics Numerous School And Community Partnerships Proudly Affiliated With Mosaic Life Care

A Little Background…. In 2013 during the CUSP project, NMC’s CAUTI rates were 14.2 per 1,000 patient days. We were still using catheters for convenience. We had high utilization rates in ED. Catheters were used for accurate I and O’s. We made some progress and got the rate down to 13.1 per 1,000 patient days by the end of the program and continued to employ the tools provided. We implemented a catheter insertion bundle. We reinforced aseptic insertion techniques. We started moving away from convenience insertions .

Evolving Practice Large update to the EMR in Jan. 2014 New order set capabilities Healthcare was continuing to evolve. Executives wanted to see improvement and innovation. April 2014, a new Evidence-Based Practice Team is formed. Nurse-driven removal protocol is developed and goes live January.

HEN 2.0 ENTRY Status We are half way there…right? NMC has a decreasing CAUTI rate though not significant by our standards. Continuing to work on CAUTI’s through the Immersion Project made sense. We have a nurse-driven removal protocol in place. We are already completing hourly rounds. All of these things are built in the EMR. NMC employs a CAUTI insertion bundle. We are half way there…right?

Quarterly Tasks/Calls Essentially 90 day PDSA cycles. Primary Tasks for NMC associated with calls/task lists Team Champion Executive Support Insertion Bundles Nurse-Driven Removal Protocol Maintenance Bundle Education Hourly Rounding

Getting Started….. Team members- OR, ED, Nursing, ES, IP, Lab, Physician Champion, ancillary. Executive support- high level Insertion bundles- Evidence based. Work flow appropriate. Nurse-Driven Removal Protocol- Discovered this is not effectively being utilized by the physicians. More later… Education- need to reinforce and assess needs. Hourly rounds- we are doing them and documenting in the EMR.

Nurse Driven Removal Protocol Why is it under utilized? Physicians reported/asked: It’s clunky Not easily accessible-forgotten How does it help my patients? What’s the research behind it? Nurses reported/asked: We are comfortable with it. We are already managing the catheters and asking for orders and assessments as appropriate.

Rounding Re-examined Hourly rounds are completed in the EMR. Upon closer examination, purposeful rounding is not being completed. Specific issues are not addressed proactively and completely. Missed opportunities for interventions are missed opportunities. Pinched tubing Catheter bag below bladder Etc.

Solutions The order set was addressed and improved for workflow. EYE ON NURSING! The order set was addressed and improved for workflow. Lunch and learn was held at monthly Medical Staff meeting Pocket card provided with accepted insertion indicators. Nursing proactively asks for entry of the protocol, if needed. Evidence based education was shared with nursing. Education for purposeful rounding has started. Successes have been shared at huddle, in emails, in thank you notes, etc. New processes and protocols will be followed and evaluated for viability.

Lessons Learned You do not always know what you know! Do not get so caught up in in the tasks that you forget the people doing the tasks. Make the “Right Things Reasonable” There is always room for improvement and new perspectives.

Next Steps We will continue to assess the effectiveness of the CAUTI program and look for education and growth opportunities. We will educate and grow staff skill in “Rounding with Purpose” We will continue to work toward lowering our catheter utilization rate in ED through education and shared resources. We will continue to work to improve outcomes for those we care for and are entrusted with.

Questions?