Paula Gabriel Dana Hayward Deb Sperandeo Nicole Moen November 16, 2012 Using NSQIP Data and Best Practices to Reduce Urinary Tract Infections Among Surgical Patients at Peace Arch Hospital Paula Gabriel Dana Hayward Deb Sperandeo Nicole Moen November 16, 2012 Surgical Wound Classification

Team Composition Alana Bajtkova, Surgical Staff Nurse Susann Camus, NSQIP Quality Improvement Consultant Kelly Dixon, Surgical Staff Nurse Kirsten Emly, Infection Control Practitioner, Infection Control Sharlene Enos, Clerk, Surgery Paula Gabriel, Surgical Staff Nurse Dana Hayward, Clinical Nurse Educator, Surgery Laura Holmes, PAH Surgical Clinical Reviewer Alix Kite, Clinical Nurse Educator, Operating Room Anna Lidberg, Surgical Staff Nurse Jenifer McDuff, Clinical Nurse Educator, Surgery Nicole Moen, Surgical Staff Nurse Wendy Newson, Surgery Manager & Team Sponsor Deb Sperandeo, Surgical Staff Nurse & Team Leader Surgical Wound Classification

Why preventing Catheter Associated Urinary Tract Infections (CAUTIs) matters 80% of UTIs in surgical patients are CAUTIs Potentially life threatening for patients Costly for health authorities

Context Non-risk adjusted data from NSQIP suggested UTI rates among Peace Arch Hospital postsurgical patients were higher than the NSQIP average Multidisciplinary team led by a frontline nurse established in April 2012 to lead efforts to reduce CAUTIs

Team Goals Reduce catheter-associated urinary tract infections (CAUTIs) as a postsurgical infection among PAH surgery patients by 50% between April 1 and October 31, 2012. This means reducing non-risk adjusted CAUTI rate from 3.4 to 1.7%.

Interventions to Date Development of a team Charter Implementation of Best Practices from NSQIP and from Fraser Health’s CAUTI Prevention Guideline Staff huddles and contests Factoids posted on unit walls, in washrooms PDSA Cycles Silver tipped catheter trial in hip fracture patients

Interventions to date Plan-Do-Study-Act (PDSA) cycles to test effectiveness of small changes Drainage bag placement, loop integrity Replace plastic containers with biodegradable Vernacare containers Patient education Document Foley Catheter Plan of Care in Kardex binders

Measurement PDSA cycles test how well we are implementing best practices Staff participation in huddles and quizzes are indicators of staff engagement NSQIP data helps the team track progress Surgical Wound Classification

Quality Dashboard – Foley Plan of Care

Quality Dashboard – Containers

Lessons Learned QI Consultant helpful to facilitate meetings, teach us how to apply quality improvement methods, and document processes Having the data for comparison purposes and an SCR to put the rates in context Understanding change management theory Multidisciplinary team Get practical arrangements in place before starting (e.g. booking time off to attend meetings)