C ATHETER ASSOCIATED URINARY TRACT INFECTION ( CAUTI ): A PREVENTION PLAN Utilize the Electronic Health Record (EHR) to improve nursing process and patient outcomes. Education created by Kristi Noble MSN RN OCN September 2014

G OAL OF CAUTI P REVENTION Educate RNs to prevent and reduce the incidence of a CAUTI by: Using the EHR to standardize documentation Use indications when inserting an indwelling urinary catheter

O BJECTIVES FOR CAUTI PREVENTION 1. Recall the importance of standardizing documentation for in and out times and line days. 2. Identify indications for placing an indwelling urinary catheter. 3. Identify where to locate policies and protocols for an indwelling urinary catheter within the EHR.

R EGULATIONS AND REPORTING DID YOU KNOW ? Since 2008 The Centers for Medicaid and Medicare Services have not reimbursed the cost of Hospital Acquired Infections, such as CAUTI. Since January of 2013 Munson has been manually reporting the instances of patients developing a CAUTI while in the hospital. The estimated cost of treating a CAUTI that develops while in the hospital ranges from $1,200 to $2,800.

I MPORTANCE OF DOCUMENTING INDWELLING URINARY CATHETERS IN THE EHR Improve patient outcomes Increase patient safety Better of tracking patients with an indwelling urinary catheter Able to generate reports for reimbursement Standardize documentation across multiple departments and organizations within Munson Healthcare Standardize order and discontinue process for indwelling urinary catheter

F OLEY DOCUMENTATION CURRENTLY IN FORMS WILL BE REMOVED AND MOVED TO INTERACTIVE VIEW Will move to I-view

H OW TO ORDER INDWELLING URINARY CATHETER : OLD TO NEW Nursing is responsible for verifying the presence of a current order. If no order must obtain one. Indwelling new key word, Foley can still be used.

N EW REQUIREMENTS FOR INDWELLING URINARY CATHETER ORDERS : INDICATIONS Ensure the indications are as accurate as possible If patient does not meet criteria, they don’t need a urinary catheter

A FTER ORDER IS PLACED 1. Order is placed. RN is notified on tracking shell 2. Go to task list. 3. Double click the Task Description 4. Takes RN to I-view for creation of Dynamic Group

C REATING A DYNAMIC GROUP FOR INDWELLING URINARY CATHETER IN I-V IEW In creating the dynamic group there are mandatory fields The insertion date is crucial, allows for tracking of line days to begin. Date will default forward.

R EFERENCE TEXT POLICIES AND PROTOCOLS Reference text, protocols, and policies may also be found in Lippincott or policies on the intranet Reference text with policies and protocols found by right clicking on the order

W HEN INDWELLING URINARY CATHETER DISCONTINUED RNs can discontinue the urinary catheter by right clicking on the order. Providers may discontinue or modify the catheter order by right clicking on the order. Providers can DC or modify the catheter order.

W HEN URINARY CATHETER IS DISCONTINUED 1. Go to Task List 2. Double click on task, takes RN to I-view 3. Document discontinuation 1 2 3

D ISCONTINUING THE INDWELLING URINARY CATHETER The date and time of removal is captured from the time stamp of the column. If not chart at time of removal or back chart correct time. Once charting complete RN must inactivate the dynamic group

S TRAIGHT / INTERMITTENT CATHETERIZATION For patients who require intermittent straight catheterization, a separate dynamic group needs to be created. The same group may be used for each instance of catheterization during the patient’s stay. Documentation occurs the same as all other charting in I view

A BC ’ S OF CAUTI PREVENTION Adherence to an infection prevention plan Bladder scan protocol when urinary catheter removed Condom catheter, access to commode chairs Do not use catheters unless necessary Early removal of catheter using the Electronic Health Record as a guide

Your involvement in ensuring that our patients are safe and free from catheter associated urinary tract infections is appreciated, and your care to our patients is invaluable.