April 11 th 2014 Putting a S.T.O.P to traditional use of Invasive Devices: Use it or lose it! Liz Smith

Conflict of interest No payment has been made to undertake the presentation No payment for advice given No funding for research has taken place 1000 Lives Improvement Service PHW have funded attendance No share holdings or pharmaceutical companies have any interests in the programme However, Health Foundation funding contribution was made to enable the production of communication aids for the STOP campaign and Sepsis.

Wales

Population 3 million 9 Health Boards –Vary in population –3 large –Limited tertiary –Rural – some shared services with England –Some specialised services

Scale of the problem European Centre Disease Control (ECDC) Point Prevalence Survey 2011 indicated high rates of –UC –PVC –SSIC-Section Acute patients surveyed 3369 had either UC, PVC or both Non acute surveyed 343 had either PVC or UC

Concerns Acute sector surveyed 3369 had a device insitu –60% identified as Catheter related UTI (CAUTI) –26% of inpatient population had an indwelling PVC (some more than one) Non Acute survey 343 had a device insitu –303 UC –66 PVC –103 identified catheter related infection

Getting started One ward... one day How many cannulas and catheters are insitu How many of those are clinically indicated In your professional opinion how many could be removed

Model for improvement

S.T.O.P. Stop - Is the device needed? Is there an alternative? Think - What are the clinical indicators for use? Has the patient consented? Options - Management of alternative therapies. Document the rationale for use Prevent - Health Care Associated Infections Document equipment used with traceability. Be vigilant with ‘Time in Time out’ prescription. Attention to detail.

STOP Order Before Insertion. – Clear clinical indication for insertion; to be documented in clinical notes Post insertion. Use it or lose it. – Use should re assessed every shift and reasons documented in clinical/nursing notes. – If the device has not been used after 8 hours it should be removed

Creating characters - S.T.O.P.

CAUTI Bundle

Communications as a primary driver

Cwm Taf University Health Board Orthopaedic Wards % patients Catheterised prior to theatre

Welsh Ambulance Service Trust (WAST) Cannula only

Powys Teaching Health Board Catheter only-CAUTI PPS 2011 Programme Commenced ↑ Community Nursing Teams

Hywel Dda Health Board

Final word Most organisations are reporting 50% reduction in device usage Catheters -Some HB reporting a reduction of 90% KIS-Keep it simple. Work in progress –community – those cared for at home. –Annual STOP day.

Thank you – Diolch! (Dee olcch) Happy to share -please remember us when using our materials