2014 Performance Improvement Project Kevin Pham, Huy Tran, Lawrence Kim, Tiffany Nguyen, Fady Youssef (And Aceela Muqri) | September 9, 2014 CAUTI and VA Nursing Documentation

2 FOCUS F – finding the problem O – organize resources C – clarify goals U – understand objectives S – select a plan Department of Medicine| September 9, 2014

3 Problem Benefits vs risks Personal experiences Documentation Department of Medicine| September 9, 2014

International Clinical Practice Guidelines from IDSA “Institution should consider nurse-based or electronic physician reminder systems to reduce inappropriate urinary catheterization (A-II) and CA-UTI (A-II).” IDSA Guidelines Department of Medicine| September 9, 2014

5 Computer documentation Decreased duration No change in re-cath rate Cornia PB, Amory JK, Fraser S, et al. Computer-based order entry decreases duration of indwelling urinary catheterization in hospital- ized patients. Am J Med 2003;114: Department of Medicine| September 9, 2014

6 Our Resources Long Beach Veteran Affairs Medical Records (CPRS) Nursing management staff Residents Attendings Department of Medicine| September 9, 2014

7 Goals and Objectives Objective: To improve the rate of catheter-associated urinary tract infections Primary Outcome: The rate of Foley insertion documentation of pre-intervention compared to post-intervention samples. Department of Medicine| September 9, 2014

8 Project Challenges Compliance from nursing staff Accuracy of documentation Multiple insertions Department of Medicine| September 9, 2014

9 Opportunity Statement An opportunity exists to improve: Documentation of Foley’s Why? Reduces UTI Goal? increases by 10% or greater Department Name | Month X, 201X

10 PDCA Plan Do Check Act Department Name | Month X, 201X

11 Pre-Intervention (PLAN) Team members collected rates of documentation of Foley placement once a month for 5 months Documentation consisted of a Foley insertion note entered by the patient’s RN Spreading out the data collection was intended to eliminate possible variations Department of Medicine| September 9, 2014

12 Intervention (DO) Department of Medicine| September 9, 2014 Poster Design Nursing huddle

13 Department of Medicine| September 9, 2014

14 Post-Intervention (CHECK) Team members collect rates of documentation of Foley placement Multiple Sample Days Department of Medicine| September 9, 2014

15 Outcome Pre-intervention sample: N= 25 Post-intervention sample: N= 23 Department of Medicine| September 9, 2014

16 Pre Vs Post Data Department of Medicine| September 9, 2014

17 Data Analysis The sample size is too small to demonstrate statistical significance. The raw data suggests an improvement in the rate of documentation of Foley insertion note after our intervention. Additional data collection may enhance the effect of our observed outcome. However, additional data collection requires a longer period of investigation, which is not feasible for this current project. Department of Medicine| September 9, 2014

18 Data Analysis The sample size is too small to demonstrate statistical significance. The raw data suggests an improvement in the rate of documentation of Foley insertion note after our intervention. Additional data collection may enhance the effect of our observed outcome. However, additional data collection requires a longer period of investigation, which is not feasible for this current project. Department of Medicine| September 9, 2014

19 Data Analysis The sample size is too small to demonstrate statistical significance. The raw data suggests an improvement in the rate of documentation of Foley insertion note after our intervention. Additional data collection may enhance the effect of our observed outcome. However, additional data collection requires a longer period of investigation, which is not feasible for this current project. Department of Medicine| September 9, 2014

20 Outcome Department of Medicine| September 9, 2014 We improved nursing documentation for Foley catheter placement with a simple educational intervention with the hope of reducing the rate of CAUTI at the VA.

21 Thank You! Department of Medicine| September 9, 2014