Holey Moley! What About That Foley?! Kathleen Steinmann Hennepin County Medical Center September 7, 2012

HCMC CAUTI Team Assessment Documentation Visual audits – poor securement – poor pericares Education: minimal to none Provider - RN relationship Evaluate products/convenience Plan Improve EPIC documentation Develop education tools Implement trial protocol ICU’s Convert to Bard Lubricath Tray – integrated Castile soap, – hand sanitizer and – Statlock stabilizing device

Collaboration SCIP Team – foley removal by end of POD 2 LEAN Event – Widened the net and IP recommended protocol – Implement changes housewide – Align report tools

Protocol

Education NURSING – Leadership approval for mandatory RN training – 20 minute lecture – 15 minute insertion skills training – Skills checklist (insertion/cares/stabilization/documentation) – 30 minute skill session during new nursing orientation (new) – Develop standard work for health care assistants – Education alternatives to foleys – Collaborated with skin team PROVIDER – All new residents receive insertion training – Presented to Provider Staff Meetings – Found provider champions and to gain one on one support – s

Device Utilization LOOKING GOOD!Or maybe not yet?

Success Protocol implemented Improved urine catheter kit Improved awareness/education SCIP process measure significant improvement CAUTI infection rates: too soon to tell

Challenges Implementation Costs – Product – Education Accountability Dynamic Issues – Infection vs Prevention measures – Owner Someone to “ride herd” until it becomes a habit Process measure auditing responsibility Who should manage nursing process in alignment over time with all training and monitoring Audit Fatigue

Challenges Mixed Messages for Foley – Message can vary depending on “messenger” Example: SCIP repeated messages on the process; but none addressing the outcome – need to collaborate! – Who wore out their welcome first? SCIP measure already in place; focus was only on removal Difficult now to have staff focus on cares and outcome for all patient population Provider Behaviors – Foley changing “vodoo” – Inventive culture collection techniques

What Next ?? Defect management (root cause) Bladder scan benefit MUST HAVE provider champions – – External push that this is valued and not a burr Auditing, auditing, auditing…….