1. Engaging Residents & Families in CAUTI Prevention
Content Webinar (All Staff)
May 21, 2015
Welcome to today’s content webinar on Engaging Residents and Families in CAUTI Prevention. This webinar is part of the Agency for Healthcare Research and Quality’s (or AHRQ’s) Safety Program for Long-Term Care that addresses Healthcare Associated Infections (or HAIs) and Catheter Associated Urinary Tract Infections (or CAUTI).
We have designed this education session specifically for any staff member who works in a long-term care facility. Every team member is important in helping make your long-term care facility a safe place to live and work!
Sue Collier, RN, MSN, FABC
Clinical Content Development Lead
Health Research & Education Trust
American Hospital Association

2. Learning Objectives
Upon completion of this session, participants will be able to
List three examples of resident engagement;
Discuss the benefits of engaging residents and families as partners in care; and
Explain the importance of their role in supporting resident and family engagement in CAUTI prevention.
Here are our goals for today’s session. At the end of this program, you should be able to:
List three examples of resident engagement,
Discuss the benefits of engaging residents and families as partners in care, and
Explain the importance of your role in supporting resident and family engagement in CAUTI prevention.
This webinar will help you understand how you, regardless of your role, can make a difference in the safety and quality of care for the residents and family members we serve.

3. What is Resident Engagement?
The way we keep the person, the resident, and their family at the center of every decision-making process.
How we listen to and respect the residents’ preferences and needs.
The way we communicate and share information with residents and families.
Our attitudes and actions that demonstrate the resident and their family is part of the team.
Let’s start by taking about what we mean by resident engagement. The first element of resident engagement is keeping the resident and their family at the center of every decision. This means that when we take action or make decisions, we should involve the residents and their family members whenever possible. How we listen to and respect the residents’ preferences and needs is another way we can show that residents a part of the team. We are engaging residents when we ask them to share their needs and then show them respect by honoring their choices. The way we communicate and share information with residents and families is another way we can demonstrate true engagement. We support residents as partners when we share accurate and complete information in a way that they can understand and they can participate in their care decisions. When we say we believe the resident is an important team member and then we show this belief in our actions, we are engaging residents and their loved ones as partners. The bottom line, our attitudes and actions must reflect that the resident and their family are valuable team members.
Resident engagement happens when there is an environment and culture that promotes residents, families, clinicians, and all facility staff working together to improve quality and safety.
Additional Facilitator Notes
Consider resident or staff stories from your facility that provide examples of resident engagement
Consider resident or staff stories from your facility that provide examples of not engaging the resident or family member

4. Why Is Resident Engagement in CAUTI Prevention Important?
Leading cause of death and complications
150, ,000 admissions to hospitals from nursing homes each year
Prevention of these infections is critical in order to promote resident safety
Every number is a resident!
So why is this topic so important? Let’s review some statistics for CAUTI. The data reminds us why this topic matters to the residents and families we serve. We know that infections in nursing homes are a leading cause of death and complications. In fact, anywhere from 150,000 to 300,000 admissions to hospitals from nursing homes each year are due to infections. This means a large percentage (26-50%) of hospital transfers are due to infections. Infections cost more than other adverse event that results in hospitalization. Residents who get sick and must be transferred to a hospital could die of a healthcare associated infection. So prevention of these infections is a very important step we can take to promote resident safety.
Remember, every statistic, every number represents a resident.
Additional Facilitator Notes
Consider presenting your facility’s performance information, especially as it relates to admissions to hospitals or percentage of infections.
Share quality or resident safety data in terms of the numbers of residents who are impacted by infections or harm.
Montoya, Mody. Aging health December ; 7(6): 889–899. doi: /AHE
Stone et al ICHE 2012.
Smith PW et al ICHE 2008.

5. Benefits to Engaging Residents and Family
Residents and family have the ultimate concern for infections
Residents and family can help the staff by
Asking questions
Identifying problems and solutions
Staff can be more efficient and feel more valued in a resident-centered environment
Facilities have better outcomes when there is shared decision making
There are also a number of benefits to engaging residents and their family members in safety and quality programs. A key benefit has to do with the information we just shared concerning the data on HAIs. Such infections can be deadly or result in complications and additional costs for the resident and facility. We need everyone on the team to work together to prevent infections. Residents and their family can help staff by asking questions, helping staff identify problems and providing ideas to solve the problems.
Staff can work more efficiently in resident-centered care environments and can devote time where it is most needed. When we involve every team member, including the resident, we can save time and rework because we have extra eyes and hands helping provide care and focusing on the things that matter.
Residents who feel valued as team members are better equipped and more willing to value the contributions of all staff. And staff members are often more comfortable caring for people they know.
There are also benefits to the long-term care facility. LTC facilities have better quality outcomes when there is shared decision making. Resident-centered facilities can gain referrals from people who recommend the facility to others as a place for care. And staff prefer to stay and work in facilities in which there is a relationship of mutual respect between staff and residents.
Additional Facilitator Notes
Consider resident or staff stories from your facility that demonstrate the benefits
Think of benefits that are unique to your facility. E.g., is your facility known in the community as a place in which staff and residents feel valued? Are there examples of how resident or family involvement prevented an infection or CAUTI?

6. Group Discussion - Benefits
What are some benefits to engaging residents and family in infection prevention?
Can you list at least three benefits of engaging residents and family members in infection prevention? I provided a number of examples , but as a group, reflect on those examples and describe some of the benefits for your facility. Also, consider how you could improve your environment or culture to make it more resident- and family –centered.
Additional Facilitator Notes
Think about how you would describe your facility’s culture as it relates to resident-centered care. What are the shared values and beliefs regarding resident-centered care and resident safety?
Ask staff how they communicate with residents and family members about the patient safety program. How do staff share information or education?
Ask residents how they learn about the facility’s infection prevention or safety program. How do residents find out how they can participate in patient safety efforts?
Be ready to talk about what your expectations are relative to involving residents in infection prevention. E.g. washing hands before eating or participating in social activities, avoiding catheter insertion unless indications are met, helping make sure catheters are maintained properly, etc.
Group Discussion - Benefits

7. How Can YOU Support Resident and Family Engagement in CAUTI Prevention?
Include residents and their family in care decisions
Involve residents and their family in safety rounds
Share resident stories in meetings
Ask residents or family members to share their stories
Provide CAUTI prevention education to residents
Share what you are doing to help prevent infections
Ask residents and family to help educate staff
As I said earlier, we need everyone on the team to support resident involvement in the CAUTI prevention efforts. Let’s talk about what you can do to support this work.
A first step may include just getting to know the residents. Ask them about their likes and dislikes.
Then, include them in care decisions, especially when it involves taking steps to prevent an infection. This may include involving residents and family members in safety rounds. Encourage staff in other departments and on other shifts to do the same.
Stories of how residents have been positively impacted by your efforts to keep them safe are very powerful. Share these stories in meetings so everyone can understand what behaviors and attitudes demonstrate that residents are indeed team members. Ask the residents and their families to share their stories. We can learn so much when we listen to examples of how residents were able to feel a part of preventing harm or helping staff do everything possible to keep them safe.
Educate residents about CAUTI prevention. You can do this by talking with residents on rounds or during special education sessions or during Resident Council meetings. Share specific information about what you are doing and what they can do to prevent CAUTI. In fact, you can ask residents or family members to be part of the staff education and to help develop any educational materials that may be used by the residents.
There are so many ways you can show how much everyone in your facility cares about the residents. What better way to show you care than to make sure the residents know what you are doing to prevent infections.
Additional Facilitator Notes
Think about how you would describe why your facility cares about infections and resident safety. Ask staff if they believe actions and attitudes reflect this concern.
Discuss your QAPI efforts or other aspects of your quality and resident safety program.
Provide examples of the education materials designed specifically to help residents and family learn more about CAUTI prevention.
Ask questions like: Would residents/family at your facility feel comfortable asking your staff if they have washed their hands ? Would staff feel comfortable asking each other if they have washed their hands? Provide examples of desired behaviors of all staff.

8. Describe what you do currently to engage residents and families in preventing CAUTI or any infections?
I have provided some examples of what all staff can do to engage residents and family members in CAUTI and infection prevention. Take a minute and think about what you are doing now that includes residents and families in patient safety and CAUTI prevention.
As a group, reflect on the examples and think about the ways you can improve.
Additional Facilitator Notes
Be prepared with a list of at least five examples of how you are currently engaging residents and family members. Connect these examples to the CAUTI prevention program.
Encourage staff to recognize what is already being done before focusing on areas for improvement.
Talk about the importance of team work and how every staff member (direct care or support staff) matters when it comes to improving safety and reducing infection. Give examples such as housekeeping reducing germs with environmental cleaning, dietary reducing spread of infection when washing resident’s hands before eating, Activities staff reporting subtle changes in residents mental status that could indicate an infection, etc.
Share statements such as “I know my work protects residents and staff” or “I believe I add value as a member of the safety team”.
Group Discussion

9. Engaging Residents and Families With C.A.U.T.I and T.E.A.M.S.
This next slide includes pictures of two resources we created to help teams understand what they can do to prevent CAUTIs.
The CAUTI Infographic Poster includes the steps caregivers can take to reduce catheter-associated urinary tract infections by practicing evidence-based technical skills. CAUTI interventions include:
Cather Removal
Aseptic insertion
Using Regular Assessments
Training for Catheter Care
Incontinence Care Planning
The T.E.A.M.S. Infographic is a tool to help guide long-term care facilities in their efforts to improve safety culture, which can also improve resident safety and staff satisfaction. The T.E.A.M.S. interventions includes:
Team formation to plan and implement program
Excellent communication skills learned
Assess what’s working and plan to expand
Meet monthly to learn together
Sustain efforts and celebrate success
Both of these tools can be printed as posters or brochures and displayed or shared in your facility.
We can use these guides to provide additional suggestions for how you can work with each other and with residents to prevent CAUTI and improve the safety culture in your facility. Let’s spend the next few minutes examining how you can use these tools to work with residents as safety partners. Each of you will have slightly different roles in your facility. But each of you can play an important part in supporting residents as team members and partners in care.
Additional Facilitator Notes
Bring copies of each of these infographics to the education session.
Post these materials in locations visible by staff and residents and family members.
Use these tools to reference how each team members has the opportunity to engage residents and families in each of the key “letters” highlighted in the infographics.

10. Your Role in Supporting Resident & Family Engagement in CAUTI Prevention (T.E.A.M.S.)
Invite residents/family to serve on the safety teams; include resident stories in all safety improvement teams
Encourage residents to speak up and communicate concerns
Share information concerning the CAUTI prevention efforts
Ask residents to their share stories
Include safety information in Resident Council meetings
Invite residents to participate in new staff orientation and education
Include CAUTI prevention information in admission packets
This slide includes just a few examples of how you can engage residents using the TEAMS pneumonic.
When you form safety or CAUTI prevention teams, include residents or family members on the team and in planning the meetings. If they cannot attend, share stories about how residents received care that prevented infections.
Let residents and family know what you are doing to prevent infections. Residents, families and volunteers will be interested to know that you are working on a project aimed at improving their safety. Encourage residents to speak up and ask questions. Ask residents to share their stories and to give examples of how they can see a change in communication and prevention practices.
Share prevention information in Resident Council meetings.
To sustain your efforts to improve the culture of safety, include residents in new staff orientation and education. Place CAUTI prevention information in all admission packets and review the materials with all new residents and their family members.
Remember, everyone can participate in the CAUTI team training opportunities and in-services to learn new ways to improve the culture.
Additional Facilitator Notes
Invite a variety of team members to the education session. Include leaders (Administrator, DON, etc.), CNAs, Nurses, Dietary, Housekeeping, Activities staff, Social Work -- anyone who works in the facility
Encourage participants to discuss their personal contributions to the culture of safety. Share examples of how each person has a role in safety and in engaging residents and families as partners.
Use a team building exercise to show how every one is connected. Examples include: A Ball of String, Story Telling
Ask the facility team lead to share additional information concerning how they are using the TEAMS pneumonic to guide improvements in safety culture

11. Your Role in Supporting Resident & Family Engagement in CAUTI Prevention (C.A.U.T.I.)
Monitor and report small changes in a resident's condition
Ensure proper catheter insertion and maintenance
Train residents/family in catheter care hygiene
Explain the signs and symptoms of UTI
Discuss alternatives to an indwelling catheter
Include family in catheter assessments
You can also use the CAUTI pneumonic to involve residents and families in the technical or clinical aspects of CAUTI prevention.
Any staff that interact with residents, even if only for brief moments, can report small changes in a resident’s condition. These small or sometime significant changes can be signs of infection.
Staff who are responsible for inserting, maintaining or removing catheters can make sure they are using proper catheter insertion and maintenance practices. Explain to staff how to insert catheters properly and staff can help train residents and family members in proper catheter care use and hygiene. It is important that residents understand why staff are assessing the need for an indwelling catheter and what staff are doing to prevent UTIs.
You can also explain the signs and symptoms of UTI to residents and include the family members in catheter assessments. Ask residents and/or family members their preferences, needs and concerns. Discuss the appropriate use of catheters and antibiotics, as well as alternatives to an indwelling catheter. We want to be sure that the residents and their loved ones have the same information we have to keep them safe.
Additional Facilitator Notes
Invite a variety of team members to the education session (clinical and support staff). Encourage each staff member to talk about how their role can support CAUTI prevention, even if they do not provide direct care.
Share stories of how support staff (e.g. dietary, housekeeping, Activities staff) have observed changes in resident conditions or how family members have identified signs or symptoms.
Use a team building exercise to show how every one is valued. Example includes: I Make a Difference
Ask the facility team lead to share additional information concerning how they are using the CAUTI pneumonic to guide improvements in safety culture

12. Group Discussion - ACTION STEPS
How can we work together to be sure the residents and their families are part of the CAUTI prevention program in our facility?
You have heard a lot of information today and have discussed specific examples of how each of you have a role in engaging residents in CAUTI and infection prevention.
Take a moment and think about how the team can work together to support this effort. Think about what you will do individually to work with your fellow team members and with residents and their family members.
Each and every one of you are important members of the team to prevent CAUTIs and to improve resident safety. As you learn more about how to improve the culture, talk with your teammates about what you learned and how you can apply this new information. You can then work as a team to help educate residents and families about what your facility is doing to prevent infections.
Some of you will be involved in providing formal education; others may be involved in reinforcing positive behaviors related to infection control. For example, Nurses may be more involved in communicating with physicians and non-physician providers so they can share information concerning what your facility is doing to involve the resident and family members in CAUTI prevention. Dietary and Housekeeping staff have opportunities every day to assure there is a safe environment and support for each resident. And remember, residents and families can be your partners in the work to improve safety and reduce infections.
Group Discussion - ACTION STEPS

13. Stay Updated with Useful Resources
AHRQ Safety Program for Long-term Care: HAIs/CAUTI Project Website
Login information
Username: ltcsafety
Password: ltcsafety
TeamSTEPPS® for Long-term Care
AHRQ Safety Program for Long-term Care: HAIs/CAUTI Project Website
Login information
Username: ltcsafety
Password: ltcsafety
TeamSTEPPS® for Long-term Care
As we wrap up today’s discussion, I’d like to thank you for your time and attention to this program and for working to make your long-term care facility a safer place for residents, family members, and staff.
The following resources are available to you as participants in this program. We hope that these resources will be useful as you help your facility improve its culture of safety.
The first resource is a link to the AHRQ Safety Program for Long-term Care: HAIs/CAUTI project website. On the website you will find a variety of tools to help you prevent CAUTIs and improve your facility’s culture of safety.
The second resource is a link to the TeamStepps for Long-term Care web page. TeamStepps is a communication and teamwork system that offers solutions to improving collaboration and communication within health care facilities. The resources on this page are specifically designed for the long-term care environment.
The third resource is a link to a downloadable version of the T.E.A.M.S Infographic we discussed during this onboarding module.
The fourth resource is a link to a downloadable version of the C.A.U.T.I. Infographic we discussed during this onboarding module.
T.E.A.M.S. Infographic C.A.U.T.I Infographic