1. CAUTI Content Call #6 A Hospital’s Perspective CAUTI Prevention: Implementation in a Community Hospital

2. CAUTI Prevention Implementation in a Community Hospital Mary Jo Skiba RN BSN Project Manager QI/Research January 2011

3. 146 Licensed Beds Med Surg (2 Units) ICU (8 Bed) Women’s Health Inpatient Rehab Inpatient Psych Non-Profit Sole Community Provider Community Hospital

4. Remove barriers and identify steps towards successful CAUTI project initiation Demonstrate educational strategies Maintain success Objectives

5. Plan, Plan, Plan… then Plan some more… Have a Plan

6. CAUTI Team Policies Awareness Campaign Data Collection Plan Project Start Date Education Plan for Follow-Up Project Planning

7. Establish CAUTI Team Members Involve frontline staff Have a physician champion Include charge nurses Include staff development Determine the scope of your initial project Policy - Urinary Catheterization Review/Revise Use policy in toolkit Don’t re-create the wheel Consolidate into one policy if possible - ?Automatic Catheter Stop Policy

8. Project Awareness Hospital Newsletter Flyers Screen Savers KEYSTONE HAI (Hospital Associated Infections) “Bladder Bundle Project” Preventing Catheter Associated Urinary Tract Infections

12. Data Collection Data collectors Data forms – Add qualifiers specific to your hospital Assure understanding of project requirements 5 days week =Mon thru Fri (not W/E) Data entry web-based program

13. Project Start Date Use calendar or Gantt chart to plot activities Check vacation schedules of key staff Watch out for major holidays Be Flexible

14. Planning Education Nursing Who will be trained Who will train How will we train When will we train How will we do make-ups How much ongoing training or re-training needed Physicians Who will train How will we train When will we train

15. Two Fold Approach 1.Didactic CAUTI Face to Face Inservice All Nursing/Aides Guideline For Prevention of CAUTI Physician CME Dept Meetings 2. Demonstration of Insertion Competency

16. Developing CAUTI Education Don’t Re-create The Wheel Use Other Hospitals PowerPoint Slides Update/Revise to Fit Jerri’s Story North Carolina Prevent CAUTI Toolkit http://www.ncqualitycenter.org/resources.lasso

17. Trained the trainers

19. Urinary Catheter Insertion Competency Traveling Mannequin 100% Aides and all nurse frequent inserters (ED, OR, WHU, IP Rehab, ICU) Read Policy Take Quiz Perform Procedure Instant Remediation and Repeat Demonstration

20. 167 Competencies Avg 15 min/staff member 41 Aides, 126 Nurses

21. Improper Cleaning26 Improper Gloving24 Contaminated field45 Didn’t know needleless cath port for specimens 30 Outcome

22. Urinary Catheter Insertion Competency Improvement Plan Require Field Competency all Aides within 2 months - supervised by RN’s Newly hired Aides trained by RN’s Yearly Aide hands on demonstration of competency

23. Strategies Caths flagged with date of insertion Secured to legs Specimen collection for culture - Don’t use first urine drained from catheter - ED patients – prior to collection, change catheter unless known change within 7 days - Inpatients… If catheter in for 7 days must change prior to specimen collection Perineal hygiene prior to caths “John Door” educational posters

24. Foley Catheter Prevalence

25. 1/1/2008 - 4/30/2008 ARMC Keystone Center for Patient Safety and Quality Comparative Data Units Data PointNumDenPrevelance Rate ReportingNum DenPrevelance Rate Pre 56 233 24.03 29 7753,912 19.81 Int 1 54 239 22.59 26 6973,400 20.50 Int 2 27 169 15.98 27 6503,709 17.52 Post 1 34 187 18.18 26 5693,262 17.44 171 828 20.65 2,69114,283 18.84 1/1/08 –4/30/08 ARMC Michigan

26. Outcomes ARMC Monthly Urinary Cath Related UTI’s 2006 46 CAUTI’s Avg 3.8 mo 2007 32 CAUTI’s Avg 2.7 mo 2008 28 CAUTI’s Avg 2.3 mo 2009 6 CAUTI’s Avg 0.5 mo

27. Outcomes ARMC Monthly Urinary Cath Related UTI’s 2006 46 CAUTI’s Avg 3.8 mo 2007 32 CAUTI’s Avg 2.7 mo 2008 28 CAUTI’s Avg 2.3 mo 2009 6 CAUTI’s Avg 0.5 mo

28. Investigation Cath competency plan not followed Focus was on hospital EMR implementation Daily cath patrol not consistent Prevalence rates up

29. New Plan Annual competency aide and ED/OR nurses Competency imbedded in orientation/annual skills evaluation Agenda Item every leadership/staff mtg Charge nurses do daily Cath Patrol- Med Surg Metric reports monthly to staff and physicians Cath necessity built into EMR documentation Decrease size standard cath from #16 to #14

30. Outcomes ZERO!! ARMC Monthly Urinary Cath Related UTI’s

31. Be vigilant…Plan for and carry out follow-up interventions Don’t worry alone…… “Courage is being scared to death, but saddling up anyway” (John Wayne) Questions? mjskiba@agh.org