1. On the CUSP: Stop CAUTI ED Intervention
National ED Office Hours
Co Hosted by:
Emergency Nurses Association &
Health Research and Educational Trust
Moderated by:
Shannon Davila, New Jersey Hospital Association
September 10, 2014 at 10 CT/ 11 ET

2. ED Office Hours Agenda General Overview ED Success Story Presentation
Neel Pathak, HRET
ED Success Story Presentation
Deborah Cioffi, Barnabas Health, NJ
Discuss Utilization Rates and Barriers Specific to the ED Environment
Tina Adams, Clinical Content Development Lead, HRET
Marlene Bokholdt, Nursing Education Editor, ENA
Karen Jones, Infection Prevention and Control, St. John Hospital & Medical Center
ED CAUTI Data Collection: Tips for Success
Shannon Davila, Clinical Quality Improvement Manager, New Jersey Hospital Association
Discuss General Questions/Concerns
National Project Team

3. The CAUTI Emergency Department Improvement Intervention
What is the On the CUSP: STOP CAUTI ED Improvement Intervention?
Expanding the reach of the On the CUSP: STOP CAUTI national collaborative
Instilling a culture of partnership between emergency departments and in-patient units
Broadening exposure to national experts
American College of Emergency Physicians (ACEP)
Emergency Nurses Association (ENA)

4. ED Improvement Intervention Goals
Learning best practice techniques for CAUTI Prevention:
Technical change (Process):
Determine catheter appropriateness
Preventing unnecessary placement
Promoting compliance with institutional guidelines
Promoting proper insertion techniques
Culture change (CUSP):
Teamwork and communication amongst frontline staff
Identify nurse and physician champions for leadership and buy-in
Collaboration with in-patient units

5. Decreasing Catheter Use in the Emergency Department
Deborah Cioffi, RN, MSN, MSA
Administrative Director, Emergency Services
Monmouth Medical Center

6. CAUTI A Call to Reverse the Trend in Emergency Departments

7. Barnabas System ED’s Joined the- On the Cusp: Stop CAUTI
National initiative with AHA/HRET to implement a proven culture change model-Comprehensive Unit –Based Safety Program (CUSP) and Intervention to Prevent Catheter Associated Urinary Tract Infection (CAUTI)

8. ED Project Timeline BASELINE: Sept 17- 30, 2013
Collect urinary catheter initial placement prevalence.
Number of admissions from the ED
Number of admissions from the ED with a newly placed indwelling catheter
PRE-IMPLEMENTATION:
Oct 1 – Nov 16, 2013
Prepare for the implementation.
Create staff awareness and excitement about the program.
Begin emergency physician and nursing staff education.
IMPLEMENTATION:
Nov 17 – 30, 2013
(14 consecutive days)
Education on proper (aseptic) insertion technique and maintenance, as well as removal of catheters placed prior to transfer to inpatient units if appropriate.
Number of admissions from the ED with newly placed indwelling catheter.
SUSTAINABILITY: Quarterly, any 14 days of the following months:
Feb 2014
May 2014
Aug 2014
Nov 2014

9. MMC ED Team Deborah Cioffi, RN, MSN, MSA Victor Almeida, DO, FACEP
Administrative Director, Emergency Services
Victor Almeida, DO, FACEP
Chairman, Emergency Services
Jean Straker-Darbeau, RN, DNP
ED Educator
Caitlin Mahoney, RN
Staff Nurse
Kathy Rivera, RN
Performance Improvement Coordinator
Carolyn Korotky, RN, BA, BSN, RN-BC, CIC RN
Infection Control

10. Baseline Data Reporting
Number of ED catheter insertions Number of Admissions
Did patient present to ED with a catheter in place?
Was an order present for insertion?

11. Challenges Intervention
Keeping education on the forefront
Instituted catheter topics with daily huddle
Yearly competency did not include visual / tactile urinary catheter insertion
ED observation and “hands on” insertion practices as annual competency
RN completion of mandatory field in the Electronic Health Record
Staff champion and educator to conduct audit of documentation
Staff unaware of how much urine is in bladder. Bladder scanner in house not readily available
ED presented a request to foundation. Foundation purchased the bladder scanner
Urinary Catheter Kit did not contain all necessary equipment. Kit was not user friendly
Reached out to our catheter kit representative to look at new catheter insertion kits
Alternatives were not readily available for staff to choice from
Added straight catheter to equipment bundle
Placed straight catheter as an alternative choice next to catheter kits in ED storeroom.
Other options were explored. New condom catheter being trialed.
Proper placement of urinary catheter bag during transport to prevent UTI
ED champion and fellow staff committee members looking at hooks to place on equipment to identify proper placement of catheter bag
Brightly colored wipeable sticker to apply to equipment that indicates proper placement

12. Our Next Steps Recognized that urimeters are needed for inpatients
Adding urimeters in the storeroom so that they are available to be used to avoid having to
Mechanism to be implemented to ensure proper placement of catheter system on stretchers and wheelchairs to prevent backflow which can lead to a urinary tract infection
Barnabas Health systemwide committee was formed. Meets biweekly. Pat McNamee, Deb Cioffi
All 7 Barnabas Health Hospitals have formed Hospital Based Committee that report up to the Systemwide Steering Committee
The Nurse driven protocol for Catheter insertion and removal was implemented across the system

13. Polling Question 1
How is urinary catheter insertion competency in staff assessed in your emergency department? (CHOOSE ONE)
a)      Observation during insertion on patient(s)
b)      Simulation
c)       Written test and/or computerized module
d)      There is no competency for ED staff

14. Polling Question 2
2. What is your data source for tracking urinary catheter insertions in your emergency department? (CHOOSE ONE)
a) Nursing insertion documented on paper or electronic medical record
b) Physician order documented on paper or electronic medical record
c) Supply/stock records
d) Laboratory results

15. Polling Question 3
3. Which component of CAUTI prevention strategy would you like to focus on for your emergency department? (CHOOSE ONE)
a)  Insertion practices (i.e., sterile technique, 2-person insertion)
b)  Improving communication among ED staff to ensure UCs are placed only when appropriate
c) Improving communication among ED and inpatient staff to ensure UCs are placed only when appropriate
d) Developing more involved, more visible CUSP CAUTI leaders (physicians & nurses) in the ED

16. Utilization Rates & Barriers
Discuss Utilization Rates and Barriers Specific to the ED Environment

17. ED CAUTI Data Collection Tips for Success
Shannon Davila
Clinical Quality Improvement Manager, NJHA

18. Let’s Review the Measures
Required ED metrics:
Number of admits from the ED, including observation patients
Number of admits from the ED, including observation patients with a newly placed indwelling catheter in the ED
Additional recommended ED metrics:
Catheter appropriateness
Total number of indwelling catheters placed in the ED

19. Potential Data Sources
Paper Chart
Electronic Health Record
Nursing documentation
Physician Order Entry
Supply Log
QI checklist/log
Laboratory data

20. Review Potential Data Sources
Where do nurses document? Do they chart urinary catheter insertion?
Where do physicians place their orders? Do they routinely and consistently order urinary catheters?
Are catheters a charged item? Can you access billing lists or supply records?
Do you collect UA’s on all patients that receive a urinary catheter? Can you isolate those ED pts from lab data records?

21. Get to know your IT friends!
Find out who in is charge of your ED EHR system
Get this report request in the queue as soon as possible
Be very clear what data points you want to capture (example: indwelling NOT straight cath insertions)
May use this an opportunity to update the ED documentation (add insertion criteria)

22. Don’t Wait! Collect and enter data as soon as possible
Know your data collection schedule

23. Benefit of Collecting Both Measures
Gives a multi dimensional view of what is going on
Will help to show the impact of interventions
Helps to create consistency across hospital units

24. Share the Wealth Have a co- lead or data collector
Look for alternative options for data collection
Review data with your team on a regular basis
Share your report template with others

25. Questions? Other Suggestions?

26. General Questions/Concerns?
ED Office Hours
General Questions/Concerns?

27. Quarterly ED Office Hours
Access slides, recording, and transcript of today’s webinar on the national project website:
Upcoming Office Hours:
Wednesday, December 10, 2014 at 11 ET/10 CT
Wednesday, March 11, 2015 at 11 ET/10 CT
Wednesday, June 10, 2015 at 11 ET/10 CT

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