1. REDUCING URINARY TRACT INFECTIONS PRESENTED BY PAULINE FLEURY STAFF DEVELOPMENT/QUALITY IMPROVEMENT HOLY TRINITY NURSING & REHABILITATION CENTER www.htnr.net fleury@htnr.net

2. HOW IT STARTED Too Many Specimens Ordered Look at Who ECOLI # 1 Organism Look at Why Missed Assessments Look at How Who ~ MD’s Identified as quick to order specs Why ~ Poor “Hygiene” practices when CNA’s provide resident care ~ Residents’ own hygiene practice How ~ How are the nurses assessing? Or are they practicing in a ‘task’ mode?

3. WHAT WE DID ROUNDS/CONCLUSION Validated incorrect hygiene practices Hydration/ Toileting status not consistently being monitored Nurses not always assessing thoroughly PLAN OF ACTION STARTED Met with all involved and reviewed issues Creation of documentation form that addresses symptoms of UTIs MD’s; PA’s; NP’s apprised of this action plan Brought to QI Committee Retrospective audit done from January 2011 to present

4. WHAT WE DID {continued} PLAN OF ACTION Inservices done for nursing staff on recognizing signs and symptoms of UTIs; measures to prevent ~BACK TO BASICS! Competition for units ~ Broke down UTI rates for each unit monthly, reported at QI and publicly thanked staff for their hard work by recognition in company newsletter and posterboards PLAN OF ACTION Set Threshold at 7% or less based on prior Quality Measures (No industry standard set for healthcare acquired UTIs) DNS reviewed at monthly Nurses/CNA Meetings Asked floor staff about their practice as well as direct observation of such Utilized INTERACT Care Paths and SBAR for assessments Monitored Documentation

5. The Proof is in the Percentages!!! (2011-present)

7. WHAT MATTERED & CHALLENGES Working with individual units We met our goal Keeping it simple Posting the data where all could see Weekend Coverage with MDs Nurses need to learn assertiveness skills