AHA/HRET HEN 2.0 CAUTI WEBINAR ELIMINATING CAUTI: A FOCUS ON IMPLEMENTATION CHALLENGES. May 3, :00 a.m. 12:30 p.m. CT

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1 AHA/HRET HEN 2.0 CAUTI WEBINAR ELIMINATING CAUTI: A FOCUS ON IMPLEMENTATION CHALLENGES May 3, :00 a.m. 12:30 p.m. CT 1

2 WELCOME AND INTRODUCTIONS Natalie Erb, Senior Program Manager, HRET 11:00 11:05 2

3 AGENDA FOR TODAY 11:00-11:05 AM Welcome and Introductions Open and housekeeping information, including review of relevant HRET HEN resources, change packages and Listserv. 11:05-11:10 AM HEN Data Update Update on national progress to date in CAUTI reduction including national percent reporting and percent reduction. 11:10-11:25 AM Hospital Story Lovelace Westside Hospital Hospital story on reducing catheter device days. Story will emphasize both successful strategies and on-going areas for improvement. 11:25 AM-12:05 PM Review the Evidence: When are Indwelling Urinary Catheters Appropriate in the ICU? Identify the appropriate indications for using an indwelling urinary catheter. Apply an ICU checklist and use clinical cases to improve clinical decision-making to avoid inappropriate indwelling urinary catheter use in your ICU. 12:05 12:20 PM Hospital Story CHRISTUS Health Louisiana Hospital story on rapid cycle improvement tests of change implemented at CHRISTUS Health St. Frances Cabrini Hospital to eliminate CAUTI. 12:20-12:25 PM Bring it Home Action items and tying together of didactic, hospital-level and improvement science information. 12:25-12:30 PM Q&A All Natalie Erb, MPH Senior Program Manager, HRET Julia Heitzer, MS Data Analyst, HRET Cheryl Sundheimer, RN, BSN Director of Quality, Risk and Infection Control Lovelace Westside Hospital Albuquerque, New Mexico Jennifer Meddings, MD, MSc University of Michigan Jill Hulin, RN, BSN, LNC, CIC Infection Prevention Coordinator CHRISTUS St. Frances Cabrini Hospital Alexandria, Louisiana Natalie Erb, MPH Senior Program Manager 3

4 ENCYCLOPEDIA OF MEASURES (EOM) Cataloged measure information available on the HRET HEN website HEN Core Topics (evaluation measures) HEN Core Process Measures HEN Additional Topics 4

5 SIGN UP TODAY: INFECTIONS LISTSERV Infections Analytics Listserv is available for: Sharing: HRET resources Publically available resources Best practices Learnings from subject matter experts Troubleshooting for data reporting and analysis Sign Up Here 5

6 HEN DATA UPDATE Julia Heitzer, Data Analyst, HRET 11:05 11:10 6

7 HEN DATA UPDATE Outcome Measure: Catheter-Associated Urinary Tract Infection (CAUTI) Rate 7

8 HEN DATA UPDATE Outcome Measure: Catheter-Associated Urinary Tract Infection (CAUTI) Standardized Infection Ratio (SIR) 8

9 HEN DATA UPDATE Process Measure: Urinary Catheter Utilization Ratio 9

10 HEN DATA UPDATE Process Measure: Urinary Catheter Removed in a Timely Manner 10

11 HEN DATA UPDATE CAUTI Rate per 1,000 Urinary Catheter Days - Data submitted to AHA/HRET as of: 3/30/ CAUTI Rate (per 1,000 catheter days) ICUs excluding CAUTI Rate (per 1,000 catheter days) All Inpatient locations excluding NICUs Baseline CAUTI Rate (per 1,000 catheter days) All Inpatient locations excluding NICUs Number (%) of hospitals reporting 1242 (96%) 1183 (91%) 1176 (91%) 1151 (89%) 956 (74%) 689 (53%) CAUTI Rate (per 1,000 catheter days) ICUs excluding NICUs % Number (%) of hospitals reporting 793 (92%) 749 (87%) 748 (87%) 737 (86%) 593 (69%) 429 (50%) -- Results for months in which data submission was less than 50% should be interpreted cautiously, as the data on which the results are based is not yet complete. 11 Relative reduction from baseline, most recent quarter (Dec 2015, Jan & Feb 2016) -2% --

12 HEN DATA UPDATE CAUTI Standardized Infection Ratio (SIR) - Data submitted to AHA/HRET as of: 3/30/2016 The Standardized Infection Ratio (SIR) is available only for those hospitals reporting to NHSN. The SIR calculation in NHSN is based on a 2009 baseline. CDC will readjust the SIRs to a new baseline in December Results based on SIRs should be interpreted cautiously. SIRs may not be available for smaller hospitals. For smaller hospitals with low catheter utilization and infrequent infection events, assessing improvement is challenging Standardized Infection Ratio (SIR) All Inpatient locations excluding NICUs Standardized Infection Ratio (SIR) ICUs excluding NICUs Standardized Infection Ratio (SIR) All Inpatient locations excluding NICUs Baseline Number (%) of hospitals reporting 871 (85%) 820 (80%) 777 (76%) 773 (76%) 627 (61%) 479 (47%) Relative reduction from baseline, most recent quarter (Dec 2015, Jan & Feb 2016) -44% -- Standardized Infection Ratio (SIR) ICUs excluding NICUs % Number (%) of hospitals reporting 726 (90%) 679 (85%) 641 (80%) 636 (79%) 508 (63%) 387 (48%) -- Results for months in which data submission was less than 50% should be interpreted cautiously, as the data on which the results are based is not yet complete. 12

13 HEN DATA UPDATE Urinary Catheter Utilization - Data submitted to AHA/HRET as of: 3/30/ Urinary catheter utilization ratio - All Inpatient locations excluding NICUs Urinary catheter utilization ratio ICUs excluding NICUs Baseline Urinary catheter utilization ratio - All Inpatient locations excluding NICUs Number (%) of hospitals reporting 1234 (95%) 1167 (90%) 1162 (90%) 1138 (88%) 942 (73%) 685 (53%) Urinary catheter utilization ratio ICUs excluding NICUs Number (%) of hospitals reporting 747 (87%) 740 (86%) 742 (86%) 731 (85%) 587 (68%) 424 (49%) 13 Relative reduction from baseline, most recent quarter (Dec 2015, Jan & Feb 2016) Results for months in which data submission was less than 50% should be interpreted cautiously, as the data on which the results are based is not yet complete. -2% -- 0% --

14 Hospital Story: Lovelace Westside Hospital Cheryl Sundheimer, RN, BSN, Director of Quality, Risk and Infection Control 11:10 11:25 14

15 HOSPITAL STORY - LOVELACE WESTSIDE Cheryl Sundheimer, RN, BSN Director of Quality, Risk and Infection Control Lovelace Westside Hospital Albuquerque, New Mexico 15

16 ABOUT US WESTSIDE IS THE BEST SIDE! 90 licensed beds General Med/Surg, Pediatrics, Bariatrics, Obstetrics Received Eggstra Special Effort Recognition in HEN

17 TESTS OF CHANGE AND WHAT WE LEARNED Nurse-initiated protocol implemented May 2015 HOUDINI - part of initiative to decrease CAUTIs systemwide NIP initiated to be proactive in preventing CAUTIs Started hospitalwide with post-op patients Specifically discontinued Foleys at 6 am Re-educated nurses on how to place Foleys, keeping bag below level of bladder, peri-care Daily audits of Foleys (position of bag, days in place, peri-care given, used the HOUDINI protocol) Surgeons determined didn t need as many Foleys, ended up discontinuing immediately after surgery instead of next day 17

18 HOUDINI PROTOCOL Acronym for qualifying indicator for an indwelling catheter: Hematuria, gross Obstruction, urinary Urologic surgery or other surgery as ordered by provider Decubitus ulcer, open sacral, or perineal wounds in incontinent patients I&O for critically ill patient management or when IV diuretic therapy Nursing comfort care/hospice care or neurogenic bladder dysfunction or chronic indwelling catheter Immobility due to physical constraints (unstable fracture, ventilator) 18

19 BARRIERS AND HOW WE RESOLVED Nurses had to be re-educated on how to place Foleys, and proper level of Foley bags Used simulation mannequins PCT re-education on peri-care and keeping Foley bag below level of bladder Time involved in training and education of clinical staff (nursing and physicians) Decided to focus on most important initiatives and those that would have early success; had to put other initiatives on the back burner 19

20 MEASURES WHAT AND HOW Data from HEN Comprehensive Data System Monthly CAUTI rate - 0 rate since February 2015 Monthly Foley device rate % in October % in February % in March 2016 Data is shared in Town Halls, ICC, Quality Council, MEC, Board, Corporate Operational Reviews 20

21 ADVICE FOR OTHERS Use CHG cloth wipes daily with ICU patients Use CHG cloth wipes prior to all IP surgeries Peri-care prior to Foley placement for broken hips Re-educate on foley care for all staff RT, PT, PCT, - anyone touching the Foley bag. 21

22 QUESTIONS? Cheryl Sundheimer Director of Quality, Risk, and Infection Control 22

23 Review the Evidence: When are Indwelling Catheters Appropriate in the ICU? Jennifer Meddings, MD, MSc 11:25 12:05 23

24 When are Indwelling Urinary Catheters Appropriate in the ICU? Learning Objectives 1. Identify the appropriate indications for using an indwelling urinary catheter. 2. Apply an ICU checklist and use clinical cases to improve clinical decision-making to avoid inappropriate indwelling urinary catheter use in your ICU. Jennifer A. Meddings MD, MSc University of Michigan Medical School

25 Lifecycle of Urinary Catheter Catheter Placement 1 Indwelling Urinary Catheter Catheter Removal 3 2 Maintenance Care of Urinary Catheter Adapted from Meddings J, Saint S. Disrupting the life cycle of the urinary catheter. Clin Infect Dis. 2011;52(11):

26 Disrupting the Lifecycle of Urinary Catheter Step 0: AVOID INDWELLING CATHETER Ensure Aseptic Placement 1 Indwelling Urinary Catheter Prompt Removal of Unnecessary Catheters 3 2 Maintain Awareness and Proper Care of Catheters in Place Adapted from Meddings J, Saint S. Disrupting the life cycle of the urinary catheter. Clin Infect Dis. 2011;52(11):

27 Using Appropriateness Criteria to Reduce Catheter Use Step 0: AVOID INDWELLING CATHETER Ensure Aseptic Placement 1 Place/keep urinary catheter only when appropriate Optimize use of alternatives Prompt Removal of Unnecessary Catheters 3 Indwelling Urinary Catheter 2 Maintain Awareness and Proper Care of Catheters in Place Adapted from Meddings J, Saint S. Disrupting the life cycle of the urinary catheter. Clin Infect Dis. 2011;52(11):

28 Using Appropriateness Criteria to Reduce Catheter Use Step 0: AVOID INDWELLING CATHETER Ensure Aseptic Placement 1 Place/keep urinary catheter only when appropriate Optimize use of alternatives Prompt Removal of Unnecessary Catheters 3 Indwelling Urinary Catheter 2 Maintain Awareness and Proper Care of Catheters in Place Reminders/stop orders use appropriateness criteria to prompst catheter removal Daily review of continued need for urinary catheter Adapted from Meddings J, Saint S. Disrupting the life cycle of the urinary catheter. Clin Infect Dis. 2011;52(11):

29 Using Appropriateness Criteria to Reduce Catheter Use Step 0: AVOID INDWELLING CATHETER Ensure Aseptic Placement 1 Place/keep urinary catheter only when appropriate Optimize use of alternatives Prompt Removal of Unnecessary Catheters 3 Indwelling Urinary Catheter 2 Maintain Awareness and Proper Care of Catheters in Place Reminders/stop orders use appropriateness criteria to prompst catheter removal Daily review of continued need for urinary catheter Adapted from Meddings J, Saint S. Disrupting the life cycle of the urinary catheter. Clin Infect Dis. 2011;52(11):

30 Alternatives to Indwelling Catheters (next CAUTI webinar!) Male, female urinals Male external catheters Intermittent straight catheters Bedside commode Scale Incontinence care supplies Bladder ultrasound Pictures are not intended to imply recommendations for specific products or brands.

31 Strategies to improve how your ICU team reduces inappropriate catheter use Develop a shared mental model between ICU nurses and physicians for when indwelling urinary catheters are appropriate for measuring urine output for patients in your ICU. Recruit (not assign) an ICU nurse and physician as bedside champions to lead the project for reducing urinary catheter use. Develop a communication workflow for prompting removal of IUCs by default when no longer meeting appropriateness criteria: checklists to prompt discussion regarding catheters in rounds, empowered nurses to remove catheters for all shifts when no longer needed, and criteria-informed catheter stop-orders.

32 Tools to improve knowledge about appropriate use of urinary catheters May 2015

33 Tools to improve knowledge about appropriate use of urinary catheters May 2015 May 2015 Refined urinary catheter criteria based on challenges that nurses and physicians have expressed when applying 2009 CDC criteria such as difficulty turning, patient requests, multiple medical problems, etc. Multidisciplinary panel of 15 nurses and physicians who reviewed literature and discussed/rated 299 clinical scenarios about catheter use Available by free access at annals.org

34 Table 2. Guide for Foley Catheter Use Table 3. Guide for Intermittent Straight Catheterization Table 4. Guide for External Catheter Use Table 5. Side-by-side comparison of appropriateness of urinary management strategies (Foley, ISC, external non-catheter) for common uses of urinary catheters Figure 4. ICU Daily Checklist for Foley Catheter Use

35 Clinical Case 1 for Discussion: Your patient is a 45 yo previously healthy woman who was admitted to the ICU with severe sepsis, requiring aggressive IV fluid resuscitation and vasopressor therapy. Does she need an indwelling urinary catheter (commonly known as a Foley)? A. Yes, Foley because admitted to the ICU. B. Yes, because hourly urine output is being used to guide fluid resuscitation and vasopressor dose. C. No, because has no history of incontinence.

36 Clinical Case 1 for Discussion: Your patient is a 45 yo previously healthy woman who was admitted to the ICU with severe sepsis, requiring aggressive IV fluid resuscitation and vasopressor therapy. Does she need an indwelling urinary catheter (commonly known as a Foley)? A. Yes, Foley because admitted to the ICU B. Yes, because hourly urine output is being used to guide fluid resuscitation and vasopressor dose. C. No, because has no history of incontinence

37 Clinical Case 2 for Discussion: Your patient is a 66 yo man who was admitted from the ED to the ICU with a severe COPD exacerbation requiring BiPAP. Does he need a Foley catheter? A. Yes, Foley because admitted to the ICU. B. Yes, because patients in ICU need accurate I/O measurements. C. Not if he is able to urinate by other means.

38 Clinical Case 2 for Discussion: Your patient is a 66 yo man who was admitted from the ED to the ICU with a severe COPD exacerbation requiring BiPAP. Does he need a Foley catheter? A. Yes, Foley because admitted to the ICU B. Yes, because patients in ICU need accurate I/O measurements. C. Not if he is able to urinate by other means

39 Catheter Appropriateness for Measuring Urine Volume Is this method of urine collection appropriate? Foley ISC External catheter Non-catheter options Daily (not hourly) urine volume required to guide treatment. Yes if cannot be assessed without catheter Uncertain in critically ill patient if distressed. Yes if chronic ISC need Yes if cannot be assessed without catheter Exam/daily weight. Urinal, bedpan, commode hat, etc. Examples: acute renal failure work-up, IVF or oral/iv bolus diuretics, fluid management in respiratory failure Hourly urine volume is required to provide treatment. Yes No No No Examples: manage hemodynamic instability, hourly titrate IVF, drips (vasopressors, inotropes, diuretics)

40 Catheter Appropriateness for Measuring Urine Volume Is this method of urine collection appropriate? Foley ISC External catheter Non-catheter options Daily (not hourly) urine volume required to guide treatment. Yes if cannot be assessed without catheter Uncertain in critically ill patient if distressed. Yes if chronic ISC need Yes if cannot be assessed without catheter Exam/daily weight. Urinal, bedpan, commode hat, etc. Examples: acute renal failure work-up, IVF or oral/iv bolus diuretics, fluid management in respiratory failure Hourly urine It is INAPPROPRIATE to use a urinary catheter simply because a patient is volume is required Yes being cared for in No an intensive care unit! No No to provide treatment. Examples: manage hemodynamic instability, hourly titrate IVF, drips (vasopressors, inotropes, diuretics)

41 Develop a shared mental model between ICU nurses and physicians for when indwelling urinary catheters are appropriate for measuring urine output for patients in your ICU. Starter discussion: For which types of patients do your nurses and physicians agree do NOT require an indwelling catheter while in your ICU? Patients admitted to ICU for a technology or nursing service not available on non-icu unit, but without an illness for which hourly urine output guides care, such as: BiPAP, frequent neuro checks, insulin drips, chronic trach/vent. Patient has stabilized no longer tenuous status (example: patient with sepsis, who is no longer requiring aggressive fluids or pressors). Floor status patient located in ICU but awaiting availability of non-icu bed Patient with very little urine output for days none to measure

42 ICU daily checklist for Foley appropriateness Is the Foley catheter still appropriate for your ICU patient? If the patient does NOT have one of the following 5 criteria (detailed in upcoming slides), remove the Foley.

43 ICU daily checklist for Foley appropriateness 1. Urine volume measurement need: A. Is HOURLY urine volume measurement being used to inform and provide treatment? B. Is DAILY urine volume measurement being used to provide treatment AND volume status CANNOT be adequately assessed by daily weight or urine collection by urinal, commode, bedpan, or external catheter?

44 ICU daily checklist for Foley appropriateness 2. Does the patient have a urologic problem that is being treated by a Foley catheter? Examples: Urinary retention that cannot be monitored or addressed by bladder scanner/isc Anticipated urinary retention due to paralytic meds Recent urologic or gyn diagnosis or procedure for which Foley removal is not yet recommended

45 ICU daily checklist for Foley appropriateness 3. Urine sample that CANNOT be collected by other method such as urinal, external catheter, ISC Sample type? Use Foley? Use ISC? Use External Catheter? Sterile sample for urine culture No Yes Yes, if staff trained for sterile application Non-sterile urine sample No Yes Yes 24-hour sample Yes If all urine can be collected by ISC Yes, preferred option in cooperative men Post-void residual measurement No No, unless cannot be assessed by bladder scanner No

46 ICU daily checklist for Foley appropriateness 4. Urinary incontinence that cannot be addressed by non-catheter methods (barrier creams, incontinence absorbent products) because nurses CANNOT turn and provide skin care with available resources (lift teams, lift machines) or transition to external catheter for cooperative men? Examples: hemodynamic/respiratory instability, strict immobility post-procedure, urinary incontinence contaminating open (stage 3 or 4) pressure ulcers

47 ICU daily checklist for Foley appropriateness 5. Foley catheter is providing comfort from severe distress related to urinary management that cannot be addressed by non-catheter option, ISC or external catheter. Examples: Difficulty voiding due to severe dyspnea with position changes needed to manage urine without IUC Address patient/family goals in dying patient Acute/severe pain upon movement with demonstrated difficulties using other urinary management strategies

48 Clinical Case 3 for Discussion: Your patient is a 25 yo man who was admitted with acute urinary retention due to spinal injury. Which catheter type(s) are appropriate? A. Foley B. ISC C. External Catheter D. Suprapubic catheter

49 Clinical Case 3 for Discussion: Your patient is a 25 yo man who was admitted with acute urinary retention due to spinal injury. Which catheter type(s) are appropriate? A. Foley B. ISC C. External Catheter D. Suprapubic catheter

50 Acute Urinary Retention Is this method of urine collection appropriate? Foley ISC External catheter Non-catheter options Acute retention WITHOUT bladder outlet obstruction Acute retention WITH bladder outlet obstruction Yes Yes if bladder can be emptied by 4-6 hour ISC Foley/ISC appropriateness vary by reason for obstruction. Consider Urology consultation for prostatitis and urethral trauma, because may be better managed with suprapubic, or expert placement of catheter. No External catheters collect urine released by the bladder, and cannot address urinary retention. Bladder scanner, to reduce number of catheterizations when no or little urine is seen in bladder

51 Clinical Case 4 for Discussion: 80 yo woman who is admitted with syncope, awaiting pacemaker placement, who is admitted to ICU for a higher level of monitoring and nursing care than available outside the ICU. She has chronic urinary incontinence and is a high fall risk. Should she have Foley catheter placed to prevent skin breakdown, with bonus of reducing fall risk? A. Yes B. No

52 Clinical Case 4 for Discussion: 80 year old woman who is admitted with syncope, awaiting pacemaker placement, who is admitted to ICU for a higher level of monitoring and nursing care than available outside the ICU. She has chronic urinary incontinence and is a high fall risk. Should she have Foley catheter placed to prevent skin breakdown, with bonus of reducing fall risk? A. Yes B. No. Does not decrease fall risk, acts as one-point restraint, increases infection risk

53 Managing Incontinence: No Skin Issue, No Difficulty Turning Is this method of urine collection appropriate? Foley ISC External catheter Non-catheter options Incontinence (no skin issue), nurses can turn/provide skin care Incontinence, can be turned, patient requests catheter No No No, unless has chronic ISC needs No, unless has chronic ISC needs No Uncertain Skin issues from urinary incontinence can often be prevented or managed without catheters: e.g., barrier creams, prompted toileting, etc.

54 Managing Incontinence, No Skin Issues, with Difficulty Turning due to: Is this method of urine collection appropriate? Excess weight (>300 pounds) from obesity or edema Turning causes hemodynamic or respiratory instability Strict temporary immobility post-op from vascular procedure Foley Yes Yes ISC No, unless has chronic ISC needs No, unless has chronic ISC needs External catheter Yes Yes Yes. All catheters appropriate if cannot manage urine otherwise. Non-catheter options Skin issues from urinary incontinence can often be prevented or managed without catheters: e.g., barrier creams, prompted toileting, etc.

55 Managing Incontinence when Patient has Skin Issues Incontinenceassociated dermatitis Closed pressure ulcers: stage I, deep tissue injury Open pressure ulcers: stages II-IV, unstageable Is this method of urine collection appropriate? Foley ISC External catheter Non-catheter options No No Stage II: Uncertain Stage III-IV, unstageable: Yes No, unless has chronic ISC needs No, unless has chronic ISC needs Yes if ISC adequate to manage the incontinence Yes if severe, otherwise uncertain Uncertain Stage II: Uncertain Stage III-IV, unstageable: Yes Urinary incontinence dermatitis can often be managed without catheters: e.g., barrier creams, prompted toileting, etc. All non-catheter options appropriate if would not worsen ulcer due to location

56 Take Home Points: Indwelling Catheters ICU bed assignment is not a sufficient appropriate indication for an indwelling urinary catheter. The ICU patient still needs a specific medical indication to justify the risk of the indwelling urinary catheter. Indwelling catheters: urology consultation may be needed to assess most appropriate catheter (Foley vs. suprapubic) for certain types of acute urinary retention with obstruction (e.g., prostatitis, urethral injury). Not all open sacral/hip wounds require indwelling catheter if the wound can be kept clean by other methods.

57 Take Home Points: Alternatives to Indwelling Urinary Catheters External condom catheters: even experienced clinicians may not be aware these catheters are inappropriate to address urinary retention or to measure hourly urine output. Intermittent straight catheters: often appropriate to help manage retention and overflow incontinence, but cannot provide hourly urine measurements. Non-catheter alternatives: even experienced clinicians may not be aware of the potential for non-catheter strategies (e.g., barrier creams, prompted toileting) to adequately address incontinence-related concerns.

58 Hospital Story: CHRISTUS St. Frances Cabrini Hospital Jill Hulin, RN, BSN, LNC, CIC, Infection Prevention Coordinator 12:05 12:20 58

59 O F LEY PHASE U CA TI T U ILIZATION Jill Hulin, RN, BSN, LNC, CIC, Infection Prevention Coordinator CHRISTUS St. Frances Cabrini Hospital Alexandria, Louisiana 59

60 ABOUT US 285 bed acute care hospital 26-bed ICU Surgical services Medical services 14-bed Neonatal ICU 26-bed Step-down Unit 60

61 TESTS OF CHANGE AND WHAT WE LEARNED September 2015: Implemented new Foley insertion kit designed to make insertion easier and diminish the risk of errors during insertion House-wide competency demonstration and education for nurses December 2015: Implemented a nurse-driven Foley removal protocol Standardized all Foley documentation for nurses in computer charting system February 2016: Distributed device list to managers daily March/April 2016: House-wide training for all nursing assistants regarding causes of CAUTIs and peri-care Consolidated bathing products to one general product 61

62 BARRIERS AND HOW WE RESOLVED New kit barriers: One size (style) does not fit all Provide bag insertion kits to appropriate units Documentation: Old habits die hard Eliminated all other places for Foley documentation Necessity review: More old habits that die hard Work with the managers and the nurses to ensure that Foley necessity is understood and correctly applied 62

63 MEASURES WHAT AND HOW The ultimate goal is zero CAUTIs Weekly reports of infections to all units Immediate feedback to managers on any CAUTI Managers responsible for implementing corrective actions needed Monthly report to unit, administration and corporate quality group New measure is utilization rates for each unit Will share rates before and after the changes and monthly thereafter. 63

64 ADVICE FOR OTHERS Educate, educate and then when you finish educating EDUCATE some more Reminders, flyers, bathroom readers anything to remind and educate Don t forget the nursing assistants Start a manual collection of device days before implementing the documentation changes to ensure accurate data collection Be flexible 64

65 WRAP-UP AND NEXT STEPS Most units have decreased their utilization of Foley catheters by approximately 50 percent since implementing the protocol Begin providing feedback to key stakeholders regarding their utilization Continue to review for Foley necessity and provide real time feedback Questions? Contact Info: Jill Hulin CHRISTUS St. Frances Cabrini Hospital (318)

66 BRING IT HOME Natalie Erb, Senior Program Manager, HRET 12:25 12:30 66

67 PHYSICIAN LEADER ACTION ITEMS What are you going to do by next Tuesday? Apply the appropriateness criteria to current patients. How many did not meet the criteria? What are you going to do in the next month? Evaluate processes at your facility regarding urinary catheter appropriateness. What assumptions can be questioned? Myths debunked? Consider how you can support the implementation of nurse-driven protocols. 67

68 UNIT-BASED TEAM ACTION ITEMS What are you going to do by next Tuesday? Find out your unit s CAUTI rate and urinary catheter utilization rate. Do you track it over time? Understand the urinary catheter alternatives that are available in your facility. What are you going to do in the next month? Examine and revise current processes related to urinary catheter placement. Begin a process for tracking your urinary catheter utilization and CAUTI rates. 68

69 HOSPITAL LEADERS ACTION ITEMS What are you going to do by next Tuesday? Know your hospital s catheter utilization rate and CAUTI rate. Do you see higher rates in some units vs. others? What are you going to do in the next month? Support units that are succeeded in reducing infections to spread their successful interventions to others. Support training and education for the staff on alternatives to urinary catheters. 69

70 PFE LEADS ACTION ITEMS What are you going to do by next Tuesday? Examine how patients and/or their families are currently engaged regarding catheter placement. Identify new opportunities to partner with patients and families to avoid unnecessary placement and to interrupt the catheter life cycle where appropriate. What are you going to do in the next month? Invite a patient/family advisor onto you improvement team dedicated to CAUTI reduction. 70

71 THANK YOU! Find more information on our website: Questions/Comments: 71