The Impact of Clinical Decision Support (CDS) Tools on Catheter Associated Urinary Tract Infections (CAUTI) January 22, 2010.

Transcription

1 4 th Annual NDNQI Conference The Impact of Clinical Decision Support (CDS) Tools on Catheter Associated Urinary Tract Infections (CAUTI) January 22, 2010 UPMC St Margaret Bonnie B. Anton, MN RN Debra Wolf, PhD MSN BSN RN Susan DiNucci, BSN RN Sharon Rummel, BS Barbara A Jordan MSN RN 2 1

2 Demographics UPMC St Margaret Acute care and teaching hospital 800 primary care and specialty physicians Magnet designated hospital One of 19 Hospitals in the UPMC system RN School of Nursing LPN School of Nursing 2004 implemented electronic health record 3 Objectives Define electronic clinical decision support (CDS) tools Describe the impact of CDS tools on catheter associated urinary tract infections (CAUTI) Identify the important role the informatics nurse plays in solving patient outcome issues 4 2

3 Electronic Clinical Decision Support (CDS)Tools Purposes Means of providing knowledge Types Order Sets Alerts Rules Reference material 5 Problem: CAUTI 2006 Increasing two year trend of UTIs Percent of Patients with HAUTI Cases per Discharges x 100) 2 Year Trend 2.0% May 2004-April % of hospital acquired infections were Catheterassociated urinary tract infections (CAUTI) 1.6% 1.2% 0.8% 0.4% 0.0% May-04 Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec-04 Jan-05 Feb-05 Mar-05 Apr-05 May-05 Jun-05 Jul-05 Aug-05 Sep-05 Oct-05 Nov-05 Dec-05 Jan-06 Feb-06 Mar-06 Apr

4 Goal and Objectives To reduce and sustain a reduction in the number of hospital acquired catheter associated urinary tract infections (CAUTI) at UPMC St. Margaret Improve insertion technique and catheter management through education of staff Utilize electronic health record technology Implement improved product technology--silver alloy hydrogel coated catheters 7 Solutions Multidisciplinary team formed Role: Analyze data, recommend practice/policy changes Determine education needs of the staff through direct observations of Foley insertions and care Literature searches Greater risk for UTI if indwelling catheters in place longer than 4 days Availability of improved catheter product technology (silver coated Foley catheter Use of erecord technology Clinical Decision Support Tool 8 4

5 Solutions Urinary Catheter Observation Tool Insertion technique Care of urinary catheters Electronic Decision Support Tools Daily unit-based Urinary Catheter List Correct documentation of I/O Electronic prompts to the nurse-reassess daily catheter need Notify medical staff to D/C catheter if not needed 9 Solutions Use of erecord Technology: Daily unit list of patients with indwelling urinary catheters Patients are listed if electronic documentation of I/O under Catheter vs Voided Prompts the Resource nurse to ask, Can the catheter be removed? Daily task/prompts for patient s nurse to reassess criteria for catheter received until catheter removed Nurse documents validity of the need for the catheter RN address need for removal 10 5

6 Approved Foley Catheter Criteria List Close monitoring of urine output in critically ill patient Comfort measures only care (terminally ill) Continuous bladder irrigation Non-urologic surgery less than 24 hours ago Stage III or IV sacral/perineal pressure ulcer Surgical/trauma in perineal area Urinary retention Urologic surgery Documentation occurs on Foley Catheter Necessity Form in erecord 11 Solutions Silver Coated Urinary Catheters Evidence from research literature supports the use of silver alloy/hydrogel coated urinary catheters in a variety of clinical settings for short term use (less than 14 days) Cost analysis showed cost per catheter was approximately 2X that of non coated catheters. Savings projected according to infections prevented. 12 6

7 June 1-30 th 2006 Education of Staff June 30, 2006 erecord Catheter List Nov 2006 erecord Rule Dec 2006 Silver Coated Catheter CAUTI per 1000 Catheter Days J- 06 F- M- A- M- J J- 06 A- 06 S- O- N- D J- 07 F- M- A- M- J J- A S- O- N- D Rate J- 08 F Results CAUTIs per 1000 Catheter Days J-07 F-07 M- 07 A-07 M- 07 J-07 J-07 A-07 S-07 O-07 N-07 D-07 J-08 F-08 M- 08 A-08 M- 08 J-08 J-08 A-08 S-08 O-08 N-08 D-08 J-09 F-09 M- 09 A-09 M- 09 J-09 J-09 A-09 S-09 O-09 Rate

8 Outcomes Number of CAUTIs at UPMC St. Margaret: 2006: 102 CAUTI--Baseline year 2007: 66 CAUTI--35% reduction comparing 2008: 42 CAUTI--36% reduction comparing 2009: 29 CAUTI (Jan-Oct) Decrease in rate of CAUTIs 7.2/1000 catheter days in 2006 to 2.0/1000 catheter days in 2009 (Oct) 15 Lessons Learned Identify the problem Collaborative Teamwork Utilize the evidence available Let the erecord work for YOU! 16 8

9 Thank you 17 9