No Catheter, No CAUTI Scenario 3 Urinary catheter in the community setting

Transcription

1 No Catheter, No CAUTI Scenario 3 Urinary catheter in the community setting Course lead Colette Laws-Chapman Faculty Course / No Catheter, No catheter Target Curriculum associated urine infection Delegates Scenario name (CAUTI) Scenario 3 Discharge with indwelling Catheter Group Size GPs, Allied health professionals, District and community nurses?? Patients Name: Patients Age: Major Problem Learning Goal Thomas Hayes 78 year old Male Medical Indwelling catheter in the community setting Medical / Clinical Assessment of patient with catheter. Community care of catheter Calling for help. Infection control & dignity. Suggested NTS / Technical Effective communication Utilising available resources Calling for help Care & Compassion De-escalation Narrative Description Staffing Thomas Hayes was admitted to A&E with acute urinary retention and confusion secondary to a urine tract infection (UTI). A catheter was inserted in A&E at 2am. He was later transferred to the ward. There was no documentation of insertion and it was assumed by the medical team that this was a long term catheter. Thomas is discharged two days later with the catheter in-situ. His NOK is his son who lives in Ireland whom he rarely sees. Thomas suffers from long term memory problems. The DN has been asked to go and see Thomas for a check up on his catheter. The patient has an EDL and the DN received a fax referral for a check up. Past medical history: Memory problems, Hypertension, Hypercholesterolemia Drug history: Simvastatin 40mg, Amlodipine 10mg, Folic acid-5mg Allergies: nil known Social history: Non-smoker. Lives alone. NOK is his son who visits three times a year. Mobilising independently with a stick. Neighbour gets his shopping once a week and checks on him daily. Faculty Control Room: 1 x technician 1 x debriefer Faculty Role Players: 1 x neighbour Candidates 2x District Nurse or 1xGP and 1xDN No catheter, No CAUTI - Scenario 1 Urinary catheter in the community - Page 1 of 8

2 Case Briefing Manikin preparation Room set up Simulator operation Props needed Notes to faculty To All Candidates Thomas Hayes 78 has been discharged 24 hours ago from the hospital following urinary retention secondary to a UTI. You (DN) have been asked to follow up his discharge and check his catheter. He is new to the service and this is your initial assessment. NA-you have been asked to visit Thomas to check up on how he is coping with his catheter. You have spare catheter supplies. Actor in home setting Actor in own clothes Catheter leg bag with urine To Role Players Neighbour-you know Thomas well and are concerned that he has been discharged with a catheter and no education around it. This is the first time you have been round since he came home from hospital as you have been on holiday. Home setting with props-home environment screens, magazines, pictures with family, tea etc n/a Walking stick DN notes with initial assessment paperwork & District Nurse bag EDL & DN referral from hospital As the patient is discharged with catheter passport the District Nurse should fill them in saying the catheter is for long term retention unknown cause. They would contact the GP to ask permission to TWOC in the community. They can escalate to the continence and bowel nurse in the community for a post void bladder scan. They can TWOC the patient and either they can perform a bladder scan or a joint visit with the specialist nurse. No catheter, No CAUTI - Scenario 1 Urinary catheter in the community - Page 2 of 8

3 Observations: Initial PAR score HR 80 0 O2 sats 99% 0 BP 120 / 82 0 Temp 36.5 C 0 RR 15 0 Urine 550mls 0 Output GCS E=4 V=5 M= 6 0 Total 15 Total PAR Score 0 BM = 5.8 No catheter, No CAUTI - Scenario 1 Urinary catheter in the community - Page 3 of 8

4 Results of Investigations Bloods n/a Gases n/a Imaging Other n/a No catheter, No CAUTI - Scenario 1 Urinary catheter in the community - Page 4 of 8

5 Patient Role Thomas Hayes, 78 (actor) Scenario You were admitted to A&E with acute urinary retention and confusion secondary to a urine tract infection (UTI). A catheter was inserted in A&E at 2am. You were later transferred to the ward. You were discharged two days later with the catheter in-situ. Your NOK is your son who lives in Ireland whom you see approximately three times a year. You suffer from memory problems. You were discharged with the catheter and one of the nurses checked that you knew how to use it before you went home. You don t understand why you have it but it makes it easy for you to go to the toilet as your mobility isn t what it used to be and you suffered from occasional incontinence. You have no prostate problems as far as you know. You understand that you can t remember things very well so tend not to question them. Past medical history: Memory problems, hypertension, hypercholesterolemia Drug history: Simvastatin 40mg, Amlodipine 10mg, Folic acid Allergies: nil known Social history: Non-smoker. Lives alone. NOK is his son who visits three times a year. Mobilising independently with a stick. Neighbour gets his shopping once a week and checks on him daily Instructions You tell the DN that you don t really know why you have the catheter in but the nurses on the ward kindly showed you how to use it. You quite like how convenient it is as you were occasionally incontinent and your mobility is not as good as it used to be. You would like to keep it in really for these reasons however when the risks are explained to you, you realise that it will be good to have it removed and makes you a bit anxious. No catheter, No CAUTI - Scenario 1 Urinary catheter in the community - Page 5 of 8

6 Neighbour (plant/ faculty role) Scenario Thomas Hayes was admitted to A&E with acute urinary retention and confusion secondary to a urine tract infection (UTI). A catheter was inserted in A&E at 2am. He was later transferred to the ward. There was no documentation of insertion and it was assumed by the medical team that this was a long term catheter. Thomas is discharged two days later with the catheter in situ. His NOK is his son who lives in Ireland whom he rarely sees. Thomas suffers from long term memory problems. The DN has been asked to go and see Thomas for a check up on his catheter. Past medical history: Memory problems, hypertension, hypercholesterolemia Drug history: Simvastatin 40mg, Amlodipine 10mg, Folic acid Allergies: nil known Social history: Non-smoker. Lives alone. NOK is his son who visits three times a year. Mobilising independently with a stick. Neighbour gets his shopping once a week and checks on him daily. Instructions You have known Thomas for 20 years and have always been close. You pop in most days to see him and drop off his shopping. You are very concerned as you discovered he now has a catheter when you visited him this morning. You insisted on being there when the district nurses visit. You aim to make a complaint to them about the catheter as you don t know why it was inserted and whether it was appropriate for Thomas to have one given his memory problems. You are concerned that he seems to have no supplies with him. You are very angry at first with the DN and the hospital and can t believe that someone could be discharged with a catheter and not know why. You feel that it is inappropriate and don t understand why it is there in the first place. You would like to make a complaint about this. You are de escalated if the DN explains and apologises. On instruction from faculty you can locate where the catheter passport is and this says that the catheter is long term. No catheter, No CAUTI - Scenario 1 Urinary catheter in the community - Page 6 of 8

7 GP (on phone if no delegate) Scenario Thomas Hayes was admitted to A&E with acute urinary retention and confusion secondary to a urine tract infection (UTI). A catheter was inserted in A&E at 2am. He was later transferred to the ward. There was no documentation of insertion and it was assumed by the medical team that this was a long term catheter. Thomas is discharged two days later with the catheter in situ. His NOK is his son who lives in Ireland whom he rarely sees. Thomas suffers from long term memory problems. The DN has been asked to go and see Thomas for a check up on his catheter. The patient has an EDL and the DN received a fax referral for a check up. Past medical history: Memory problems, hypertension, hyperchloestremia Drug history: Simvastatin 40mg, Amlodipine 10mg, Folic acid Allergies: nil known Social history: Non-smoker. Lives alone. NOK is his son who visits three times a year. Mobilising independently with a stick. Neighbour gets his shopping once a week and checks on him daily. Instructions Prompt a SBAR handover. You talk through any indication of why the catheter might be insitu and prompt the DN to question why it is in-situ. Hopefully the DN will conclude that it is not needed and then a TWOC will be prompted which you agree with. Otherwise advise a catheter passport plus patient education and escalation to the community continence team for assessment and TWOC. No catheter, No CAUTI - Scenario 1 Urinary catheter in the community - Page 7 of 8

8 Learning cue card for transition This scenario is based on a real case and the aim is to reflect on safe patient discharge from hospital to community. This scenario focuses on the fourth part of the catheter care bundle looking at quality improvement about the management of catheters out of hospital. To empower assessment of need For patient education and support on discharge and the need for catheter passports to support this transition (also essential information if patients are admitted with catheters, To reiterate the use of catheter passports in the community and to show examples of them and why they are so important. Also for patient education on why they must challenge catheters and that they shouldn t be used for patient comfort such as incontinence and mobility. No catheter, No CAUTI - Scenario 1 Urinary catheter in the community - Page 8 of 8