Using PDSA Cycles to Implement CAUTI Bundles and Transfer Communication between Settings

Transcription

1 Using PDSA Cycles to Implement CAUTI Bundles and Transfer Communication between Settings Katherine Abraham Evans, DNP, FNP-C, GNP-BC, ACHPN Clinical Assistant Professor DNP Program Coordinator Georgia State University Byrdine F. Lewis School of Nursing and Health Professions

2 Institute for Healthcare Improvement

3 Plan Do Study Act PDSA

4 Aim Every goal will require multiple smaller tests of change What is the goal you are trying to accomplish Describe your first (or next) test of change: When to be done Where to be done

5 List the tasks needed to set up this test of change Plan Person responsible When to be done Where to be done Predict what will happen when the test is carried out Measures to determine if prediction succeeds

6 Do Describe what happened when you ran the test

7 Study Describe the measured results and how they compared to the predictions

8 Act Describe what modifications to the plan will be made for the next cycle from what you learned

9 Implementation of PDSA for CA-UTI Preventing Catheter-Associated Urinary Tract Infections: Four Components of Care 1. Avoid unnecessary urinary catheters 2. Insert urinary catheters using aseptic technique 3. Maintain urinary catheters based on recommended guidelines 4. Review urinary catheter necessity daily and remove promptly ww.ihi.org

10 Avoid Unnecessary Urinary Catheters Utilize recommended guidelines for appropriate catheter placement from CDC, SHEA-IDSA and NHS Perioperative use for selected surgical procedures Urine output monitoring in critically ill patients Management of acute urinary retention and obstruction Assistance in pressure ulcer healing for incontinent patients At patient request to improve comfort at end of life

11 Alternatives to Indwelling Catheters External condom catheters Intermittent catheterization Utilization of bladder ultrasound for determination of urinary retention

12 Avoid Unnecessary Catheters Develop criteria based on guidelines Prior to any new catheter criteria must be met Use a checklist of catheter criteria Empower staff to stop catheter insertion an discuss alternatives if criteria are not met

13 Avoid Unnecessary Catheters Include a checklist on catheter insertion packs Build criteria into Electronic Health Records Ensure departments have appropriate alternatives i.e. condom caths Modify admission assessment to establish appropriateness of urinary catheters present on admission Review cases of insertion that do not meet criteria Educate staff

14 Aseptic Technique Use appropriate hand hygiene Insert catheters using aseptic and sterile equipment Use the smallest catheter possible

15 Aseptic Technique Create standard catheter supply kits Include appropriate technique in insertion checklist Place index card on catheter kits Measure as an all or nothing process with regular monitoring Assign responsible person for stocking kits

16 Maintain Catheters Based on Guidelines Maintain a sterile, continuously closed drainage system Keep catheter properly secured Keep collection bag below the level of the bladder at all times Maintain unobstructed urine flow Empty bag regularly separate container for each patient, spigot does not touch container

17 Maintain Catheters Based on Guidelines Verify and document routine maintenance every shift Ensure all needed items are on hand Make documentation accessible Provide system alerts to prompt staff Require documentation Provide sample collection supplies as a bundle

18 Review Catheter Necessity Daily Include catheter necessity daily as part of nursing assessment Develop protocols for catheter removal Implement automatic stop orders Place reminders in records requiring documentation of need Utilize alerts in Electronic Health Record

19 Getting Started Select the team Assess the current status Contact infectious disease department Ensure supplies adequate Organize an educational program Introduce evidence

20 First Test of Change Identify pilot unit Use insertion checklist Work with nursing staff protocols, procedures Ensure approach present on all shifts Process feedback Engage in additional PDSA

21 Measurement Use measures already collected if possible Evaluate choice of measures for usefulness Process and outcome measures if possible Share measures with staff to improve motivation

22 Resource How to Guide: Prevent Catheter-Associated Urinary Tract Infections Institute for Healthcare Improvement

23 Care Coordination Care Transitions Transfer Communication

24 Area Resources Georgia Hospital Association Care Coordination Workgroup Atlanta Regional Care Transitions Workgroup Georgia Quality Improvement Organization Alliant/GMCF

25 SWOT analysis Strengths Weaknesses Opportunities Threats Transfer Communication

26 How can your organization improve What are the areas of weakness? What is the low hanging fruit Areas for Improvement

27 Transfer Communication Models Care Transitions Program Dr. Eric Coleman Better Outcomes for Older Adults Using Safe Transitions BOOST Project RED Re-Engineered Discharge Geriatric Resources for Assessment and Care of Elders (GRACE)

28 Areas to Review Transfer form is it effectively utilized, how can this be improved? Handoff report is it an afterthought, how can providers/settings contact one another? Medication reconciliation Includes stop and start dates for meds i.e. antibiotics Advance directives

29 Areas to Review Any MDRO s and treatments If isolation precautions why? Be specific (why, what, where, associated diagnoses) Does a patient have devices if so why, insertion date, d/c date Positive cultures colonization date & source

30 Questions?