Device Utilization and CAUTI Prevention. Lori Fornwalt, RN, CIC Infection Prevention Coordinator October 4, 2016

Transcription

1 Device Utilization and CAUTI Prevention Lori Fornwalt, RN, CIC Infection Prevention Coordinator October 4, 2016

2 DISCLOSURES Nothing to disclose

3 OBJECTIVES Explain relationship between catheterassociated UTI s and device utilization List 3 steps to decrease device use Describe 3 strategies to prevent CAUTIs List 2 ways to improve communication and engagement of healthcare professionals

4 Ah, my SIR is below the benchmark! 4

5 Everyone is climbing! We Can t Let up! All patients deserve the best outcome possible! 9/29/2016 5

6 WHY KEEP PUSHING? >13,000 deaths annually 2 CAUTIs 70% CAUTIs are preventable 30% Foleys inserted in ED are unnecessary For each Foley Day, the risk of CAUTI is 10% Yoko et al. SHEA A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals (2014) 9/29/2016 6

7 Urinary Catheter Biofilm Development Pseudomonas at 2 hrs Pseudomonas at 18 hrs Tambyah et al, Mayo Clinic Proc. (2002) 7

8 Grandview Strategies: CAUTI Prevention Silver-Coated Foleys Inpts/transfers with indwelling Foley Nurse-Driven Removal Policy/Protocol Foley Bundle Include PCTs, Transport, M.D.s, Nurses UA Reflex (WBC, Leuks, Bacteria) only if clinically indicated Coude Cath Kits prevent breaking the seal Foley Care external cath-chg & ETOH coated port covers Training, Training and more Training! 9/29/2016 8

9 Grandview Strategies: Device Utilization Reduction Nurse-Driven Removal Policy/Protocol Review Necessity -BSR/Safety Huddles/IP Rounding Daily monitoring of unit-specific device use Straight Cath every 6-8hrs/Foley alternative ED- Foley reduction initiative Networking/Engagement Communication w/m.ds, staff 9/29/2016 9

10 COMMUNICATION & NETWORKING MAGIC QUESTIONS 1. Does the doctor know when they have a HAC? 2. Are you notified ASAP when coding finds a HAC? 3. Was it simply Asymptomatic Bacteriuria? 4. Have you checked M.D. Order Sets? 5. Why, Why, Why. usually leads to the root cause 9/29/

11 ED Foley Reduction Initiative 2012 Trend - CAUTI Rate (1CAUTI/576 Foley Days) If Foley inserted in ED, it stayed an avg of 4 days Data shared with ED Leadership- Dr. Jeff Jones ED Staff Foley Necessity Insertion Guidelines Urinary Retention, Promote Wound Healing, Strict I&O if unable to void in a receptacle, Post-op, Hospice Care Gould et al. HICPAC Guidelines for Prevention of Catheter Associated Urinary Tract Infections (2009)

12 ED Initiative Results 1 st Yr ED 27% fewer Foleys: 1,148 fewer Foley days Prevented 2 CAUTIs

13 Foley Catheters Inserted in ED /29/

14 ED Initiative Results ED 56% fewer Foleys: Average 2000 fewer Foley days/year Prevented 3.4 CAUTIs per year CAUTI Rate down 61% (1.77 to 0.70)

15 A Foley is Not a Fashion Statement Saint Alphonsus Theresa Polzin, RN Float Pool Performance Improvement Marsha Franklin, RN ER Performance Improvement Sherry Silvers, CNA CCU 9/29/

16 Device Utilization Utilization Rate= # of devices divided by Patient Days EXAMPLE: 500 Foley Days/1000 Pt Days = 0.50 Utilization Rate 9/29/

17 SAMPLE: UNIT SPECIFIC DEVICE UTILIZATION REPORT 0.60 PICU - FOLEY UTILIZATION Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Foley Ratio NHSN Pooled Mean Regular, ongoing, unit feedback essential! 9/29/

18 SAMPLE: Utilization Rate Compared to Like-Units Does EVERYONE know how they are doing? 9/29/

19 Essentials for Success Leadership Support ED Staff Engagement, Accountability Frequent Feedback How are we doing? NURC: Networking Understanding the Adult Learner Relationships Communication 9/29/

20 Electronic-Age Communication Do You See Anyone Talking? Gordon, J., et al. Col Med Rev, Let s Talk About Improving Communication in Healthcare(2015) 9/29/

21 Better Results with NURC Networking = getting to know people Understanding the Adult Learner a. Why must know why 1 st b. How- Now I know why, how can I help? c. Hands on more meaningful Relationships They are cared for, taken care of Communication What? EMR, No talking, Remote Order-Entry McClay, C., APIC Infection Prevention Competency Review Guide (2010) 9/29/

22 WE CAN ALL GET TO THE TOP! 9/29/

23 9/29/

24 QUESTIONS? 9/29/