NYS PARTNERSHIP FOR PATIENTS Educational Session: CAUTI Guide to Patient Safety (GPS) Results Part II Tuesday, June 24, 2014
NYS PARTNERSHIP FOR PATIENTS Agenda 2
NYS PARTNERSHIP FOR PATIENTS Overview of CAUTI GPS Questions o Questions 1 through 10 o Higher percentage is better o Questions 11A through D o Lower percentage is better 4
NYS PARTNERSHIP FOR PATIENTS Brookdale University Hospital and Medical Center: CAUTI GPS Results 5
Cortland Regional Medical Center provides quality healthcare with skill and compassion, meeting the lifelong healthcare needs of all citizens of Cortland and the surrounding communities. Services include: Inpatient Community Hospital with 162 Licensed beds including medical, surgical, telemetry, ICU, mental health, maternity, & transitional care services Emergency & Urgent/Prompt Care Services Outpatient surgery, endoscopy, lab, cardiology, physical medicine and rehab, & radiology services Long Term Home Health Services Rehabilitation Care Facility Adult Day Care Services
Goal 2012: Develop guidelines and tools needed to implement Joint Commission s NPSG 07.06.01 by 1/1/13 and establish a baseline internal benchmark rate. 2013: Obtain an internal benchmark rate below 1.6/1000 catheter days (the 2012 baseline) We achieved a rate of 0.6/1000 catheter days in 2013. What is our current rate for 2014? We achieved at rate of 0/1000 catheter days in 2014.
Background 5-10% of all hospitalized patients in the US will develop a health care associated infection (HAI). 40% of all HAIs are urinary tract infections. 80% of UTIs are attributable to indwelling urinary catheters. In 2012, the preventing catheter associated urinary tract infections (CAUTI) was added as a National Patient Safety Goal. CAUTI is the most frequent HAI in hospitals and long term care.
Standard Strategies Conduct a risk assessment. Do not insert an indwelling urinary catheter unless it is absolutely necessary. Use appropriate technique when placing and maintaining indwelling urinary catheters. Remove indwelling urinary catheter as soon as possible. Evaluate efforts to reduce CAUTI.
Risk Assessment Electronic Admission Assessment Screen for chronic foley and when placed Evaluate if chronic foley meets criteria If meets criteria new catheter is placed Electronic Shift Assessment Assess need based on CDC criteria listed in screen Documentation includes: Whether they have a catheter or not Insertion date Foley day Whether they meet criteria or not Following maintenance bundle (listed on the screen for the nurse as a reminder).
Meditech Shift Assessment
Insertion Only inserted when absolutely necessary. Urinary catheterization is not routine. CDC criteria is used to guide appropriate use. Consider alternatives: Condom catheter Toileting Assessing voiding residuals with bladder scan Straight catheterization Suprapubic catheter Engaged providers and nursing staff who have changed the culture to more seriously consider the impact and risk of catheterization before insertion.
Maintenance Securement device --Cath-secure stickers less catheter movement therefore decreasing the opportunity for biofilm to make its way into the urinary tract system. Maintenance bundle: hand hygiene, catheter and pericare, securement, maintaining a closed system, and where the bag/urometer should be positioned (not the floor) at rest and during transport.
Removal Shift assessment determines if patient NO longer meets criteria. If patient does not meet criteria, the provider is called for order for removal. We have developed and will soon be implementing a nurse-driven protocol for providers to order a urinary catheter with removal per protocol allowing the nurse to automatically remove the catheter when CDC criteria is not met.
Evaluation Root Cause analysis is completed on every HAIs A sub-committee of the Infection Control Committee was formed to institute CAUTI prevention program. CAUTI rates are reported monthly at Nursing Leadership/QI and Patient Safety meetings. Evaluation of practices in 2012 generated the following other changes: Bladder scanner was purchased and training on use was provided. New securement device selected New Orientation and Annual Education Modified specimen collection policy to decrease impact of biofilm
Specimen Collection Chronic indwelling catheters present on admit are changed if patient meets criteria PRIOR to obtaining a specimen. If a urine sample is needed from a patient at any point during hospitalization and the foley is greater than 48 hours old, it must be replaced with a clean foley (entire system) prior to obtaining a urine specimen. If in doubt, place a new catheter philosophy. Scrub the hub technique is stressed when obtaining a specimen from the catheter.
Training Orientation training for RNs, NA, & techs Annual skills day training Training includes the following: CAUTI definition, stats, significance Insertion technique and CDC criteria Maintenance bundle Principles of correct specimen collection Impact on the patient Impact on reimbursement and quality Medical Staff Newsletter reinforcing criteria for catheter use and removal
Outcome TAKE EVERY PRECAUTION
Lessons Learned Technique Technology Training Patience Persistence Medical Staff support Administrative support
References Trautner, B. & Darouiche, R. (2004). The role of biofilm in catheter associated urinary tract infections. American Journal of Infection Control, 32 (3), 177-183. The Joint Commission (2013). 5 Sure-fire methods for complying with NPSG.07.06.01. The Joint Commission:The Source, January, 2013.
NYS PARTNERSHIP FOR PATIENTS Hospital Questions and Discussion Facilitated by Maria Sacco
NYS PARTNERSHIP FOR PATIENTS Next Steps o Next CAUTI Web conference: o September 30, 2014, 10:00 to 11:00 a.m. 23 June 23, 2014