cauti content call #6 a hospital’s perspective cauti prevention: implementation in a community...
TRANSCRIPT
CAUTI Content Call #6A Hospital’s Perspective
CAUTI Prevention:Implementation in a Community Hospital
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CUSP/CAUTI Content Call #2 - The Science of SafetyModerator – Sam Watson; Speaker – Sean Berenholtz03/22/11 2 ET/1 CT/12 MT/11 PT Attendee: (866) 256-9295 60 Min.CUSP/CAUTI Content Call #3 - Care and Removal InterventionModerator – Sam Watson; Speaker – Mohamad Fakih04/05/11 2 ET/1 CT/12 MT/11 PT Attendee: (866) 256-9295 60 Min.CUSP/CAUTI Content Call #4 - Data CollectionModerator – Sam Watson; Speaker – Sam Watson04/19/11 2 ET/1 CT/12 MT/11 PT Attendee: (866) 256-9295 60 Min.CUSP/CAUTI Content Call #5 - The View from the BedsideModerator – Sam Watson; Speaker – Russ Olmsted05/03/11 2 ET/1 CT/12 MT/11 PT Attendee: (866) 256-9295 60 Min.CUSP/CAUTI Content Call #6 - Implementation in a Community HospitalModerator – Sam Watson; Speaker – Mary Jo Skiba05/17/11 2 ET/1 CT/12 MT/11 PT Attendee: (866) 256-9295 60 Min.
CUSP/CAUTI Content Call #1 – CUSP Moderator – Sam Watson; Speaker – Sean Berenholtz03/07/11 2 ET/1 CT/12 MT/11 PT Attendee: (866) 256-9295 60 Min.
CAUTI Content Call Schedule
CAUTI PreventionImplementation in a Community Hospital
Mary Jo Skiba RN BSNProject Manager QI/Research
January 2011
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146 Licensed Beds
Med Surg (2 Units) ICU (8 Bed) Women’s Health Inpatient Rehab Inpatient Psych
Non-ProfitSole Community Provider
Community Hospital
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• Remove barriers and identify steps towards successful CAUTI project initiation
• Demonstrate educational strategies
• Maintain success
Objectives
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• CAUTI Team• Policies • Awareness Campaign• Data Collection Plan• Project Start Date• Education• Plan for Follow-Up
Project Planning
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•Establish CAUTI Team Members • Involve frontline staff • Have a physician champion• Include charge nurses• Include staff development• Determine the scope of your initial project
•Policy - Urinary Catheterization • Review/Revise• Use policy in toolkit• Don’t re-create the wheel• Consolidate into one policy if possible
•Automatic Catheter Stop Policy
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Project Planning
Hospital Newsletter
Flyers
Screen Savers
KEYSTONE HAI(Hospital Associated Infections)
“Bladder Bundle
Project”
Preventing Catheter
Associated Urinary Tract Infections
A Focus On
Patient Safety
Infection Control Initiative
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Project Awareness
Data Collection•Data collectors
•Data forms – Add qualifiers specific to your hospital
•Assure understanding of project requirements
•5 days week =Mon thru Fri (not W/E)
•Data entry web-based program
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Project Start Date
• Use calendar or Gantt chart to plot activities• Check vacation schedules of key staff• Watch out for major holidays
Be Be FlexibleFlexible
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Planning Education
• Nursing• Who will be trained• Who will train• How will we train• When will we train• How will we do make-ups• How much ongoing training or re-training needed
• Physicians•Who will train•How will we train•When will we train
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Two Fold Approach
1. Didactic• CAUTI Face to Face Inservice • All Nursing/Aides• Guideline For Prevention of CAUTI • Physician CME• Dept Meetings
2. Demonstration of Insertion Competency
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Developing CAUTI Education
• Don’t Re-create The Wheel
• Use Other Hospitals PowerPoint Slides
• Update/Revise to Fit
Jerri’s Story North Carolina Prevent CAUTI Toolkithttp://www.ncqualitycenter.org/resources.lasso
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Urinary Catheter Insertion Competency
• Traveling Mannequin• 100% Aides and all nurse frequent inserters
(ED, OR, WHU, IP Rehab, ICU)• Read Policy• Take Quiz• Perform Procedure• Instant Remediation and Repeat Demonstration
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Improper Cleaning 26
Improper Gloving 24
Contaminated field 45
Didn’t know needleless cath port for specimens 30
Outcome
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Urinary Catheter Insertion Competency
Improvement Plan
• Require Field Competency all Aides within 2 months - supervised by RN’s
• Newly hired Aides trained by RN’s
• Yearly Aide hands on demonstration of competency
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Strategies
• Caths flagged with date of insertion• Secured to legs• Specimen collection for culture
- Don’t use first urine drained from catheter - ED patients – prior to collection, change catheter unless known change within 7 days - Inpatients… If catheter in for 7 days must change
prior to specimen collection• Perineal hygiene prior to caths • “John Door” educational posters
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0
4
8
12
16
20
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@Unit Rate@Vendor RateR
ate
1/1/2008 - 4/30/2008
ARMC Keystone Center for Patient Safety and Quality
Comparative Data
Units
Data Point Num Den Prevelance Rate Reporting Num Den Prevelance Rate
Pre 56 233 24.03 29 775 3,912 19.81
Int 1 54 239 22.59 26 697 3,400 20.50
Int 2 27 169 15.98 27 650 3,709 17.52
Post 1 34 187 18.18 26 569 3,262 17.44
171 828 20.65 2,691 14,283 18.84
1/1/08 –4/30/08
ARMC
Michigan
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OutcomesARMC Monthly Urinary Cath Related UTI’s
2006 46
CAUTI’sAvg 3.8
mo
2007 32
CAUTI’sAvg 2.7
mo
2008 28
CAUTI’sAvg 2.3
mo
2009 6 CAUTI’s
Avg 0.5 mo
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OutcomesARMC Monthly Urinary Cath Related UTI’s
2006 46
CAUTI’sAvg 3.8
mo
2007 32
CAUTI’sAvg 2.7
mo
2008 28
CAUTI’sAvg 2.3
mo
2009 6 CAUTI’s
Avg 0.5 mo
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Investigation
• Cath competency plan not followed
• Focus was on hospital EMR implementation
• Daily cath patrol not consistent
• Prevalence rates up
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New Plan
• Annual competency aide and ED/OR nurses • Competency imbedded in orientation/annual skills
evaluation• Agenda item every leadership/staff mtg• Charge nurses do daily Cath Patrol- Med Surg• Metric reports monthly to staff and physicians• Cath necessity built into EMR documentation• Decrease size standard cath from #16 to #14
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OutcomesARMC Monthly Urinary Cath Related UTI’s
ARMC Monthly Urinary Cath Related UTI's
-4
-2
0
2
4
6
8
10
Jan-
06
Mar-0
6
May-0
6
Jul-0
6
Sep-
06
Nov-0
6
Jan-
07
Mar-0
7
May-0
7
Jul-0
7
Sep-
07
Nov-0
7
Jan-
08
Mar-0
8
May-0
8
Jul-0
8
Sep-
08
Nov-0
8
Jan-
09
Mar-0
9
May-0
9
Jul-0
9
Sep-
09
Nov-0
9
Jan-
10
Mar-1
0
May-1
0
Jul-1
0
Sep-
10
Nov-1
0
Jan-
11
Mar-1
1
May-1
1
ZERO!!
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Be vigilant…Plan for and carry out follow-up interventions
Don’t worry alone…
“Courage is being scared to death, but saddling up anyway”
(John Wayne)
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Questions