1. On the CUSP: Stop CAUTI ED Intervention National ED Office Hours Co-hosted by: Emergency Nurses Association Health Research and Educational Trust December 10, 2014 at 10 CT/ 11 ET 1

2. ED Office Hours Agenda 2 Welcome and Agenda Overview – Shannon Davila, NJHA Polling Questions – Shannon Davila, NJHA No More CAUTI: Preventing Catheter Associated Urinary Tract Infections – Elizabeth Mizerek, Robert Wood Johnson University Hospital Hamilton Open Discussion and Q&A – National Project Team

3. Polling Question 1 3 What has been the major focus of your team’s effort throughout the project? 1.Integrating the appropriate indications into your MD orders and RN documentation systems 2.Designing staff competencies to test staff knowledge around need for catheter, insertion, and maintenance 3.Improving teamwork and communication efforts among clinicians that care for patients with catheters 4.Implementing alternative strategies to indwelling catheters (example- use of condom catheters, straight cathing for sample collection)

4. Polling Question 2 4 If your team has a urinary catheter competency in place for staff, please choose the main components of that program: 1.Online self- directed education learning module 2.Hands on simulation program for insertion and maintenance procedures 3.Group discussion following lectured presentation of urinary catheter best practices 4.A hybrid model using both active in-person and online training 5.We do not currently have a urinary catheter competency program for staff

5. Elizabeth Mizerek, MSN, RN, CEN, CPEN, FN-CSA ED Nurse Educator, Robert Wood Johnson University Hospital Hamilton

6.  Impact of CAUTI  Insertion indications – decision making scenarios  Review of policies and procedures  Demonstrated insertion competency

7.  Catheter associated urinary tract infection  Publicly reported  Most common cause of healthcare acquired infections Up to ¼ of hospital patients may have an indwelling urinary catheter

8.  Increased length of stay – 3.8 days!  Increased healthcare costs - $500 million annually  Non-reimbursement of CAUTI related expenses

9.  Increased risk for patient mortality  2 nd leading cause of sepsis  13,000 deaths annually associated with CAUTI

13.  Urinary retention or urinary flow obstructions

14.  Monitoring fluids in critically ill patients

15.  Healing of significant sacral or perineal wounds

16.  Improving comfort at end of life

17.  Selected perioperative use

18.  Immobilization due to trauma

19.  Bladder scanner to assess volume of urine in bladder  Straight catheter  Condom catheter for men

21.  Incontinence Catheters do not protect skin

22.  Morbid obesity

23.  Limited mobility or debility Catheters do not prevent falls

24.  Dementia or confusion Catheters do not prevent falls

25.  Monitoring of fluids in non-critically ill patients You can monitor output many ways

26.  Urine specimen collection Straight cath!

27.  Patient or family request Educate patient and family on catheter risks

28.  Staff convenience Catheters don’t save us time

30. Acute stroke patient with left sided weakness who is going to receive IV t-PA

31.  Foley  No Foley

32. Family requests foley for patient….and provider orders it.

33.  Foley  No Foley

34. Hip fracture going to OR…..eventually

35.  Foley  No Foley

36. Elderly, confused non-ambulatory patient

37.  Foley  No Foley

38. Critically ill ICU patient

39.  Foley  No Foley

40. Patient unable to provide clean catch urine

41.  Foley  No Foley

42. Acute CHF receiving lasix on bi-pap

43.  Foley  No Foley

45.  Consider supplies  What is included in kit  Closed system for all catheter sizes and types  Where supplies are located  Availability of staff to assist  Overbed tables

47.  Do not routinely replace indwelling catheters based on duration  Assess each catheter placement individually  Reinforce appropriate urine specimen collection techniques

49.  When, where and how to nurses learn to place indwelling urinary catheters?  Does the learning environment match the practice environment?

52.  Good perineal care prior to opening kit  Alcohol based hand hygiene  Appropriate draping  Appropriate swabbing  Contamination of catheter – bring two kits

57.  Shared mental model – trained nurses and techs together  Teamwork to facilitate placement  Empowered all staff to speak up when breach of sterile technique noted – patient safety!

58.  Provide feedback to staff  Post CAUTI rates and link to insertion  One on one education and remediation  Don’t forget providers education!

59.  A indwelling urinary catheter is not a life-saving procedure  Think, slow down, appropriate technique  Safe practice, safe care!

60.  emizerek@rwjuhh.edu emizerek@rwjuhh.edu  eam1944@aol.com

61. ED Office Hours 61 General Questions/Concerns?

62. Quarterly ED Office Hours 62 Access slides, audio recording, and transcript of today’s webinar on the national project website: – http://www.onthecuspstophai.org/on-the-cuspstop- cauti/educational-sessions/ed-improvement-intervention- educational-sessions/ http://www.onthecuspstophai.org/on-the-cuspstop- cauti/educational-sessions/ed-improvement-intervention- educational-sessions/ Upcoming Office Hours: – Wednesday, March 11, 2015 at 11 ET/10 CT – Wednesday, June 10, 2015 at 11 ET/10 CT

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64. ED Office Hours 64 Thank you!