Data Collection Training, Part I Outcome Data Onboarding #3 for All Long-term Care Staff (RNs, LPNs & CNAs) Welcome to today’s onboarding session titled, “Data Collection Training.” This is the third of four onboarding modules for the Agency for Healthcare Research and Quality’s (or AHRQ’s) Safety Program for Long-term Care: HAIs/CAUTI. Part 1 of this brief module is intended for all levels of long-term care staff and will introduce you to your role in outcome data collection for the LTC Program.

Learning Objectives Upon completion of this session, long-term care staff will be able to: demonstrate a working knowledge of the data used to define CAUTIs and the information collected; understand the importance of your role in supporting data collection; and understand how CAUTI data connects to overall safety and quality of care for residents and staff. Here are our goals for today’s session—attendees who complete this module will be able to: demonstrate a working knowledge of the data used to define CAUTIs and the information collected; understand the importance of your role in supporting data collection; and understand how CAUTI data connects to overall safety and quality of care for residents and staff.

Why is Data Collection Important? Data gives you the tools you need to measure your progress in reducing CAUTI and improving safety culture. Why is data important? [Click] For this project, data gives you and your facility the tools you need to measure your progress in reducing CAUTI and improving safety culture. Think about data the same as a map. You start out on a trip and hope to end up at a planned destination. In the same way, data helps you to know and assess where you are and where you are heading. In the end, data will tell you if you have met your goals and been successful. A designated team member, often the infection control nurse, will be your facility’s data coordinator. He or she will be responsible for coordinating your facility’s data collection. You may be asked to assist in collecting certain measures at your facility.

What Data Will Your Facility be Collecting? You are probably wondering, what data you will be involved in collecting for this project. Data collection responsibilities will vary by facility depending on the needs of your data coordinator. At each facility the data coordinator will be responsible for tracking the number of catheter-associated urinary tract infection (CAUTI). There are very specific criteria that are used to determine if a person has a CAUTI, so it is important to have clear, concise documentation in the medical record for accurate tracking. The Outcome Data Definition flyer here provides you with a snapshot of what we’re collecting and why. The data you collect and enter daily determines the rates for catheter utilization, CAUTI and assesses if the clinical interventions are impacting the number of urine cultures sent. You can use the Data Collection Tool to document this data in one central location. The tool will calculate these rates for you to make reporting this data easy.

Number of Residents in the Facility Each Day This is needed to calculate the CAUTI infection rate. The data that you, as the front-line staff member, will most likely assist with collecting for your facility is the number of residents in the facility each day of the month. This number includes all residents, whether or not they have a catheter. This number should be collected at the same time each day of the month. Why is this number important? The number of residents in your facility will be used to calculate the rates of infections in your facility.

Number of Residents with Indwelling Urinary Catheters Each Day This is needed to calculate the rate of catheter use at your facility. In order to calculate the catheter utilization rate it is important that you also collect the number of residents with an indwelling urinary catheter (sometimes called a Foley) each day at your facility. The count does not include in and out catheters, suprapubic or urostomies. You learned in onboarding 2 that indwelling catheters are inserted into the urethra and stay in place. Every day a resident has an indwelling urinary catheter equals one catheter day. Nurses may request nursing assistants and support staff to assist with collecting this information. So on the unit, if a resident normally has an indwelling urinary catheter and for some reason it was removed you may want to remind the nurse who is tracking this information that the catheter is out and make sure not to count it. Again, this number should also be collected at the same time each day of the month. On the right side of this slide you will see and example of how a facility will calculate the number of catheter days. It is not critical that you understand this calculation, but it is important for you to know how important the data you collect is.

Number of CAUTIs Each Month This is needed to calculate the CAUTI infection rate. A designated team member often the infection control nurse will be tracking the number of Catheter-Associated Urinary Tract Infection (CAUTI). There are very specific criteria that are used to determine if a person has a CAUTI. It will be important to have clear, concise documentation in the medical record to allow for accurate tracking. You will be provided with more training on the importance of documenting the CAUTI signs and symptoms you already learned about (in onboarding 2) during onboarding 4, on infection prevention surveillance. Why is this number important? The number of residents in your facility will be used to calculate the rates of infections in your facility.

Number of Urine Cultures Ordered Each Month Why is this number important? The number of residents in your facility will be used to calculate the rates of infections in your facility. The nurse or other staff member on a unit may be asked to help track and report how many urine cultures were sent on a monthly basis for every resident, whether or not they have a catheter. Why do we care about the number of urine cultures sent per month? Urine cultures are often sent when residents do not have signs or symptoms of a urinary tract infection. One example may be a resident had a fall so urine culture was sent to make sure the resident did not have an infection. Many older adults, especially those with a long-term indwelling (urinary) catheter, have bacteria in their urine all the time. Frequently, doctors will see bacteria in the urine culture result and immediately treat the resident with antibiotics, even if the resident did not meet the criteria for having a CAUTI or UTI. So you can see, unnecessary urine culturing could lead to residents being treated for an infection they do not have. Unnecessary antibiotic use can lead to resident health complications, secondary infections and bacterial resistance. So, if there are less urines cultures sent, then we will have less unnecessary antibiotic use. You will also learn more about the importance of avoiding unnecessary antibiotic use during training module 4. Too many urine cultures can lead to false-positive CAUTI identification. Fewer urine cultures lead to fewer CAUTIs and unnecessary antibiotic use.

What is Your Role …. How Can You Support CAUTI Data Collection Success? What are your daily tasks and responsibilities? How might your daily tasks and responsibilities relate to the outcome data measures of the LTC Program? Resident days? Catheter days? Number of CAUTIs? Number of urine cultures ordered? What can you do daily to ensure accurate data are collected and recorded? How should staff at your facility be involved in data collection? As we wrap up today’s discussion, I’d like to leave you with a few questions to discuss with your peers: What can YOU do to support data collection? Take a second to think about your role in your facility. What are your daily tasks and responsibilities? How might these daily tasks and responsibilities relate to the data measures we discussed today? And what can you do daily to ensure accurate data are collected at your facility? Finally how should staff at your facility be involved in data collection? What role will charge nurses play? What about certified nursing assistants? Some facilities may ask nurses to track and report the daily number of residents on their unit or the daily number of residents with CAUTIs and CNAs might be enlisted to help count the daily number of residents with a catheter. Tracking procedures will vary by facility, but it is essential for all facility staff to know the key information being followed for this project: Resident Days, Catheter Days, Number of CAUTIs and the Number of Urine Cultures Ordered. Onboarding 4 will provide you with more information on CAUTI surveillance and reporting. Remember that all long-term care facility staff are important in reducing CAUTIs and improving safety culture.

Stay Updated with Useful Resources AHRQ Safety Program for Long-Term Care: HAIs/CAUTI Project Website Login information: ltcsafety.org Username:   ltcsafety Password:    ltcsafety TeamSTEPPS® for Long-Term Care: http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/longtermcare/ Long-term Care Safety Toolkit—Coming Soon! Outcome Data Definitions Flyer LTC Program Data Collection Tool The following resources are available to you as participants in the AHRQ Safety Program for Long-term Care: HAIs/CAUTI project. We hope that these resources will be helpful on your journey to reduce CAUTIs and HAIs and improve your facility’s Culture of Safety. Resources: The first resource is a link to the AHRQ Safety Program for Long-term Care: HAIs/CAUTI project website. On the website you will find a variety of tools to help you prevent CAUTIs and improve your facility’s Culture of Safety. The second resource is a link to the TeamStepps for Long-term Care web page. TeamStepps is a communication and teamwork system that offers solutions to improving collaboration and communication within health care facilities. The resources on this page are specifically designed for the Long-Term Care environment. The third resource is a link to the AHRQ Safety Program for Long-term Care: HAIs/CAUTI Long-term Care Safety Toolkit. The toolkit is designed to support learning and implementation efforts to improve safety culture in long-term care facilities. In six learning modules, the toolkit provides concepts and tools that aim to change the way facilities do their work and provide care, allowing for better outcomes and higher quality of care for residents. The fourth resource is a link to the Outcome Data Definitions Flyer previewed today during this module. The fifth resource is a link to a downloadable version of the Data Collection Tool highlighted during this module