1. The Power of Observation Penny Hill, RN, MPH, CIC Infection Prevention San Juan Regional Medical Center

2. Objectives Identify methods of observation which best simulate actual practice Identify communication and education means for process / practice improvement Identify HOW TO GET OUT OF THE OFFICE and have fun doing it!!

3. Sleuth Spy Observe Surveillance Monitor Feedback Watch Learn GET OUT OF THE OFFICE!!

4. Observing Foley Insertion Practices In an effort to decrease CAUTI rates, we began by looking at Foley Insertion Practices Partnered with BARD Clinical Educators Observed current foley insertion practices in a female model utilizing our current foley kit Included nurses/techs in all inpatient nursing units & ED

5. Setting the Stage Explained to staff we were evaluating our current foley kit and housewide insertion practices. No names were taken and no one would fail. We were simply observing their technique and the use of our current kit. Infection prevention staff and BARD clinical educators completed score card for each observation.

6. What We DID Observe One nurse completed all elements correctly All others did not utilize all of the kit contents Hand hygiene was rarely observed after cleaning the patient and prior to donning sterile gloves (they threw away the hand sanitizer!) Sterile gloves were often contaminated when placing the drape under the patient

7. What We DID Observe, cont Some contaminated field by touching kit wrap to their glove or arm when opening Some contaminated sterile gloves during insertion by touching the meatus with sterile glove All walked us through their securement process Few spoke about hand hygiene after removing sterile gloves.

8. Model Practice vs Patient Practice Utilizing a simulation for practice may not indicate true clinical practice (ie, hand hygiene prior to and after procedure) Staff may be nervous about observation and skip steps Majority of staff seemed at ease and inserted foley as they would on a patient.

9. Our Results The results of our observations lead us to investigate a better foley insertion kit Staff education needed to improve aseptic foley insertion techniques Partnered with BARD and SJRMC Clinical Nurse Educator group to provide education on use of an improved foley insertion kit as well as aseptic insertion technique

10. Decreasing CAUTIs: Phase 1 Obtained new foley kits that included: – Clear directions for opening wrap – Necessary supplies in order of use – Numbered steps on tray – Place for lubrication & catheter to prevent contamination – Labels for foley bag – Urometer automatically included

11. Lessons Learned Provide a non-threatening environment for observation Assure staff they will not be named or graded Assure ALL departments are represented and conduct education for staff Follow up with nursing after new product introduced

12. Decreasing CAUTIs: Phase 2 HOUDINI nurse assessment-driven urinary catheter removal process began 6/28/16. Appropriate use of protocol monitored by nursing Currently conducting a 6-Month data collection for HOUDINI documentaion, CAUTIs & Device Utilization rates by department

13. The Power of Observation: Infection Prevention Rounds

14. The Power of Observation: Infection Prevention Rounds Findings

16. GET Out Of The Office!! Set a small goal (observations once a week for 1 hour) Partner with others (EVS, Plant Ops) Focus on a problem (glove boxes stored next to the sink) Take your phone or a camera Give departments feedback Pictures are worth a thousand words!!