1. Good Morning and Welcome Thursday, April 23, 2015 Cohort 9 – ICU SCCM Georgia Meeting

2. Introductions and Welcome Kathy McGowan Kathy McGowan, MPH VP, Quality and Safety, GHA Jan Ratterree, RN, BSN, CIC Infection Prevention/Patient Safety Specialist, GHA Amy Christie, MD Clinical Lead Medical Center, Navicent Health Leslie Culpepper, RN Clinical Lead Medical Center, Navicent Health Will Miles SCCM MD Lead Carolinas Healthcare Charlotte Diane Byrum SCCM RN Lead Society of Critical Care Medicine

3. Georgia Hospitals  Athens Regional Hospital  DeKalb Medical at Hillandale  DeKalb Medical at North Decatur  Emory Johns Creek Hospital  Emory Saint Joseph’s of Atlanta  Emory University Hospital  Emory University Hospital Midtown  Hamilton Medical Center  Medical Center, Navicent Health  Rockdale Medical Center  St. Mary’s Health Care System

4. 17 States

5. 272 Hospitals/392 ICU’s Arkansas 11 Arizona 23 Florida 44 Illinois 16 Kansas 18 Kentucky 24 Colorado 12 Minnesota 15 New Jersey 45 Oklahoma 15 Tennessee 40 Texas 13 California 2 Georgia 35 North Carolina 31 South Carolina 21 Virginia 27 392

6. Introducing the No Preventable Harms Campaign: Creating the safest healthcare system in the world. Starting with catheter-associated urinary tract infection prevention Sanjay Saint, et American Journal of Infection Control 43(2015) 254-9

8. Opportunity for improvement Opportunity for Improvement Consider local policies and procedures Allow the initiative to be individualized according to site/unit One initiative at a time/provide time between initiatives Make sure all stakeholders are involved in initial conversation and have input Be clear about who should be involved at the local level (e.g., champions and a project manager). Involve all affected staff

9. State of the Collaborative Dr. Will Miles

10. Dr. Amy Christie & Leslie Culpepper, RN Georgia Physician and RN Lead Medical Center, Navicent Health New Evidence in CAUTI Prevention Strategies

12. Indications for Placement ANA introduced CAUTI Tool in February 2015 Incorporates CDC best practices One page guideline to assess the appropriateness of urinary catheter insertions 14 Hospitals participated to test and refine the CAUTI reduction tool and reported positive results

15. Indications for Placement

17. Proper Insertion/Alternatives

18. 2-Person Insertion Ideal!

19. Eliminating catheter-associated urinary tract infections in the intensive care unit: Is it an attainable goal? Tominaga GT, Dhupa A et al. American Journal of Surgery (2014) 208, 1065-1070.

20. 2 person UC placement, physician notification of CAUTI, reinstitution of pre- packaged bath/peri-care, and implementation of once daily UC care decreased IR

21. Appraising the Literature on Bathing Practices and Catheter-Associated Urinary Tract Infections Urologic Nursing 2015, 35: 11-17.  Purpose to evaluate the bathing and cleansing procedures and the impact of those practices on CAUTI prevention  Meta-analysis: 22 articles included in evaluation  Bath basins increase risk of HAI  Chlorhexidine wipes: CHG no significant difference when compared to sterile water in peri-urethral cleansing prior to catheter insertions  No significant difference in CAUTI reduction when use CHG wipes for cleaning  Plain wipe bathing: Studies have shown a significant reduction in CAUTI

22. Know When Urinary Catheter is No Longer Needed Multidisciplinary team education: Finding your champions  I-ACT Training to reduce HAI Nurse Driven Catheter removal protocol Identifying and getting buy-in from stakeholders

23. Interdisciplinary Academy for Coaching and Teaching: Supports the idea of having a hospital based boot camp

24. Addressing the Stakeholders Infectious Disease SpecialistsUrologists Reduce CAUTI. Reduce antibiotic use. Reduce potential of increased resistance and Clostridium difficile disease. Reduce trauma (mechanical complications): 1.Meatal and urethral injury 2.Hematuria HospitalistsGeriatricians Infectious and mechanical complications. Potential catheter complications prolonging length of stay. Hospitalists care for a large number of patients. Their support may help significantly improve the appropriate use of the urinary catheter. Many elderly are frail. Urinary catheters are placed more commonly in elderly inappropriately. Urinary catheters increase immobility and deconditioning risk, in addition to infection and trauma.

25. Addressing the Stakeholders Rehabilitation SpecialistsSurgeons The urinary catheter reduces mobility in patients: one point restraint. Rapid recovery (improvement in ambulation) may be hampered by the catheter (in addition to the other associated risks). Surgical Care Improvement Project: Remove catheters by postop day 1 or 2. Inappropriate urinary catheter use postoperatively will negatively affect the surgeon’s profile. Risk of infection and trauma related to the catheter. IntensivistsEmergency Medicine physicians Discontinue no longer needed devices upon transfer from the ICU to floor, including urinary catheters. Intensivists can support the DAILY evaluation of catheter need to reduce harm risk. EARLY MOBILITY? Up to half of the patients are admitted through the emergency department (ED). Inappropriate urinary catheter placement is common in the ED. Promoting appropriate placement of urinary catheters in the ED will reduce inappropriate use hospital-wide.

26. The Landscape of CAUTI Interventions

28. Introducing the No Preventable Harms Campaign: Creating the safest healthcare system in the world. Starting with catheter-associated urinary tract infection prevention Sanjay Saint et al. American Journal of Infection Control 43(2015) 254-9.

29. Pad Weighing for Reduction of Indwelling Urinary Use and Catheter-Associated Urinary Tract Infection. Beuscher JWOCN 2014, 41: 604-608. Key for any Catheter Removal Protocol is to offer alternatives to monitor urinary output Bladder Scanner In a 7 month period saw a significant reduction in catheter utilization and CAUTI rates

30. CAUTI QI Project Results Indwelling Catheter Utilization Rate CAUTI/1000 catheter days

31. Interventions are very important along every aspect of catheter lifecycle

32. Data Review CAUTI On the CUSP Cohort 9 Jan Ratterree RN, BSN, CIC Infection Control/Patient Safety Specialist Georgia Hospital Association

41. Discussion What’s working well and what’s getting in our Way? Physicians Nurses Data managers & Improvement professionals Report Out

42. Lunch & Culture of Safety Video

43. Storyboard Rounds – Hospital Teams Storyboard Rounds Discuss KEY Lessons and RESULTS Among Teams!

44. “Take Aways” Team Lessons from Storyboards! (Facilitators and hospital teams take notes) Highlight key pearls from Storyboards to support improvement!

45. Questions of the Day!

46. Next Steps Team Planning and Action Plan Team Huddle and Completion of a WHO, WHAT, and WHEN Plan

47. Team Report Out Next Steps Teams will take when they return. What do sites need to be successful?

48. Highlights from Culture of Safety Video CUSP Tools Diane Byrum, RN