1. HAI Affinity Group CAUTI Prevention: The Nurse Driven Protocol for Catheter Removal April 10, 2013 Denise Flook, RN, MPH, CIC HAI Collaborative Lead Vice President, Infection Prevention/Staff Engagement

2. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 2 Objectives Describe the benefits of a standardized urinary catheter removal process. Outline the essential elements of a Nurse Driven Protocol for urinary catheter removal Discuss barriers to implementing a Nurse Driven Protocol and how they can be overcome 2

3. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 3 Where We Are 3

4. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 4 The Nurse As A Driver of Reduction of Catheter Days If the catheter is not present then the CAUTI is not going to develop Effective method is a nurse driven protocol to reduce catheter days 4

5. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 5 5 Identify the What and Why – Reduce urinary catheter days using a reliable, standard process – Prevent CAUTI, reduce patient harm Obtain leadership support: 1. Administration 2. Nursing 3. Physician Identify both nurse and physician leaders to be the point people for the initiative. – Nursing: potential candidates include nursing director, or a very effective nurse manager/charge nurse – Physician: who will support the use of a nurse driven protocol Starting at the Beginning

6. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 6 6 Partner with nursing, case management, infection prevention, and physicians. Evaluate areas with high prevalence of utilization. Use point prevalence to help decide initial units. Start with one general medical/surgical unit. Identify the Where

7. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 7 7 Recruit the Team and Begin the Work Identify front line staff to assist in developing process Share the data and goals Develop a process using evidence-based processes

8. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 8 8 Important Essentials The nurse should note the catheter's presence and evaluate the indication during the patient's daily nursing assessment. Discuss during Bedside Report – Does the patient have a urinary catheter? – What is the reason for use? Involve the patient and the family The patient’s nurse will initiate the urinary catheter discontinuation process if there are no appropriate indications for utilization present.

9. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 9 Test Your Process, Improve, Spread, Sustain Use small tests of change Improve the process Standardize and receive approvals Implement fully – Education and competency Spread Measure and provide feedback Sustain 9

10. Learn. Act. Improve. Spread. Keep the Drum Beat Going. CONTACT INFORMATION Denise Flook dflook@gha.orgdflook@gha.org. 770-249-4518