1. Munroe Regional Medical Center Journey to Reducing CAUTI

2. Munroe Regional Medical Center Objectives Where we started What we’ve accomplished What our vision is for the future

3. Munroe Regional Medical Center In the beginning… August 2008- Munroe joined a VHA Rapid Adoption Network (RAN) Initiative to reduce CAUTI –With a specific goal to reduce device days Organized a multidisciplinary team

4. Munroe Regional Medical Center The Stream Team Educators Infection Prevention Coordinators Front line nurses Senior nursing administrator Physicians Quality Coordinator

5. Munroe Regional Medical Center Why so many device days? Catheters were being placed in the emergency room and forgotten No clear rationales for catheter insertion/continuation Catheters weren’t addressed until ready for discharge- prolonged length of stay

6. Munroe Regional Medical Center First Steps…Avoid Catheterization Addressed unnecessary placement by developing specific criteria for insertion/continuation

7. Munroe Regional Medical Center Consider alternatives… Condom Catheters Urinals/female urinals Cloth Chux Frequent toileting Bladder scanning

8. Munroe Regional Medical Center Next Step…Timely Removal Developed a nurse driven policy allowing nursing to remove catheters when no longer meeting criteria Set a goal to reduce device days by removing catheters within 3 days

9. Munroe Regional Medical Center

11. Computer charting altered to match our policy Document: Date of insertion # of days (pop-up warning) Catheter size Continue catheter reason

12. Munroe Regional Medical Center SCIP Measure Conflict Late 2010 we learned of future SCIP measures Changed to “Cut the rate by 48” –Goal to remove catheters by Day #2

13. Munroe Regional Medical Center Assist with physician documentation Reminder became permanent part of record Reminded surgeons to document why the patient required prolonged catheterization

14. Munroe Regional Medical Center House wide Education Updated Insertion skills checklist Catheter care (patient care techs) Proper transporting techniques for patients with catheters –Transporters –Physical therapy –Volunteers

15. Munroe Regional Medical Center House Wide Education Examples…

16. Munroe Regional Medical Center In Feb 2011 we joined the FHA CAUTI Initiative

17. Munroe Regional Medical Center Science of Safety Invited all staff to preview the science of safety video Promoted a culture of safety on our unit

18. Munroe Regional Medical Center Nursing Quality Council Added Catheters to our PI Plan –Audit quarterly: Date/Time of bags Securement device use Catheter reminder tool on chart Electronic charting compliance

19. Munroe Regional Medical Center Further defined criteria for catheter insertion/continuation

20. Munroe Regional Medical Center Changed stocked items in Pyxis We removed all 16F catheters and replaced with 14F –Making it easier for staff to choose the smallest appropriate catheter

21. Munroe Regional Medical Center New Signage on our supply Pyxis

22. Munroe Regional Medical Center Updated Staff Education Computer based learning Update computerized charting Updated Policy

23. Munroe Regional Medical Center Focused on proper specimen collection for RNs and PCTs

24. Munroe Regional Medical Center Physician Education Physician champion educated MDs on proper criteria for urinalysis –Avoid routine urinalysis on asymptomatic patients –Discourage unnecessary antibiotic therapy

25. Munroe Regional Medical Center Utilized On-the-Cusp Tool Kit

26. Munroe Regional Medical Center CAUTI Case Analysis Reviewed each CAUTI –Where the catheter was inserted –Duration of catheter –Reason for insertion/continuation –Looked for trends –Discussed findings with staff involved

27. Munroe Regional Medical Center Daily catheter audits by charge RNs

28. Munroe Regional Medical Center Utilization Trends

29. Munroe Regional Medical Center Looking ahead… Incorporating more education into orientation house wide Include Science of Safety video during general orientation Continue to track and trend CAUTIs house wide to improve quality

30. Munroe Regional Medical Center References Center for Disease Control (2009). Guideline for prevention of catheter-associated urinary tract infections 2009. Retrieved December 28, 2011 from, http://www.cdc.gov/hicpac/pdf/CAUTI/CAUTIguideline2009final.pdf Gokula, R., Hickner, J., and Smith, M. (2004). Inappropriate use of urinary catheters in elderly patients at a midwestern community teaching hospital. American Journal of Infection Control, 32 (4), 196-199. Mosby’s Nursing Skills (2010). Specimen collection: sterile urine from a catheter. Excerpted and adapted from Perry AG, Potter PA: Clinical nursing skills & techniques, ed 7, St. Louis, 2010, Mosby. Michigan Health and Hospital Association (2011). Care Counts Account. Retrieved from, http://mhacarecounts.org/UserLogin.aspx?Url=/ http://mhacarecounts.org/UserLogin.aspx?Url=/ Pronovost, P. (2005). Improving patient safety. Johns Hopkins University. Retrieved from, http://www.safercare.net/OTCSBSI/Staff_Training/Entries/2009/9/6_1._The_Science_of_Im proving_Patient_Safety.html http://www.safercare.net/OTCSBSI/Staff_Training/Entries/2009/9/6_1._The_Science_of_Im proving_Patient_Safety.html Robinson, S., Allen, L., Barnes, M., Berry, T., Foster, T., Foster, T., Friedrich, L., et al. (June 2007). Development of an evidence-based protocol for reduction of indwelling urinary catheter usage. MEDSURGE Nursing, 16(3), 157-161.