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Journey to

Reducing
CAUTI
Munroe Regional Medical Center

Objectives
Where we started
What weve accomplished
What our vision is for the future

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


Munroe Regional Medical Center

The Stream Team


Educators
Infection Prevention
Coordinators
Front line nurses
Senior nursing
administrator
Physicians
Quality Coordinator
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 werent addressed until ready for
discharge- prolonged length of stay

Munroe Regional Medical Center

First StepsAvoid Catheterization


Addressed unnecessary placement by
developing specific criteria for
insertion/continuation

Munroe Regional Medical Center

Consider alternatives

Condom Catheters
Urinals/female urinals
Cloth Chux
Frequent toileting
Bladder scanning

Munroe Regional Medical Center

Next StepTimely 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

Munroe Regional Medical Center

Munroe Regional Medical Center

Munroe Regional Medical Center

Computer charting altered to


match our policy
Document:

Date of insertion
# of days (pop-up warning)
Catheter size
Continue catheter reason

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

Munroe Regional Medical Center

Assist with physician


documentation
Reminder became
permanent part of
record
Reminded surgeons
to document why
the patient required
prolonged
catheterization
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

Munroe Regional Medical Center

House Wide Education


Examples

Munroe Regional Medical Center

In Feb 2011 we joined the


FHA CAUTI Initiative

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

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

Munroe Regional Medical Center

Further defined criteria for


catheter insertion/continuation

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

Munroe Regional Medical Center

New Signage on our supply


Pyxis

Munroe Regional Medical Center

Updated Staff Education


Computer based learning
Update computerized charting
Updated Policy

Munroe Regional Medical Center

Focused on proper specimen


collection for RNs and PCTs

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

Munroe Regional Medical Center

Utilized On-the-Cusp Tool Kit

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

Munroe Regional Medical Center

Daily catheter audits by


charge RNs

Munroe Regional Medical Center

Utilization Trends

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

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.
Mosbys 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=/
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
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.
Munroe Regional Medical Center

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