Carly Metcalf

Dana Lester
Colton Herinckx
Caroline Hansen
Peggy Spangler

Problem Solving/Decision Making Assignment (PS-2)

1. WHAT IS THE PROBLEM; DESCRIBE THE PARTS
The major problem in this scenario is implementing a pilot program in the Progressive Care Unit (PCU)
similar to the pilot program in the Intensive Care Unit (ICU). While the cranberry extract protocol worked in
the ICU due to the patient-to-nurse ratios, the ratios in the PCU are much larger and therefore the protocol
will need to be modified. In order to implement a similar program in the PCU, all hospital employees
working here will need to be trained; it is important to note that PCU staff may need to be trained
differently than ICU staff as PCU employees may interact more with patients. Due to the higher
patient-to-nurse ratio, communication between different branches will also become trickier (Sara said ICU
dietitians and nurses spent more time together than PCU dietitians and nurses). Finally, a protocol needs
to be made for educating patients that are discharged with take-home catheters.

2. GENERATE A LIST OF POTENTIAL BRAINSTORMING SOLUTION IDEAS FOR EACH OF THE

PARTS.

What RD needs to do: Responsible for ordering UTI-stat, collecting, putting labels on it, take to nursing
station. Ensure consistent timing of order. Pick a time for order/pick-up to create good workflow with
nurses). Double checking allergies on chart when doing initial assessment, educate ALL nurses about
options of administering (oral, with juice, as a shot, etc). Maybe include infection prevention team during
education.

Nurse Protocol:
Nurses also work with discharge patient training.
Create a new protocol for discharge options to INCLUDE UTI-Stat. Include coupons for retail options and
pamphlet.
Participate in training as far as administer options, amount (2x a day).

Infection prevention staff may be need to reassigned somewhere else (may not be needed in PCU/ICU if
everyone receives cranberry extract, could maybe train nurses) They probably still need to check that
catheters are taken out as soon as possible.
Nurses need to be aware that cranberry extract can be given orally as well as through IV
Dietitians need to be able to provide education for families/patients that have take-home catheters

3. Choose a solution and generate a small written protocol, with details about how it might work.

All patients in the ICU and PCU should be given cranberry extract to avoid communication problems,
avoid patients believing they are being mistreated (i.e., asking why another patient is receiving
treatments that they arent), and ensuring consistent treatment across all patients. Since the hospital is
able to buy the cranberry extract cheaply and packets store well, this seems like a reasonable solution.
 Problem Parts of Protocol approaches Considerations to approaches
Description protocol

Need to Giving all Have dietitians order If this fails to prevent UTIs it could
implement a patients extract enough extract for all end up costing more money than it
cranberry patients (calculations saves
extract pilot below)
program in PCU
Retraining Schedule training Need to come up with a way to
everyone (esp. meetings as needed retrain the nurses and schedule a
nurses) (outline above) time to meet with them to train

Educating Create Pamphlets must be easy to

patients on pamphlets/provide understand and eye catching
discharge coupons for nurses to
hand out on discharge

Breakdown of Responsibilities (New Protocol)

Dietitians Responsibilities
Checking for allergies while conducting assessment
Ordering UTI-stat on a consistent basis (i.e., every week at a scheduled time)
Collecting UTI-stat
Labelling UTI-stat
Bringing UTI-stat to nursing station
Educate nurses about all administration routes (i.e., can be given orally and through intravenously)
Educate nurses about correct dosage (i.e., minimum of 36 mg per day, not all at once)

Infection Prevention Teams Responsibilities

Assist dietitians in educating nurses

Nurses Responsibilities
Administer UTI-stat (twice a day)
Educate patients with take-home catheters at discharge (include coupons and pamphlet)
Training Plan

1. Schedule training dates with PCU nurses on upcoming in-service training dates
a. Provide at least two training sessions to accommodate all PCU nurses
b. Invite ICU nurses currently trained in pilot UTI-Stat protocol
c. Schedule a follow up-training session
2. Topics to Cover
a. Overview and use of UTI-Stat (medical food)
i. Benefits and outcomes UTI-Stat protocol against UTI
1. Benefits of preventing UTI vs.treating (emphasizing reduced workload)
b. Proposed protocol
i. Prescription/Dosage
1. Warfarin prescription (involving Doc)
ii. Allergies/Contraindications
iii. Methods of administration (oral or IV)
1. 300-500 mg daily twice for cranberry juice extract supplements for people w/
diabetes
c. Patient/Family education
i. Discharge/coupon details
ii. Giving cost info/where to purchase

a. List and describe all the resource and logistical parts to your solution

In order to decrease CAUTIs, we have decided it would be most efficient to provide every patient in the
ICU and PCU with cranberry extract (aside from patients with allergies, etc.). To us, this seemed to be the
easiest solution; if patients receive the cranberry extract by default, the communication aspect of the
problem becomes easier and no one is missed. In addition, the entire process becomes more streamlined.
The dietitian responsible for ordering/stocking UTI-stats would be able to order a pre-determined number
weekly rather than making new calculations each week.

As previously mentioned, the dietitian(s) are responsible for making sure there is always enough UTI-stat
on hand, labeling the packets to ensure patients receive the UTI-stat, and placing orders at a consistent
time. Nurses are responsible for administering the UTI-stat twice per day to patients and educating those
with take-home catheters at discharge. Finally, the infection prevention staff is responsible for helping the
dietitians educate the nurses about the UTI-stat. Retraining for this new protocol will be necessary (a basic
outline is provided above). Key points include making sure the nurses understand that UTI-stat can be
taken orally as well as intravenously and making sure nurses can adequately educate patients at
discharge.
b. Describe how aspects of the organization would be impacted by the plan and how they may
need to be addressed.

The biggest branch that would be impacted by this protocol is the Infection Prevention staff. While they
were previously responsible for notifying dietitians about which patients needed UTI-stat, this would no
longer be necessary (as all patients would be receiving UTI-stat as a preventative measure). Under this
protocol, the Infection Prevention staffs main responsibilities would be assisting the dietitians in educating
the nurses and removing patients catheters as soon as possible. The other major changes have already
been described; in summary, they include having the dietitians responsible for ordering/stocking/labeling
UTI-stat and having the nurses administer the UTI-stat twice a day and educating patients at discharge
with pamphlets. Rather than select patients receiving UTI-stat, all patients would receive an adequate
dose.

c. Generate and include the process to implement and evaluate the plan.

The implementation for this protocol would be fairly simple after obtaining approval to give UTI-stat to all
ICU and PCU patients that do not have allergies and are not prescribed warfarin. On whatever day
UTI-stats are normally ordered, the dietitian responsible for placing orders would order a standardized
amount based on maximum occupancy expected rather than the variable amount that they are used to
ordering. All patients in ICU and PCU would receive UTI-stat as a preventative measure. To ensure that all
employees understand the new protocol, they would attend training sessions. Multiple training sessions
would be offered to ensure that all employees would be able to attend. Finally, nurses would hand out
pamphlets and coupons on discharge to patients with take-home catheters to provide education.

To evaluate the effectiveness of this proposed protocol, the hospital could record the number of CAUTIs
that occur each month after the pilot program is in place. This would be compared against the number of
CAUTIs the hospital had each month on average prior to pilot programs implementation. The more
months that data is collected, the stronger the comparison becomes. If there is a significant decrease in
CAUTIs, the program can be considered successful; if not, the program will need to be reevaluated. While
the ultimate goal of the program is to save the hospital money, there are other non-monetary factors that
need to be taken into consideration too (such as the fact that if CAUTI rates drop after implementation of
this pilot program, the hospitals reputation will likely improve).

d. Do some analysis on the problem, as discussed in class. If they can reduce the incidence of
Urinary Tract Infections by some %, estimate the cost that this might save based on her Rationale
information

Assume 60% occupancy

Cost calculations:
$0.92/dose
ROI $6:1 to $12:1
Assuming $28-$55 for bid dosing x 1 mo
$692-$785 average cost UTI and 50% efficacy
Max 24 patients with overflow
Ave length of stay 4.5 days
patients have catheter
Assume 60% occupancy rate

Annual doses given if everyone in PCU will receive cranberry extract:

If assumed 60% occupancy using overflow (24 beds max)
365 days/4.5 length of stay x 14.5 max x 2 doses per day = 2353.2 doses per year
Then the total cost of just cranberry extract is 2353.2 x $0.92 = $2164.04 annually
Number of Patients Annually
Assuming 60% occupancy with 24 beds
365/4.5 length of stay x 14.5 = 1177 patients annually
CAUTI rates PCU 2016 = 2.56/1000 device days
Device days = 365 x 14.5 x 0.50 catheters in PCU = 2646 device day/yr if assume 24 beds
2.56/1000 device days x 2646 device days = 6.8 CAUTI for 24 bed annually at current rate
Current cost of UTIs in PCU (a UTI costs $692-$785) Average $739 for one UTI
$5025 spent on UTI in PCU 2016 based on 6.8 CAUTI annually

Our proposed Goal for CAUTI in PCU = 1.00/1000 device days (this is a reduction of 60%)
This would mean a reduction in CAUTI to 2.65 annually
At average cost of $739 for one UTI
Cost of UTI based on goal rate of 1.00/1000 device days,
$1958 spent on UTI at goal (2.65 x $739 = $1958)
Would save around $3067 on UTIs at goal rate ($5025 - $1958 = $3067)
The cost of UTI-STAT packets at hospital would be about $2164
So our proposal would save: $903 = $3067 (cost savings of reduced UTI)-$2164 (cost of packets)
There would be additional savings from reduced Medicare penalties and potential income from the
Hospital Transformation Performance Program.
Also, if UTI rate could be reduced to 0 as it was in the ICU, savings would be increased.
ROI was estimated at 6:1. We would spend $2164 on UTI-stat packets, Return would be $12,984 at
original ROI of 6:1. ROI with our proposal would be reduced since everyone would receive UTI-stat
packets and only 50% have catheters. Likely reduced to approximately 3:1.