Transcript Presentation - Patient Safety - Georgia Hospital Association

Good Morning and Welcome
Thursday, April 23, 2015
Cohort 9 – ICU SCCM Georgia Meeting
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
Georgia Hospitals
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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
17 States
272 Hospitals/392 ICU’s
Arkansas
Arizona
Florida
Illinois
Kansas
Kentucky
Colorado
Minnesota
New Jersey
Oklahoma
Tennessee
Texas
California
Georgia
North Carolina
South Carolina
Virginia
11
23
44
16
18
24
12
15
45
15
40
13
2
35
31
21
27
392
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
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
State of the Collaborative
Dr. Will Miles
New Evidence in CAUTI
Prevention Strategies
Dr. Amy Christie &
Leslie Culpepper, RN
Georgia Physician and RN Lead
Medical Center, Navicent Health
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
Indications for Placement
Proper Insertion/Alternatives
2-Person Insertion Ideal!
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.
2 person UC placement, physician notification of CAUTI, reinstitution of prepackaged bath/peri-care, and implementation of once daily UC care decreased IR
Appraising the Literature on Bathing Practices
and Catheter-Associated Urinary Tract Infections
 Urologic Nursing 2015, 35: 11-17.
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Purpose to evaluate the bathing and cleansing procedures and the
impact of those practices on CAUTI prevention
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Meta-analysis: 22 articles included in evaluation
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Bath basins increase risk of HAI
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Chlorhexidine wipes: CHG no significant difference when compared
to sterile water in peri-urethral cleansing prior to catheter insertions
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No significant difference in CAUTI reduction when use CHG wipes
for cleaning
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Plain wipe bathing: Studies have shown a significant reduction in
CAUTI
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
Interdisciplinary Academy for Coaching and Teaching:
Supports the idea of having a hospital based boot camp
Addressing the Stakeholders
Infectious Disease Specialists
Urologists
• Reduce CAUTI.
• Reduce trauma (mechanical
complications):
• Reduce antibiotic use.
• Reduce potential of increased resistance
and Clostridium difficile disease.
1. Meatal and urethral injury
2. Hematuria
Hospitalists
Geriatricians
• Infectious and mechanical complications.
• Many elderly are frail.
• Potential catheter complications
prolonging length of stay.
• Urinary catheters are placed more
commonly in elderly inappropriately.
• Hospitalists care for a large number of
patients. Their support may help
significantly improve the appropriate use
of the urinary catheter.
• Urinary catheters increase immobility
and deconditioning risk, in addition to
infection and trauma.
Addressing the Stakeholders
Rehabilitation Specialists
Surgeons
• The urinary catheter reduces mobility in
patients: one point restraint.
• Surgical Care Improvement Project:
Remove catheters by postop day 1 or 2.
• Rapid recovery (improvement in
ambulation) may be hampered by the
catheter (in addition to the other
associated risks).
• Inappropriate urinary catheter use
postoperatively will negatively affect the
surgeon’s profile.
Intensivists
Emergency Medicine physicians
• Discontinue no longer needed devices
upon transfer from the ICU to floor,
including urinary catheters.
• Up to half of the patients are admitted
through the emergency department (ED).
• Intensivists can support the DAILY
evaluation of catheter need to reduce
harm risk.
• EARLY MOBILITY?
• Risk of infection and trauma related to
the catheter.
• Inappropriate urinary catheter placement
is common in the ED.
• Promoting appropriate placement of
urinary catheters in the ED will reduce
inappropriate use hospital-wide.
The Landscape of CAUTI Interventions
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.
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
CAUTI QI Project Results
Indwelling Catheter
Utilization Rate
CAUTI/1000 catheter
days
Interventions are very important along every
aspect of catheter lifecycle
Data Review
CAUTI On the CUSP Cohort 9
Jan Ratterree RN, BSN, CIC
Infection Control/Patient Safety Specialist
Georgia Hospital Association
Discussion
What’s working well and what’s getting in our Way?
• Physicians
• Nurses
• Data managers & Improvement professionals
Report Out
Lunch & Culture of Safety Video
Storyboard Rounds – Hospital Teams
Storyboard Rounds
Discuss KEY Lessons and
RESULTS Among Teams!
“Take Aways”
Team Lessons from Storyboards!
(Facilitators and hospital teams
take notes) Highlight key pearls
from Storyboards to support
improvement!
Questions of the Day!
Next Steps
Team Planning and Action Plan
Team Huddle and Completion of a WHO,
WHAT, and WHEN Plan
Team Report Out
Next Steps Teams will take when they
return.
What do sites need to be successful?
Highlights from Culture of Safety Video
CUSP Tools
Diane Byrum, RN