Transcript Implementation of an ICU Exit Checklist in the Intensive Care Unit

Ashley Dobuzinsky, BSN, RN, CCRN
Lynn Orser, MSN, RN, CCRN, PCCN
St. Vincent’s Medical Center
Discuss:
 Development
of the ICU Exit Checklist
 Implementation
 Outcomes
process
 To
address increasing incidence of HAI among
hospitalized patients through the utilization of an
ICU Exit checklist
 To
decrease utilization of central venous
catheters (CVC) and indwelling catheters
 Improve
team
communication among the healthcare

Setting
 30-bed mixed surgical/medical ICU, inclusive of 6 bed
PCU
 Closed unit-Intensivist led model

Pre-implementation data
 Collected over a 30-day period from August 2012September 2012 on patients transfers from the
ICU/PCU. Monitoring for the presence of CVC or
indwelling catheters at time of transfer.
 Of
the 84 patients tracked, 23 patients (27%)
were transferred with a CVC in place
 42
patients (50%) were transferred with an
indwelling catheter in place
 Engaging
the multidisciplinary team
 Expanding
goals of checklist to include:
 Narrowing antibiotic coverage
 Evaluation of proton pump inhibitor therapy for
discontinuation
 Notification of accepting physician at time of transfer

Staff education
ICU Exit Checklist
 Foley Catheter in place?
Yes
No
If yes, indication per MD for continuing __________________
 TLC in place?
Yes
No
If yes, indication per MD for continuing __________________
 GI prophylaxis continued? Yes
No
If yes, indication per MD for continuing ___________________
 Course of Antibiotics evaluated and
 Narrowed  Discontinued
 other_______________________________________
 Call intensivist to confirm the receiving physician has been
notified and received report prior to the patient being
transferred.
Please return completed forms to folder in the charge nurse
area in the SICU
ICU Exit Checklist
1. Foley Catheter in place?
Yes
No
Per MD Indication for use:
 Urinary retention including obstruction and neurogenic bladder.
 Short perioperative use in selected surgeries (less than 24 hours) and for urologic studies or
surgery on contiguous structures.
 Renal/Urological/Gynecological or Perineal surgical procedures.
 Hemodynamically unstable
 Accurate monitoring of intake and output.
 Assist healing of perineal and sacral wounds in incontinent patients to avoid further
deterioration of wound and skin.
 Required immobilization for trauma or surgery, for example, pelvic or hip fracture.
 Hospice/comfort care or palliative care, if requested by patient.
 Chronic indwelling urinary catheter on admission (reason will be clarified by physician).
 Hematuria/ bladder irrigation or medication instillation.
2. TLC in place?
Yes
No
Per MD Indication for use:
 Hemodynamic monitoring
 Administration of specific medications: Vasopressors, Chemotherapy, TPN, Long term
antibiotics, 3% normal saline
 Hemodialysis, plasmapheresis, apheresis
 Transvenous Cardiac Pacing
 Very poor peripheral access
3. GI prophylaxis continued? Yes
No
If yes MD reason for continuing ____________________________________________________
4. Course of Antibiotics evaluated and
 Continued  Narrowed
 Discontinued  other_________________________
 Call intensivist to confirm the receiving physician has been
notified and received report prior to the patient being
transferred.
Please return completed forms to folder in the charge nurse
area in the SICU
60
50
40
30
20
10
0
Foley present upon transfer
Central line present upon transfer
 ICU
Indwelling Catheter Utilization
 37% reduction in utilization from Sept 2012-Nov 2013
 No ICU CAUTIs Aug 2013-Oct 2013
 ICU
CVC
 14.5% reduction in patient transfers with CVC in place
 One reported CLABSI over 12 month period
 ICU
process improvement project
 Primary
goal to decrease HAI by reducing
the utilization of CVC and indwelling catheters
 Involved
a multidisciplinary team approach
 Observations
included overall decline in
utilization of CVC and indwelling catheters