April 11th 2014

Putting a S.T.O.P to traditional use of Invasive Devices: Use it or lose it!

Liz Smith

Conflict of interest

• No payment has been made to undertake the presentation

• No payment for advice given• No funding for research has taken place• 1000 Lives Improvement Service PHW have funded

attendance• No share holdings or pharmaceutical companies have

any interests in the programme • However, Health Foundation funding contribution was

made to enable the production of communication aids for the STOP campaign and Sepsis.

Wales

Population 3 million

• 9 Health Boards– Vary in population– 3 large– Limited tertiary– Rural – some shared

services with England– Some specialised

services

Scale of the problem• European Centre Disease Control

(ECDC) Point Prevalence Survey 2011 indicated high rates of– UC– PVC– SSI C-Section

Acute-9094 patients surveyed 3369 had either UC, PVC or bothNon acute-2506 surveyed343 had either PVC or UC

Concerns

• Acute sector surveyed 3369 had a device insitu– 60% identified as

Catheter related UTI (CAUTI)

– 26% of inpatient population had an indwelling PVC (some more than one)

• Non Acute survey 343 had a device insitu– 303 UC – 66 PVC

– 103 identified catheter related infection

Getting started

• One ward... one day• How many cannulas and catheters are insitu• How many of those are clinically indicated• In your professional opinion how many could be

removed

Model for improvement

S.T.O.P.

Stop - Is the device needed? Is there an alternative?

Think - What are the clinical indicators for use?Has the patient consented?

Options - Management of alternative therapies.Document the rationale for use

Prevent - Health Care Associated InfectionsDocument equipment used with traceability.Be vigilant with ‘Time in Time out’ prescription.Attention to detail.

STOP Order

• Before Insertion.– Clear clinical indication for insertion; to be

documented in clinical notes• Post insertion. Use it or lose it.

– Use should re assessed every shift andreasons documented in clinical/nursingnotes.

– If the device has not been used after 8 hours it should be removed

Creating characters - S.T.O.P.

CAUTI Bundle

Communications as a primary driver

Cwm Taf University Health Board

April May June July August0

10

20

30

40

50

60

70

80

90

Ward BWard A

Introduction of STOP order

• Orthopaedic Wards• % patients

Catheterised prior to theatre

Welsh Ambulance Service Trust (WAST)Cannula only

01-Dec

01-Jan

01-Feb

01-Mar

01-Apr

01-May

01-Jun01-Ju

l

01-Aug

01-Sep

01-Oct

01-Nov

01-Dec

01-Jan

01-Feb

01-Mar

01-Apr

01-May

01-Jun01-Ju

l

01-Aug

01-Sep

01-Oct

01-Nov

01-Dec

01-Jan

01-Feb

01-Mar

01-Apr

01-May

01-Jun

0

50

100

150

200

250

300

243

198

148.5

90108

94.5

Insertion Rate

Insertion Rate

Powys Teaching Health BoardCatheter only-CAUTI

Nov-11

Dec-11

Jan-12

Feb-12

Mar-12

Apr-12

May-12

Jun-12Jul-1

2

Aug-12

Sep-12

Oct-12

Nov-12

Dec-12

Jan-13

Feb-13

Mar-13

Apr-13

May-13

Jun-13Jul-1

3

Aug-13

Sep-13

Oct-13

Nov-13

0

5

10

15

20

25

30

35

CAUTIInsertion rate

PPS 2011Programme Commenced

↑Community Nursing Teams

Hywel Dda Health Board

2011 2012 20130

200

400

600

800

1000

1200

PatientsCathetersPVC

2011 2012 20130

50

100

150

200

250

300

350

400

CathetersPVC

Final word

• Most organisations are reporting 50% reduction in device usage Catheters -Some HB reporting a reduction of 90%

• KIS-Keep it simple.• Work in progress

– community – those cared for at home.– Annual STOP day.

Thank you – Diolch! (Dee olcch)

www.1000livesplus.wales.nhs.uk/stop

@LizSimit

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