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Transcript of CAUTI (Catheter Associated Urinary Tract Infection) Children's... · (CEI) Bundles report performed...
CAUTI (Catheter Associated Urinary
Tract Infection)
Ariana Colina, RN, BSN, CPNClinical Systems Analyst
CAUTI (Catheter Associated Urinary Tract Infection)
CAUTI - Background
According to the CDC (2017), urinary tract infections (UTIs) are the fourth most common type of healthcare associated infection. The vast majority of the healthcare-associated UTIs are caused by instruments of the urinary tract which include indwelling catheters1.
15-25% of hospitalized patients receive a urinary catheter during their hospital stay1.
1Centers for Disease Control. (2009). Catheter-associated Urinary Tract Infection (CAUTI) Toolkit. Department of Health & Human Services. Retrieved on July 6th, 2017 from https://www.cdc.gov/HAI/pdfs/toolkits/CAUTItoolkit_3_10.pdf
CAUTI – Background
Extended Hospital Stays 2 – 4 Days
Increased Health Care Costs $0.4 – $0.5 billion per year nationally
Patient Morbidity and Mortality Estimated 13,000 attributable deaths annually
Unnecessary antimicrobial use1
1Centers for Disease Control. (2009). Catheter-associated Urinary Tract Infection (CAUTI) Toolkit. Department of Health & Human Services. Retrieved on July 6th, 2017 from https://www.cdc.gov/HAI/pdfs/toolkits/CAUTItoolkit_3_10.pdf
CAUTI – Local Problem
2015 2.9 CAUTIs per 1000 Device Days Infection
Rate Total 7 CAUTIs for 2015
Goal Reduce CAUTIs by implementing the CAUTI Bundle
best practice guidelines using the electronic medical record system.
CAUTI – Design & Implementation
In 2009, the Centers for Disease Control & Prevention (CDC) published updated guidelines for prevention of CAUTIs1.
These guidelines included recommendations for a CAUTI Bundle.
1Lo, E., Nicolle, L. E., Coffin, S. E., Gould, C., Maragakis, L. L., Meddings, J., Pegues, D. A., Pettis, A. M., Saint, S., Yokoe, D. S. (2014). Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals: 2014 Update, Infection Control and Hospital Epidemiology, 35, 5. Retrieved on July 26th, 2017 from http://www.jstor.org/stable/10.1086/675718#fndtn-rf31
CAUTI – Design & Implementation
What is a CAUTI Bundle? Use of appropriate technique for catheter insertion Ensure appropriate management of indwelling
catheters Special approaches for prevention of CAUTIs1
1Lo, E., Nicolle, L. E., Coffin, S. E., Gould, C., Maragakis, L. L., Meddings, J., Pegues, D. A., Pettis, A. M., Saint, S., Yokoe, D. S. (2014). Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals: 2014 Update, Infection Control and Hospital Epidemiology, 35, 5. Retrieved on July 26th, 2017 from http://www.jstor.org/stable/10.1086/675718#fndtn-rf31
CAUTI – Design & Implementation
Project Team Clinical Systems Analyst Clinical Systems Manager Information Technology Infection Control Nurse Practitioner Nursing Director Operations Nursing Manager Medical-Surgical RN ICU RN Physician Education
CAUTI – Design & Implementation
One month project time line Weekly meetings with Project Team Testing completed non-production environment by key subject
matter experts Informal education and training
CAUTI –How Health IT was Utilized
Pre CAUTI Urinary Catheter Insertion order (Foley Insertion)
Provider places Urinary Catheterorder and completes the Urinary
Catheter Type.
CAUTI –How Health IT was Utilized
Provider places Urinary Catheterorder and completes the required field ‘Urinary Catheter Protocol’.
Post CAUTI Urinary Catheter Insertion order (Foley Insertion)
CAUTI –How Health IT was Utilized
The Urinary Catheter Order triggers a Urinary Catheter
Insertion/Discontinuation task for the nurse.
Urinary Catheter Insertion/Discontinuation Nursing Task
CAUTI –How Health IT was Utilized
Once the urinary catheter is inserted, the nurse opens the Urinary Catheter Insertion/Discontinuation task and completes the insertion of the foley.
Urinary Catheter Insertion Flowsheet Documentation
CAUTI –How Health IT was Utilized
Hourly assessment and documentationof the urinary catheter.
Routine Hourly Nursing Documentation
CAUTI –How Health IT was Utilized
Urinary Catheter Necessity Review with Provider Task
A Urinary Catheter Necessity Review with Provider task triggers 48 hours after the
initial catheter insertion order.
CAUTI –How Health It was Utilized
Urinary Catheter Necessity Review with Provider Task
If the patient meets indication for continuation of urinary catheter, the
system will trigger an additional task for necessity for review with the provider in
24 hours.
CAUTI – Value Derived
2015 - Baseline Period 2.9 CAUTIs per 1000 Device Days Infection Rate Total 7 CAUTIs
2016 – Evaluation Period 1.28 CAUTIs per 1000 Device Days Infection Rate Total 3 CAUTIs
reduction after implementation
CAUTI –Value Derived: Patient Safety
525559
757
597 600645 623
472
724
1 13
21
0 02
1
-0.5
4.5
9.5
14.5
19.5
24.5
0
100
200
300
400
500
600
700
800
Total CAUTIs
Total Device Days Total # of CAUTIs Log. ( Total # of CAUTIs)
Compliance Audits
CAUTI –Value Derived: Patient Safety
1.9 1.79
3.963.35
1.67
0 0
4.23
1.38
-1
0
1
2
3
4
5
6
7
8
9
10
# of CAUTIs/1000 Device Days
# of CAUTIs/1000 Device Days Linear ( # of CAUTIs/1000 Device Days)
Compliance Audits
CAUTI –Value Derived: Finance
$758 $758
$2,274
$1,516
$758
$0 $0
$1,516
$758
$0
$500
$1,000
$1,500
$2,000
$2,500
CAUTI Costs
CAUTI Costs Linear (CAUTI Costs)
Compliance Audits
CAUTI –Value Derived: Finance
$5,306
$2,274
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
2015 2016
CAUTI Costs
2015 2016
Decrease in CAUTI Costs
CAUTI – Surveillance
CAUTIs are included in our Clinical Excellence Indicator (CEI) Bundles report performed by the quality department. This information is updated and published on our organization’s web portal for all staff member to view on a monthly basis .
CAUTI – Future State
2017
• Future State - HOUDINI Bundle (Hematuria, Obstruction, Urologic surgery, Decubitus, Intake & Output, Neurogenic bladder dysfunction, Immobilization)
04.2012•EMR Go Live with standard urinary catheter documentation.
09.2014•CAUTI workflow design with bundle documentation changes.
Change Management
Electronic health record change process when a possible optimization is
identified.
Thank you!