Features

Reduced Infection and Improved Outcomes

Nurse-led initiative decreases indwelling catheterizations and CAUTIs

A team of nurses in the medical intensive care unit (MICU) at Abington Hospital-Jefferson Health, in Abington, Pa., identified a problem with indwelling catheterization utilization and catheter-associated urinary tract infections (CAUTIs) in their unit, resulting in the implementation of an evidence-based process improvement plan. The goal was to decrease utilization of indwelling catheters and reduce CAUTI rates, thus improving patient outcomes.

Improvement Plan
In December 2013, the utilization rate in the MICU was 0.77 urinary catheters per patient day, with an associated CAUTI rate of 2.59 per 1,000 catheter days. In January 2014, the utilization rate was 0.69 and the CAUTI rate had risen to 5.17-well above the benchmark of 0.56, according to a National Healthcare Safety Network (NHSN) data summary.

The CAUTI team began the process improvement plan by designing an educational presentation for all MICU nurses. It reviewed CDC guidelines for appropriate urinary catheter use, evidenced-based insertion techniques, care of indwelling catheters, the pathogenesis of CAUTIs, and CMS reimbursement. The hospital's catheter removal protocols and portable bladder ultrasound guidelines for retention were reviewed, as was the importance of using alternatives.

SEE ALSO: Time Management for Hospital Executives

The CAUTI team initiated "daily review of necessity" conversations with each nurse caring for patients with indwelling catheters. These conversations reminded nurses of the guidelines for appropriate catheter use and timely removal. In addition, the CAUTI team began reminding primary nurses to remove the catheter on day 3 (to conduct a trial void), then to follow the bladder scanning guidelines and intermittent catheterization, if necessary. Over time, primary nurses were removing catheters on their own-and educating residents and nurses who were pulled from other units to do the same.

MICU nurses

L to R: Kelly Purpura, MSN, RN, Dena Lampone, MSN, RN, Tracey Tolchin, RN, CCRN and Lynnann Barker, BSN, RN, CCRN, are members of Abington Hospital-Jefferson Health's CAUTI team. Jeffrey Leeser/thanks to Abington Hospital-Jefferson Health

The CAUTI team kept records of all patients with catheters and communicated face-to-face and via email to ensure that all catheters were appropriate and necessary. This sometimes included initiating conversations and following up with attending physicians. For example, a member of the team might have a conversation with a physician about a catheter that needed to stay in place for an additional 24 hours. At shift's end, one CAUTI team member would inform the next CAUTI team member, so that he or she could have a conversation with the attending physician over the next 24 hours.

Remarkable Results
CAUTIs were eradicated in the MICU for 12 consecutive months: Zero occurred between September 2014 and August 2015. The MICU experienced one CAUTI in September and one in October 2015; the rate dropped again to zero in November, where it remains as of April 2016.

The process had a substantial impact on the infection rate and strongly influenced utilization rates. From July 2014 to October 2015, utilization rates dropped and remained consistently below the NHSN benchmark of 0.56. Utilization decreased 48% from July 2014 to September 2015. Although utilization jumped slightly above the newly-established benchmark of 0.49 in October and November, MICU utilization decreased below the benchmark again in December, where it has been sustained to the present.

In addition, Abington's department of epidemiology noticed an improvement in CAUTI rates overall. The CAUTI team's timely removal of catheters prior to transfer out of the MICU decreased utilization elsewhere. The hospital's overall utilization rate decreased from 0.17 per patient day in 2014, to 0.13 per patient day in 2015, to 0.12 per patient year-to-date for 2016.

Kelly Purpura is the assistant nurse manager in the MICU at Abington Hospital-Jefferson Health in Abington, Pa.




You Might Also Like...

Catheters: A Connection to Infection

Nurses are taught to prioritize and catheter care can sometimes be put on the back burner.

Closing the Loop on Infection Control

Skilled nursing facilities have significantly reduced nosocomial infection rates using airborne pathogen control technology.

Infection Control in Orthopedics

Nurse-driven infection prevention measures span the care continuum at Hoag Orthopedic Institute, Irvine, Calif.

Reducing Sepsis Mortality

A strategic systemwide initiative reduced mortality by more than 60%.


Articles Archives


     

Email: *

Email, first name, comment and security code are required fields; all other fields are optional. With the exception of email, any information you provide will be displayed with your comment.

First * Last
Name:
Title Field Facility
Work:
City State
Location:

Comments: *
To prevent comment spam, please type the code you see below into the code field before submitting your comment. If you cannot read the numbers in the below image, reload the page to generate a new one.

Captcha
Enter the security code below: *

Fields marked with an * are required.

View the Latest from ADVANCE

 

Search Jobs

Go
 
 
 

Back to Top

© 2017 Merion Matters

660 American Avenue Suite 300, King of Prussia PA 19406

1-484-804-4888