Publication Title

Academy of Medical-Surgical Nurses (AMSN) Annual Conference in Toronto, Ontario Sept 12th – Sept 14th

Document Type

Presentation

Publication Date

9-2024

Keywords

california; sjmc

Abstract

Increased utilization and prolonged dwell times of indwelling urinary catheters (IUCs) are directly related to the risk of catheter-associated urinary tract infections (CAUTIs)- the fifth most common type of healthcare associated infection (HAI). The National Health and Safety Network (NHSN) uses the Standardized Utilization Ratio (SUR) metric to measure and compare device utilization in acute care hospitals across the nation. The national target SUR benchmark is 1.0, and a SUR under 1.0 indicates less device usage than NHSN predicts on an inpatient unit. In 2022 a Neuro Med-Surg unit experienced an overall SUR of 1.047 with 2 CAUTIs observed. A multidisciplinary team of clinical nurses, a patient care technician, the nurse manager, infection prevention, a nurse educator, and the director of quality was formed to carry out a performance improvement project. The team performed a Plan Do Study Act (PDSA) cycle aimed to decrease SUR and reduce the risk and incidence of CAUTI. The project launched in January of 2023 with a goal to decrease the SUR by 10% by July of 2023. The team analyzed data and created a process map used to identify gaps in practice and design a future state. The team identified 6 strategies to facilitate moving to the desired future state that included: the creation of retention protocol and IUC hand-off education packets given to new hires by preceptors to reinforce knowledge of existing protocols; pericare in-services on the unit provided by the Quality Care Champions; creating a process for obtaining an IUC discontinuation order within 48 hours of insertion as well as for a discontinuation order for any patient transferring into the unit with an IUC in place; development of a visual management tool in the shape of a bladder in patient rooms displaying the number of days the IUC has been in place and the date and time of the last pericare performed; revision of an audit tool used to assess IUC appropriateness and CAUTI bundle elements; and the development of a recognition program for any IUC discontinued within 48 hours. These strategies launched in April of 2023 resulted in a 9.7% decrease in SUR by July 2023. Additionally, as of February 2024, an overall 15% reduction in SUR has been sustained since the launch of the Quality Care Champions strategies in April 2023, and zero CAUTIs have been observed. The creation of the Quality Care Champion team has led to a significant and sustained decrease in SUR and CAUTI. This process improvement project highlights the impact of an engaged multidisciplinary team to reduce risk of harm caused by HAIs to patients and enrich the overall quality of care.

Specialty

Hospital Medicine

Specialty

Nursing

Specialty

Quality

Comments

Also presented at the Providence Research Symposium, September 2024

References

1. Advani, S. D., & Fakih, M. G. (2019). The evolution of catheter-associated urinary tract infection (CAUTI): Is it time for more inclusive metrics? Infection Control and Hospital Epidemiology, 40(6), 681–685. https://doi.org/10.1017/ice.2019.43

2. National Healthcare Safety Network Patient Safety Component Manual. Centers for Disease Control and Prevention. Updated January 2024. Accessed on 4/8/2024

3. Narula, N., Lillemoe, H. A., Caudle, A. S., Chemaly, R. F., Anderson, J. J., Segal, C., Porter, C. A., Swisher, S. G., Levenback, C. F., & Aloia, T. A. (2019). Postoperative Urinary Tract Infection Quality Assessment and Improvement: The S.T.O.P. UTI Program and Its Impact on Hospitalwide CAUTI Rates. Joint Commission journal on quality and patient safety, 45(10), 686– 693. https://doi.org/10.1016/j.jcjq.2019.06.001

4. Yacoub Abuzied, Sami Ayed Alshammary, Trad Alhalahlah, & Shreemathie Somduth. (2023). Using FOCUS-PDSA Quality Improvement Methodology Model in Healthcare: Process and Outcomes.Global Journal on Quality and Safety in Healthcare, 70 72.https://doi.org/10.36401/JQSH-22-19

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