AACN CSI CAUTIHAWKS: Tackling CAUTI in the ICU

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2 AACN CSI CAUTIHAWKS: Tackling CAUTI in the ICU Alisa Bowman, RN, CCRN Sarah Gattis, RN, CCRN Lauretta Lowther, RN, BSN, CCRN Laura Mills, RN, BSN, CCRN Hospital Logo or Name, Calibri 12 pt Bold

Swedish Medical Center First Hill Intensive Care Unit Located in Seattle, Washington 26-Bed Intensive Care Unit plus 16-IMCU Beds Medical and Surgical

4 Swedish Medical Center First Hill Intensive Care Unit Located in Seattle, Washington 26-Bed Intensive Care Unit plus 16-IMCU Beds Medical and Surgical Patient Population Part of the Providence Health System Joint Commission Certified Stroke Center Beacon Silver award recipient Striving for Magnet Status

5 Why Catheter-Associated Urinary Tract Infections (CAUTIs)? Improve patient outcomes Consistently above National Healthcare Safety Network benchmark rate Loss of Center for Medicare & Medicaid Services (CMS) reimbursement Loss of top Leapfrog designation

6 Project Purpose and Goals Improve patient outcomes by decreasing CAUTI rate by 50% by October 31, 2015 Educate 90% of staff by October 31, 2015 Establish 25 CAUTI champions

7 Project Initiatives Improve patient outcomes Empower staff through education Remove in less than 48 hours Standardize catheter care Standardize 0600 catheter removal time Establish staff CAUTI champions

8 Key Activities and Dates October 2014 November 2014 December 2014 January 2015 February 2015 March 2015 April 2015 May 2015 June 2015 Begin AACN CSI Small Test of Change Online Staff Survey CSI Kick-off Party NTI Poster 2 nd Quarter Kick-Off CCQC #1 Infection Nurse Quality Leader CCQC #2 CSI Midterm T-shirt Rollout System Wide Shared Leadership Abstract for NTI 2016 Background Research and Data Collection Staff CAUTI-Prevention Education

9 Key Activities and Dates July 2015 August 2015 September 2015 October 2015 November 2015 December 2015 January 2016 February 2016 March-May 2016 End of Data Collection October 31, 2015 Online Staff Post- Project Survey AACN CSI Innovation Conference NTI Podium Presentation Infection NQL Shared Leadership Unit Final Celebration Staff CAUTI-Prevention Education

10 CAUTIHAWKS Kick-Off Party February 12, 2015

12 Toolkit Surveys Swag: T-shirts, pens, and mousepads Education: teaching sessions, trifold posters, handouts, PowerPoint presentations Food and parties Gifts card incentives Educational video

13 Teaching Points Removal within 48 hours the #1 risk factor for CAUTI is prolonged urinary catheter use! Center for Disease Control indications for urinary catheter use Nurse-driven protocol CAUTI bundle Use only approved catheter care products 0600 removal CAUTI prevention tips and tricks

14 Short-Term Goals (3 Months) April 30, 2015 Goal Reduce CAUTI rate 20% Educate 50% of staff Establish 10 CAUTI champions Results 0 CAUTIs (compared to 4 in same time period last year) 71% of staff educated 25 CAUTI champions established

15 Number of CAUTIs 3-Month Data % decrease in CAUTI at 3 months February 2014-April 2014 February 2015-April 2015 Time Period

16 Intermediate Goals (6 Months) July 31, 2015 Goals Reduce CAUTI rate 40% Educate 75% of staff Establish 15 CAUTI champions Results 1 CAUTI (compared to 8 in same time period last year) 88% of staff educated 40 CAUTI champions established

17 Number of CAUTIs 6 Month Data % decrease in CAUTI at 6 months February 2014-July 2014 February 2015-July 2015 Time Period

18 Long Term Goals (9 Months) October 31, 2015 Goals Reduce CAUTI rate 50% Educate 90% of staff Establish 20 CAUTI champions Results 1 CAUTI (compared to 12 in same time period last year) 91% of staff educated >50 CAUTI champions established as resources for entire hospital

19 Number of CAUTIs 9 Month Data % decrease in CAUTI at project end February 2014-October 2014 February 2015-October 2015 Time Period

20 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Number of CAUTIs CAUTI Numbers by Month CAUTI Numbers by Month Medical/Surgical ICUs/IMCU Swedish Medical Center First Hill Campus CAUTIHAWK Project Rollout Month

21 Decrease in CAUTI Rates

22 Urinary Catheter Utilization Rates

23 Fiscal Impact Projected Savings Number of CAUTIs Prior to Launch of CSI Project (February 2014 October 2014) Estimated Cost per CAUTI Estimated cost per CAUTI of $6,913 1 Future CMS reimbursement Projected Project Savings 12 $6,913 1 $82,956 1 Centers for Medicare & Medicaid Services. Analysis report: Estimating the incremental costs of hospital-acquired infections (HACs) Payment/HospitalAcqCond/index.html. Accessed May 26, 2014.

24 Fiscal Impact Difference in CAUTI numbers: Baseline Project Estimated Cost per CAUTI Actual Project Savings 12 1 = 11 $6,913 1 $76,043 Actual project savings: $76,043 Projected future savings: $76,043 for 9 months $101, annual savings Future CMS reimbursement Decreased length of stay and increased patient turnover

25 Barriers and Key Challenges 0600 removal Meeting physician need for accurate intake and output Educating float pool staff, travelers, and Float Pool staff Effectively using our CAUTI champions Increased workload for staff Sustaining support and enthusiasm

26 Unintended Positive Outcomes to Date Increased staff engagement Invited to systemwide shared leadership Requests for CAUTI prevention tips from outside nursing units Support from intensivist group Presented poster at AACN NTI 2015 Podium presentation at AACN NTI 2016

27 Presenting our work at the Systemwide Shared Leadership meeting Our Charge Nurses and Managers CAUTIHAWK Champions! Presenting our Poster at AACN NTI 2015!

28 What We Have Learned Well-balanced team Learning individual strengths and roles Strength in numbers Impact of team presence on unit Impact of branding a project Encouragement and support are necessary to success

29 Sustainability CAUTIHAWK swag Educational video First Hill and multi-campus presentations In-services Multidisciplinary round discussions regarding catheter use Intensivist bonuses now tied to low CAUTI rates WellSpot CAUTI Web site Poster presentation at AACN NTI 2015 and 2016 Podium presentation at AACN NTI 2016

30 References 1. Alexaitis I, & Broome B Implementation of a nurse-driven protocol to prevent catheterassociated urinary tract infections. J Nurs Care Qual, 2014: 29(3), doi: /ncq Centers for Medicare & Medicaid Services. Analysis report: Estimating the Incremental Costs of Hospital-Acquired Infections (HACs) Service-Payment/HospitalAcqCond/index.html. Accessed May 26, C.R. Bard, Inc. Foley catheter care & maintenance: Patient education guide Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA. Healthcare Infection Control Practices Advisory Committee. Guideline for Prevention of Catheter-Associated Urinary Tract Infections Accessed May 25, Trautner B W, & Darouiche R O. Role of biofilm in catheter-associated urinary tract infection. American Journal of Infection Control. 2004:32(3): doi: /j.ajic

31 Thank You Joya Pickett, PhD, RN, CCNS, ACNS-BC, CCRN, coach June Altaras, CEO, and Margo Bykonen, CNO Our Managers, Staci, Renae, and Marie Christine Meyers, MSN, RN Director of Critical Care Services Our staff RNs and intensivists for tackling CAUTI Thank you Marian, Debbie, AACN, and CSI for the opportunity to incite change and improve patient outcomes on our unit!

AACN CSI CAUTI s Angels. Marie Szalanski RN, CNIII Elizabeth Lockhart BSN RN, CNII Amanda Gress RN, CNII Barbara Gabriel BSN RN, CNIII

AACN CSI CAUTI s Angels. Marie Szalanski RN, CNIII Elizabeth Lockhart BSN RN, CNII Amanda Gress RN, CNII Barbara Gabriel BSN RN, CNIII AACN CSI CAUTI s Angels Marie Szalanski RN, CNIII Elizabeth Lockhart BSN RN, CNII Amanda Gress RN, CNII Barbara Gabriel BSN RN, CNIII Duke Regional Hospital Critical Care Unit U.S. News & World Report