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

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

hospitals in the state Best Community Hospital in North Carolina

3 Duke Regional Hospital Critical Care Unit U.S. News & World Report s Best Hospitals List ranks 4 th out of 147 hospitals in the state Best Community Hospital in North Carolina Magnet-Designated Hospital for Nursing Excellence Joint Commission Certified Stroke Center 22-bed Intensive Care Unit

4 Duke Regional Hospital Critical Care Unit Patient diagnoses are variable through many specialties Medical Surgical Neurological Cardiac Bariatric Renal

5 Increased Incidence of Catheter- Associated Urinary Tract Infections (CAUTIs) in the CCU What is the identified problem? Increased device (Foley catheter) utilization Increased rate of infection (primary and secondary) Lack of knowledge Proper implementation of catheter usage, Bladder scanner, Urinary retention and catheter insertion policy, Early removal of the Foley catheter Increased use of float/agency nurses due to high census

Increased device (Foley catheter) utilization Increased rate of infection (primary and secondary) Lack of

6 Purpose and Goals The purpose of this project was to improve the incidence/scores for... Patient satisfaction National Patient Safety Goal 2013 Preventing increased length of stay Preventing secondary infections (decreasing antibiotic use and drug-resistant bacteria) Decreasing cost spent on hospitalization related to CAUTI Staff EMPOWERMENT and EDUCATION Centers for Medicare & Medicaid Services. (April 18, 2012). Analysis report: Estimating the incremental costs of hospital-acquired conditions (HACs).

(decreasing antibiotic use and drug-resistant bacteria) Decreasing cost spent on hospitalization related to CAUTI Staff

8 Action Plan Test of Change Implemented by CAUTI s Angels and the buddy system. March Madness March 4, 2013: Staff survey sent out for anonymous feedback regarding catheter care and nurse driven protocol Suggestions for Success (Response to survey feedback)

9 Action Plan March Madness March 11, 15, & 16, 2013 Kickoff Party Staff re-education for Foley catheter insertion and care CCU Standards of Care New informational bulletin board displaying the AACN project National Patient Safety Goal Audits

care CCU Standards of Care New informational bulletin board

10 Short-Term Project Goals (3 Months) Goal Implement the Test of Change Hand out survey and obtain results CAUTI Kickoff event completed 50% of staff compliant with CAUTI re-education Results Buddies assigned during huddle Suggestions for Success sent out in response to survey results Kickoff event March Madness held on March 11, 15, 16, % of staff re-educated during our kickoff event

Buddies assigned during huddle Suggestions for Success sent out in response to survey results

11 Intermediate-Term Project Goals (6 Months) Goal 75% of CCU staff re-educated on CAUTI prevention and Foley catheter care 75% of staff compliant in charting according to CCU standards of care CAUTI rates reduced by 50% Continued updates and FAQs regarding CAUTI reduction Continue with Test of Change Results 98% compliance achieved Was measured by weekly audits. 4 CAUTI in August 2012 reduced to 0 CAUTI in August 2013 Information displayed on CAUTI Bulletin Board Buddy System continued success

regarding CAUTI reduction Continue with Test of Change Results 98% compliance achieved Was measured by weekly audits.

12 Long-Term Project Goals (1 Year) Goal Results $ CAUTI Cash $ Magnet Implementation Update staff on CAUTI initiative Hang dry erase boards Cash given to staff for implementing bladder scanner or for early removal of catheter. Can spend in the treasure chest Visual cue placed outside of patient room to remind staff to REMOVE THAT FOLEY Displaying progress on the CSI project via bulletin board and during staff meetings Will hang 2-3 dry erase boards throughout the CCU displaying how many days CAUTI free 75% reduction of CAUTI Continue to obtain results from Infection Control 100% staff compliance on CAUTI re-education To date, 99% of staff are compliant with CAUTI Reeducation

Can spend in the treasure chest Visual cue placed outside of patient room to remind staff to REMOVE THAT FOLEY Displaying progress on the CSI project via bulletin board

15 Challenges Process to obtain grant money Support from unit manager and AACN Faculty Time Limited number of days to meet. Meetings held in addition to normal staffing hours Lots of s/text messages to discuss project goals Scheduling Use of Float and Agency nurses due to high census

Meetings held in addition to normal staffing hours Lots of emails/text

16 Challenges Patient Population Mixed CCU/ICU-Medical-Surgical, step-down, long-term ventilator dependent Using nurse driven protocols and nursing judgment Motivating Staff Naysayers, resistance to change Incentives, ie., CAUTI Cash

dependent Using nurse driven protocols and nursing

17 Rate per 1,000 Urinary Catheter Days Comparison Period Prior to CSI Project CCU Catheter-Associated UTI Events from 10/1/2011 to 10/31/

Rate per 1,000 Urinary Catheter Days 8 7 6 5 4 3 After the CSI Project Began 5.

18 Rate per 1,000 Urinary Catheter Days After the CSI Project Began 5.4 CCU Catheter-Associated UTI Events from 11/1/2012 to 11/30/ KICK OFF

19 Fiscal Impact Average additional cost for the hospital stay of a patient who acquired a CAUTI: $6,913 (CMS, 2012)* Prior to the CSI project (October 2011-October 2012), there were 19 CAUTIs in the CCU Total estimated cost: $131,347 During the CSI project (November 2012-November 2013), there were 9 CAUTIs in the CCU Total estimated cost: $62,217 Estimated Savings: $69,130 *Using incremental cost with comparable control group Centers for Medicare & Medicaid Services. (April 18, 2012). Analysis report: Estimating the incremental costs of hospital-acquired conditions (HACs).

2013), there were 9 CAUTIs in the CCU Total estimated cost: $62,217 Estimated Savings: $69,130 *Using incremental cost with comparable control

20 Thank You! Thank you to everyone who supported us throughout this project. Caryl Goodyear-Bruch, CSI Faculty Adrienne Olney, AACN CSI Program Manager Joy Vollers, CSI Coach Vicky Orto, Duke Regional Chief Nursing Officer Kim Wood, Critical Care Unit Director Sandy Hawk, Critical Care Unit Manager All of our co-workers at the Duke Regional Critical Care Unit

CSI Coach Vicky Orto, Duke Regional Chief Nursing Officer Kim Wood, Critical Care Unit

21 Questions?

Take CAUTION! Meghan Cardona, RN, BSN, CCRN. Sherry Ann Santarina, RN, BSN, PCCN, CCRN. Sherley John, Merin Thomas, RN, BSN, CCRN RN, BSN

Take CAUTION! Meghan Cardona, RN, BSN, CCRN Sherry Ann Santarina, RN, BSN, PCCN, CCRN Sherley John, RN, BSN Merin Thomas, RN, BSN, CCRN Purpose and Goals Neurosurgical ICU (NSCU) experienced elevated rates