Mary A. Petersen, MSN, RN
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Transcript Mary A. Petersen, MSN, RN
Urine-8 Project: Next Step
Mary A. Petersen, MSN, RN: Director of Professional Nursing Practice
Betsy Demarest, BBA, RN, CNOR: Director of Surgical Services
Trinity Medical Center – Quad Cities
Urine-8 Committee Members
Michelle Blackmer, MSN, FNP-BC, RN
Stan Buck, RN, RNFA
Pam Elliott, MBA, BFA
Chris Hansen, MS, RN
Diane Laake, RN, CMSRN
Paula Maddox, MSN, RN, CCRN
Kathryn Marhoefer, MBA, RN
Michelle Mathias, BSN, RN
Mary A. Petersen, MSN, RN (Committee Chair)
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CAUTI Statistics Nationwide
80% of HA UTIs are caused by urinary
catheters
5% deaths from HAIs are urinary
catheter associated
Cost of a CAUTI is estimated at
$500-1000, $2800 if bacteremia
Source: Michigan Keystone Project, 2008
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Trinity CAUTI Rates
CAUTIs 2006-2009
Raw
Rate /1000 pt days
#
2006
103
1.1
Year
2007
77
0.87
2008
89
0.86
2009
69
0.82
Rate / 1000 Foley days
4.25
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First Step
Determine specific nursing opportunities
1.
2.
to decrease foley related UTI’s
Conducted a one-day prevalence study
Primary aims of the study included
Quantify the level of use of indwelling
urinary catheters
Determine the level of adherence to
guidelines
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Methods
2007, 2008 & 2010 all units on each
campus surveyed
List obtained identifying all patients with
Foley and RN providing direct care
Data collector directly observed the
catheterized patients and interviewed RN
Data was collected on a standardized form
2011 & 2012 implemented Adaptive Design
methodology
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Foley Practice Areas Reviewed
Presence of a Foley catheter
Catheter secured to the pt’s abdomen or leg
Tamper Evident Seal intact (TES)
Tubing extended to prevent the development of
dependent loops of drainage tubing
Tubing secured to patient bed or chair to prevent
pulling on system
Drainage system not touching the floor
Urine bag not over filled with urine
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Percentage %
Percentage (%) of Compliance
with Total Foley Practice Areas
2007
2008
2010
8
9
10
SBAR
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Catheter Associated Urinary Tract Infection
(CAUTI) Prevention URINE-8
1
2
Good hand hygiene
3
Proper peri care:
Daily with bath, fecal incontinence, presence of
discharge or drainage and at bedtime
Document peri-care
4
Secure catheter to patient with a Stat Lock
Change Stat Lock every 7 days
Do not use Stat Lock on edematous patient
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U/A upon catheter insertion when symptoms present
▪ Document symptoms in Care cast
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Do not break the red seal
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Remove as soon as medically able
*SCIP – Remove by the end of post-op day 2
Inserted by qualified staff
Sterile technique when inserting catheter
Unobstructed urine flow
No kinks, bends, or dependent loops
Keep urine bag off the floor
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Trinity CAUTI Rates
CAUTIs 2006-2011
Raw
Rate /1000 pt days
#
2006
103
1.1
Year
Rate / 1000 Foley days
2007
77
0.87
2008
89
0.86
2009
69
0.82
4.25
2010
18
0.18
0.97
2011
18
0.19
0.9
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Trinity SCIP Data 2009 & Today
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Nurse Driven Urinary
Catheter Removal Protocol
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Lessons Learned
Nurse to Nurse Collaboration is a practiced
skill
Physician collaboration is key
Physician and Nurse communication /
education is paramount
Adaptive Design and daily monitoring
drives successful implementation
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Conclusion:
HAI’s represent a direct threat to patient
safety, healthcare quality and they are costly.
The Urine-8 project has consistently decreased
the infection rate and identified the positive
financial impact directly attributed to
evidence-based nursing practice.
The next step of adding the nurse driven
catheter removal protocol will continue to
decrease unnecessary Foley days and serve as
a tool to meet SCIP criteria and avoid CAUTI.
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