Transcript On the CUSP: Stop BSI

On the CUSP: Stop CAUTI
National Expansion
Catheter-Associated
Urinary Tract Infection
Immersion Call
1
Overview of Today’s Call
• Why this initiative is important
• Project overview:
– Expected outcomes
– What it requires
• Comprehensive Unit-Based Safety Program
• Data requirements
• What are the next steps
2
Project Goals
• Reduce CAUTIs in participating units by 25%
– Appropriate placement
– Appropriate continuance
– Appropriate utilization
• Improve patient safety culture on participating
units
3
Project Overview
Hospitals or Hospital Systems
State Hospital Associations
National Project Team
Project
Management
Clinical Faculty &
Data
Management
4
CUSP Faculty
National Project Team
Partner
Team Members
Health Research and Educational Trust
Steve Hines
Marchelle Djordjevic
Deb Bohr
Centers for Disease Control and Prevention
Carolyn Gould
Kathy Allen-Bridson
MHA Keystone Center for Patient Safety &
Quality
Sam Watson
Chris George
Dr. Sanjay Saint
Dr. Mohamad Fakih
Johns Hopkins Quality Safety Research Group
Chris Goeschel
Sean Berenholtz
5
Why This Initiative is Important
• 600,000 patients develop hospital acquired
UTIs per year
• This accounts for 40% of all hospital acquired
infections
• Catheter associated infections (CAUTI)
comprise 80% of these cases
6
Why This Initiative is Important
•
•
•
5 million urinary catheters placed per year
(US)
80% of UTIs are catheter associated
Catheter-risk of bacteruria:
 Per day: 5%
 1 week: 25%
 1 month: 100%
7
Why This Initiative Is Important
• Reduction in UC use by about 20% at St. John
Hospital in Michigan
• Similar levels of reduction seen in hospitals across
Michigan (unpublished data)
8
CUSP & CAUTI Interventions
CUSP
CAUTI
1. Educate on the science of
safety
1. Care and Removal Intervention
Removal of unnecessary catheters
2. Identify defects
Proper care for appropriate catheters
3. Assign executive to adopt unit
2. Placement Intervention
Determination of appropriateness
4. Learn from Defects
Sterile placement of catheter
5. Implement teamwork &
communication tools
9
Care and Removal at a Glance
Intervention Group (1 - 2 units)
Week 1-3
10 days
Pre-intervention: UC data collection w/analysis
of need
Week 3-4
10 days
Intervention: UC data collection w/analysis of
need plus nursing staff education/ intervention.
Rationale given to obtain orders to dc non
needed Foleys with nursing
Week 5-12
8 days
Post-intervention: UC data collection w/analysis
of need, once a week for 8 weeks
Quarterly
Post-intervention: UC data collection w/analysis
of need, once a week each quarter
10
Insertion at a Glance
Intervention Group (ED or OR)
Pre-intervention: UC data collection w/analysis
of need
Intervention: UC data collection w/analysis of
need plus nursing staff education/ intervention.
Rationale given to obtain orders to dc non
needed Foleys with nursing
Post-intervention: UC data collection w/analysis
of need, once a week for 8 weeks
Post-intervention: UC data collection w/analysis
of need, once a week each quarter
11
Expected Outcomes
• Increased awareness of appropriate
indications for indwelling urinary catheter use
• Reduced use of indwelling urinary catheters
• Improved caregiver accountability to assess
need and trigger UC discontinuation when UC
no longer necessary
• Reduced risk of urethral trauma with
reduction in utilization
• Reduced patient discomfort
12
Expected Outcomes
•
•
•
•
•
Reduction in bacteriuria
Reduction in symptomatic UTIs
Shortened Length of Stay
Decreased Cost per stay
Improved sensitivity to “patient dignity”
13
Comprehensive Unit-based Safety Program (CUSP)
An Intervention to Learn from Mistakes and Improve Safety Culture
1.
Educate staff on science of safety
http://www.safercare.net
2.
Identify defects
3.
Assign executive to adopt unit
4.
Learn from one defect per quarter
5.
Implement teamwork tools
Timmel J, et al. Jt Comm J Qual Patient Saf 2010;36:252-260.
14
What Participation Requires
Hospital Unit
The Hospital Unit will need to:
• Participate for the length of the project
• Assemble team
• Assign team leader (10% effort)
• Engage executive champion
• Engage physician champion
• Submit data
• Hold monthly patient safety meetings
• Listen to content and coaching calls
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What Participation Requires
Data Submission
Intervention
Measure
Frequency
Organizational CAUTI Readiness Assessment
Information
CUSP
Care and
Removal
Insertion
Once at start of project
HSOPS
Baseline and post
intervention
Team Check-up Tool
Quarterly
Process Prevalence & Appropriateness
Weekly within Protocol
Outcome
- UTI Rate / Device Days
Monthly within Protocol
- UTI Rate / Patient Days
Monthly within Protocol
TBD
TBD
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7
14
21
28
IMPLEMENTATION
SUSTAINABILITY
PERIOD 1
4
11
18
25
2
9
16
23
30
Baseline Data Collected
1
2
3
4
5
8
9
10
11
12
15
16
17
18
19
22
23
24
25
26
29
30
31
Intervention Data Collected
1
2
5
6
7
8
9
12
13
14
15
16
19
20
21
22
23
26
27
28
29
30
Intervention Data Collected
3
10
17
24
31
4
11
18
25
5
12
19
26
6
13
20
27
7
14
21
28
6
13
20
27
3
10
17
24
1
8
15
22
29
JUN 2011
JUL 2011
2
9
16
23
30
AUG 2011
BASELINE PERIOD
3
10
17
24
31
4
11
18
25
S
SEPT 2011
5
12
19
26
S
OCT 2011
S
Cohort 2 PROCESS
M
T
W
T
F
No Data Collected
1
2
3
6
7
8
9
10
13
14
15
16
17
20
21
22
23
24
27
28 29
30
No Data Collected
1
4
5
6
7
8
11
12
13
14
15
18
19
20
21
22
25
26
27
28
29
5
12
19
26
3
10
17
24
31
7
14
21
28
4
11
18
25
2
9
16
23
30
Cohort 2 OUTCOME
M
T
W
T
F
Baseline Data Collected
1
2
3
6
7
8
9
10
13
14
15
16
17
20
21
22
23
24
27
28 29
30
Baseline Data Collected
1
4
5
6
7
8
11
12
13
14
15
18
19
20
21
22
25
26
27
28
29
Baseline Data Collected
1
2
3
4
5
8
9
10
11
12
15
16
17
18
19
22
23
24
25
26
29
30
31
Intervention Data Collected
1
2
5
6
7
8
9
12
13
14
15
16
19
20
21
22
23
26
27
28
29
30
Intervention Data Collected
3
10
17
24
31
4
11
18
25
5
12
19
26
6
13
20
27
7
14
21
28
S
4
11
18
25
2
9
16
23
30
BASELINE PERIOD
6
13
20
27
3
10
17
24
IMPLEMENTATION
1
8
15
22
29
SUSTAINABILITY
PERIOD 1
No Data Collected
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
NOV 2011
No Data Collected
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
1
2
3
No Data Collected
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
25
26
27
28
29
30
DEC 2011
No Data Collected
4
5
6
7
8
9
10
11
12
13
14
15
16
17
24
18
19
20
21
22
23
24
31
25
26
27
28
29
30
31
Post-Intervention Data Collected
SUSTAINABILITY
PERIOD 2
Post-Intervention Data Collected
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
JAN 2012
SUSTAINABILITY
PERIOD 2
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
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Data Collection Schedule
MEASURE
CAUTI Rates (Outcome)
1. Number of Symptomatic CAUTI’s
attributable to your unit for that month
2. Number of urinary catheter days per
month (number of patients with urinary
catheter device is collected daily at the
same time each day and the total is
summed for the month)
3. Number of patient days per month
Prevalence & Appropriateness (Process)
1. Assess each patient on the unit for the
presence of a urinary catheter
2. Record the reason for the catheter
DATA COLLECTION SCHEDULE
DATES
Collect monthly for 5 months beginning in 2011:
June and quarterly thereafter (JuneJune 1-30
August will be considered baseline)
July 1-31
August 1-31
September 1-30
October 1-31
2012:
January 1-31
April 1-30
July 1-31
October 1-31
Baseline: Mon-Fri for 3 weeks
Baseline: August 1-5, 8-12, 15-19,
2011
Prospective: Mon-Fri for 2 weeks, 1 day Prospective: September 5-9, 12-16,
per week for 6 weeks then one week per 20 & 27
quarter thereafter
October 4, 11, 18, 25
2012:
January 9-13
April 9-13
July 9-13
October 15-19
What are the Next Steps
Timeline at a glance
March 2
Unit attends first immersion call
March -May
Unit attends Kick Off Meeting and begins participating in
national content/coaching calls
March - May
- Participate in content and coaching calls
- Collect and report quarterly data to monitor change
June
Unit begins base line data collection and exposure survey
20
Who to Contact with Questions
Kristina Davis, Research Specialist, HRET
[email protected]
312-422-2644