The business case for CNS leadership to fire up a shared governance team to reduce CAUTI

Purpose:
Research indicates the best approach to decrease catheter-associated urinary tract infections is to decrease urinary device days. The CNS and the shared governance team instituted evidence-based change strategies to decrease device days on medical-surgical units.

Significance:
30 million indwelling urinary catheters are inserted annually in the U.S.; an estimated 50% have no documented indication. CAUTI has many adverse outcomes including sepsis and increased mortality (Gould et al, 2009). Data in a large community hospital illustrates 55% without proper indication.

Strategy and Implementation:
Baseline data from unit-based CNS rounding and urinary catheter bundle compliance audits exposed the opportunity for improved catheter maintenance and appropriate urinary device utilization. This data was presented to the medical-surgical interdisciplinary quality council by the CNS and used as a baseline for the evaluation of improvement interventions. The CNS utilized audit and transparent feedback to the quality council as a method to influence the motivation to change practice and decrease device utilization. Change theory influenced the sharing of innovations between unit representatives to decrease device utilization. An electronic tool was created in Excel, which provided a formula for the immediate calculation of daily device utilization on each unit for the direct care nurse. Data was then provided by unit for transparent presentation and discussion at the quality council (Hysong, et al, 2006). CNS mentoring and rounding reinforced appropriate utilization of catheters.

Evaluation:
Greater than 50% of the units illustrated a decrease in device days for indwelling urinary catheters. Half of the units achieved and sustained 100% compliance with the maintenance bundle.

Implications for Practice:
CNS leadership and mentoring of direct care nurses through a shared governance council promotes consistent improvement in nurse sensitive indicators such as CAUTI. Timely transparent reporting of data improves the direct caregiver's motivation to decrease device utilization.