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During Q1FY10, a rising Catheter Associated Urinary Tract Infection (CAUTI rate prompted a quality improvement initiative for process change with a goal to reduce the CAUTI to 0.75/1000 catheter days.
Significance:
The incidence of hospital acquired infections (HAI) is an increasing patient safety concern. CAUTI account for 40% of all HAIs, affecting approximately 600,000 patients annually.
Strategy and Implementation:
An interdisciplinary team of physicians, nurses and information technology specialists was developed to create a plan and evaluate this issue. Collaboratively, existing practices were reviewed, effectiveness of Electronic Health Record (EHR) documentation was examined, and the literature was consulted to incorporate a best practice standard. As a result, the CAUTI Initiative was developed. The initiative limits the use of indwelling catheters through the use of insertion inclusion/exclusion criteria and nurse utilization of bladder scanning and straight catheterization practices. A change in the EHR allowed for more accurate documentation of indwelling catheter insertion, bladder scanning and straight catheterizations. Urinary catheter placement and removal orders were added to medical and surgical ordersets and the order entry options to increase core measure compliance. Once the initiative was developed, interdisciplinary education was required for all providers and nursing staff.
Evaluation:
EHR reports of indwelling catheter use, compliance with CMS guidelines and accurate documentation resulted in a rate decline of 1.6/1,000 catheter days to 0.0 for 5 months, a decline of indwelling catheters placed from 495 to 282/month and an increase of straight catheterizations from 21 to 57/month
Implications for Practice:
This initiative has lowered supply cost by nearly $5000 over 6 months, and significantly improved the facility CAUTI rate, impacting overall cost effectiveness and patient safety and quality of care.