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We wanted to determine if Catheter Associated Urinary Tract Infections (CAUTI) could be decreased at a 550 bed tertiary care hospital through new applications in the EHR and targeted education. In doing so, we would increase compliance with the new core measure (SCIP- 9) & improve patient outcomes.
Significance:
Virtually all hospital acquired UTIs are associated with indwelling catheters resulting in increased morbidity, mortality, costs & length of stay. The CDC reports up to 69% of CAUTI may be preventable with recommended measures. Those with catheters > 2 days were 21% more likely to develop UTI.
Strategy and Implementation:
The CAUTI taskforce had 3 major objectives. First, they devised an EHR report to empower staff in reducing CAUTI. The daily report is run by each unit and includes: patient demographics, catheter type, insertion date, & line days. The Charge RN on the unit reviews information and follows-up with direct care providers to address concerns and suggests removing catheters as soon as possible for medical patients or by postoperative day [POD] in surgical patients. Second, the computerized order entry system was revised to include catheter removal in post-op order sets and require the MD to document reason for use of a catheter after POD 2. Third, the taskforce developed a plan for teaching RNs & MDs. Topics included early removal of catheters, aseptic technique, care of the patient with a catheter, and routine communication of catheter days in reports. Posters were placed in strategic places to remind staff and in-service programs were offered.
Evaluation:
Since the EHR changes were implemented and initial education process began we achieve a 23% increase in SCIP 9 core measure guideline compliance. The rate of CAUTI decreased by 41% from 1.65 (15 infections/9079 catheter days) in 2009 to 0.98 (2/2058 catheter days) in the first quarter of 2010.
Implications for Practice:
Using the EHR empowered our nurses to be champions in reducing CAUTIs. With our reporting mechanisms, other institutions can develop similar processes to decrease catheter days and UTI rates. This has a significant impact on core measure compliance, reimbursement, and patient outcomes.