Frontline Nurse: Agent of Change in Decreasing Urinary Tract Infections and Creating a Culture of Patient Advocacy

Purpose:
Nursing Leadership recognized the need to propose an aggressive plan to decrease the incidence of UTIs on our unit.A multidiscipliary approach was created to educate all caregivers that have patient contact and provide an open dialogue as to the necessity of the catheter and potential for infection.

Significance:
In 2008, the unit had 54 CAUTIs. By 2010 our infection rate had decreased to 5 through the implemnentation of practice change, strategic planning with providers and promoting nurses to advocate for early removal of IUCs. Device days prior to the onset of this initiative peaked to 240 per month.

Strategy and Implementation:
In our daily care coordination rounds we were able to establish detailed unit criteria for catheter use. Practice change was driven by evidence based research, updated policy,and development of an algorithm for removal of the catheter.Multi-disciplinary patient care rounds were utilized to examine the justification for individual patient's requirement and presence of the IUC. If deemed unwarranted, the device was discontinued. If needed, a plan was implemented with goals addressed for a tentative removal date. Our nurse "UTI Champions" established a data collection tool which identified patient specifics, clinical need and prompters for catheter care. The data collected was used in identifying patients at risk and tracking device days.Device days are entered via shared portal and uploaded to our national database (NDNQI). Through diligence, guidance and education, the nurses advocated for the removal of the IUC when its' presence was not represented in the guidelines.

Evaluation:
This initiative has become part of the unit's culture, and device days have decreased to 120 device days per month. YTD FY 2012, there has only been 2 infections. Ongoing data collection and analysis of the data adds momentum to the initiative.

Implications for Practice:
Our nurses are empowered with the knowledge and tools to be affective in advocating for patient safety and prevention of infection. There is an increase in awareness and autonomy in their practice. Our results have been shared globally within our institution and will be presented on a national level