Meeting the EMR documentation challenge for best practice CAUTI prevention standards

Purpose:
Recognizing CAUTI as the greatest hospital associated infection risk today empowers nurses to utilize best practices by decreasing catheter days and to demonstrate compliance through documentation as recommended by The Joint Commission to meet CAUTI prevention standards.

Relevance/Significance:
Patients deserve the safest environment possible. National patient safety goals for infection prevention includes assuring only those devices absolutely necessary will be used for patient care. With a goal of reducing foley catheter days and CAUTI, front line nurses are responsible for knowing and documenting the indication for use, the accepted insertion guidelines, and need for daily review. In reviewing documentation we recognized the CAUTI prevention standard was not being met.

Strategy and Implementation:
National patient safety goals were reviewed with staff at nursing skills days. An ICU CCRN nurse made and presented a CAUTI prevention poster focusing on the risks indwelling catheters pose for patients, appropriate indications for use, insertion guidelines, and early removal. Our team consisted of an Infection Prevention nurse, nurse educators, bedside nurses and Information Technology staff. Meeting regulatory requirements was a priority in updating the electronic medical record (EMR). We incorporated approved CDC and Joint Commission indications, a standard of care reference statement, and a daily review of the need for a catheter. Education delivery was an interactive e-learning module developed by the team and executed by the education department. It was mandated for every RN, LNA, and tech that cared for patients with urinary catheters. The EMR live domain was upgraded and implemented following the education completion due date. Support continued after the initial launch.

Evaluation:
Education, awareness, increased vigilance in catheter insertion, maintenance and prompt discontinuation of urinary catheters has empowered bedside nurses towards a nurse driven protocol. Since implementing EMR practice changes, organizational CAUTI's are well below the national average at only three cases hospital wide in fiscal year 2015, after the changes in EMR documentation were executed.

Implications for Practice:
Practice at the hospital was assessed in regards to meeting national standards (CDC, Joint Commission). The EMR update and practice change increases quality care for patients by providing earlier catheter removal. Nurse empowerment was increased through nurse driven catheter removal protocols.