ON THE CUSP: STOP CAUTI
Cohort 8 - Getting Started
April 25, 2014
2-3:30 pm ET
1
Agenda
• Why Work on CUSP/CAUTI
• On the CUSP/Stop CAUTI Overview
– Cohort 8
– CUSP
– CAUTI Prevention
• Data Reporting
• Getting Started- Next Steps
– Resources
• FHA CAUTI Cohort 8 Work Plan - Monthly Key Activities
• Calls, Webinars, Website, etc.
2
Introductions
•
•
•
•
Introduce yourself (name, hospital, unit)
Describe your unit (e.g. specialty, size, etc.)
Why do you want to participate
What do you hope to gain from participation
– Boca Raton Regional Medical Center
• CVICU, MICU, SICU
– Tampa General Hospital
• 2D 1 & 2
– University of Miami Hospital
• Penthouse North
3
ON THE CUSP: STOP CAUTI
WHY PARTICIPATE
• Healthcare Associated Infections
– Affect 2 Million hospitalized patients each year in the
U.S.
• 32% develop UTIs each year
• 15% develop pneumonia
• 14% develop bloodstream infections
• Annual cost of catheter-associated UTI (CAUTI)
is $450 Million
• Up to 380,000 infections and 9000 deaths
related to CAUTI per year could be prevented
4
ON THE CUSP: STOP CAUTI
WHY PARTICIPATE
• Opportunity to implement a proven, effective culture
change model
• Hospitals can use the CUSP framework for other
process improvement projects
• Opportunity to network and learn from other hospitals
• Access to expert faculty
• Data collection and monitoring support
• Many free resources to support improvement efforts
– www.onthecuspstophai.org
– www.catheterout.org
5
ON THE CUSP: STOP CAUTI
GOALS & EXPECTED OUTCOMES
GOALS:
• Reduce mean CAUTI rates in participating clinical units by 25
percent, and
• Improve safety culture by disseminating CUSP methodology as
evidenced by improved teamwork and communication
EXPECTED OUTCOMES
•
•
•
•
•
•
•
•
•
Increased awareness of appropriate urinary catheter (UC) use
Reduced use of indwelling UCs
Empower staff to discontinue UC when appropriate
Reduced patient discomfort
Reduced incidence of bacteriuria
Reduced rates of symptomatic UTIs
Shortened LOS and decreased cost per stay
Share lessons with others
Specialized support is available for emergency departments
6
ON THE CUSP: STOP CAUTI
Program Overview
Program Requirements:
• Work with your hospital team to reduce CAUTI using
the evidence based practice
• Collect & Submit Data as scheduled
• Outcome data: CAUTI rates
• Process Data: Catheter Prevalence
• Implement the CUSP Program Using the CUSP tools:
• Unit Readiness tool
• Staff Safety Assessment
• Hospital Safety Culture Survey (HSOPS)
• Learning from Defects
• Team Check Up Tool
• Improve CAUTI rates in your hospital
• Develop & implement a Sustainability Plan
7
ON THE CUSP: STOP CAUTI
REQUIREMENTS
Program Requirements:
• Hospital inpatient units need to participate in the
program for 18 months
• Learn and implement CUSP and CAUTI prevention
interventions
• Meet regularly as a team to review data and monitor
performance improvement
• Have at least one or more team members participate in
national content and monthly coaching calls
• Share lessons with others
• Collaboration is one of the keys to rapid improvement
8
ON THE CUSP: STOP CAUTI
RESOURCES
9
CUSP
CUSP is an intervention to reduce mistakes and
improve teamwork and communication
CUSP is a good approach to use whenever there
is a gap between evidence based practice and
current practice on your unit.
10
Why Is CUSP Important?
Culture has been linked to clinical and
operational outcomes in healthcare*:
– Wrong site surgeries
– Decubitus ulcers
– Bloodstream infections
– Post-op infections
– RN Turnover
– VAP
11
*data provided by Bryan Sexton
Pre CUSP Work
• Create an CUSP CAUTI team
– Nurse, physician, administrator, infection control,
others
– Assign a team leader
• Measure culture in your clinical unit (HSOPS or other
valid process ~discuss with hospital association leader)
• Work with hospital quality leader to have a senior
executive assigned to your unit based team
12
Comprehensive Unit-based Safety Program (CUSP)
An Intervention to Learn from Mistakes and Improve Safety Culture
1.
Educate staff on science of safety
2.
Staff Safety Assessment ~Identify defects
3.
Assign executive to adopt unit
4.
Learn from one defect per quarter
5.
Implement teamwork tools
Timmel J, et al. Jt Comm J Qual Patient Saf 2010;36:252-260.
13
Science of Safety
• Understand the system determines performance
• Use strategies to improve system performance
– Standardize
– Create independent checks for key process
– Learn from mistakes
• Apply strategies to both technical work and team work
• Recognize teams make wise decisions with diverse and
independent input
14
Identify Defects
• Ask staff how will the next patient be
harmed (Does not need to be related to
CUSP/CAUTI)
• Ask how they think that harm could
be mitigated
15
Prioritize Defects
• List all defects
• Discuss with staff what are the three
greatest risks
• Work with executive and CUSP CAUTI
team to eliminate risks and learn
from mistakes
16
Executive Partnership
• Executives should become a member of the CUSP
CAUTI team
• Executives should meet monthly with the CUSP
CAUTI team
• Executives should review defects, ensure the
CUSP CAUTI team has resources to reduce risks,
and hold team accountable for improving risks
and catheter associated urinary tract infections
17
Learning from Mistakes
• What happened?
• Why did it happen (system lenses)?
• What could you do to reduce risk?
• How do you know risk was reduced?
– Create policy / process / procedure
– Ensure staff know policy
– Evaluate if policy is used correctly
Pronovost 2005 JCJQI
18
To Evaluate Whether Risks were Reduced
• Did you create a policy or procedure?
• Do staff know about the policy?
• Are staff using it as intended?
• Do staff believe risks have been reduced?
19
Teamwork Tools
•
•
•
•
•
20
Daily Goals Checklist
Morning briefing
Shadowing
Culture debriefing
TeamSTEPPS
Shadowing
• Follow another type of clinician doing
their job for between 2 to 4 hours
• Have that person discuss with staff what
they will do differently now that they
walked in another person’s shoes
21
CUSP Lessons Learned
• Culture is local
– Implement in a few units, adapt and spread
– Include frontline staff on improvement team
• Not linear process
– Iterative cycles
– Takes time to improve culture
• Couple with clinical focus (eg CUSP CAUTI)
– No success improving culture alone
– CUSP alone viewed as ‘soft’
– Lubricant for clinical change
22
CUSP is a Continuous Journey
• Add science of safety education to orientation
• Learn from one defect per month, share or post
lessons (answers to the 4 questions) with others
• Implement teamwork tools that best meet
your teams needs
• Details are in the CUSP CAUTI manual
23
24
CUSP & CAUTI Interventions
CUSP
1. Educate on the science of safety
CAUTI
1.
2. Staff Safety Assessment ~Identify
defects
Care and Removal Intervention
Removal of unnecessary catheters
Proper care for appropriate catheters
3. Executive adopts the unit
4. Learn from Defects
5. Implement teamwork &
communication tools
25
2.
Placement Intervention
Determination of appropriateness
Sterile placement of catheter
Core Prevention Strategies
Catheter Use
• Insert catheters only for appropriate indications
• Leave catheters in place only as long as needed
Insertion
• Ensure that only properly
trained persons insert and
maintain catheters
• Insert catheters using
aseptic technique and
sterile equipment (acute
care setting)
26
Maintenance
Hand Hygiene
• Maintain a closed
drainage system
• Maintain
unobstructed urine
flow
Quality Improvement Programs
http://www.cdc.gov/hicpac/cauti/001_cauti.html
CAUTI Prevention #1: Make Sure the
Patient Really Needs the Catheter
Appropriate indications
• Bladder outlet obstruction
• Incontinence and sacral wound
• Urine output monitored
• Patient’s request (end-of-life)
• During or just after surgery
(Wong and Hooton - CDC 1983)
27
Jain. Arch Int Med 95
28
http://www.cdc.gov/hicpac/pdf/CAUTI/CAUTIguideline2009final.pdf
Indications
2009 Prevention of CAUTI HICPAC
Guidelines
(Gould et al, Infect Control Hosp Epidemiol 2010; 31: 319-326)
29
Appropriate Indications for
Catheter Use
Appropriate Indications
Patient has acute urinary retention or obstruction
Need for accurate measurements of urinary output in critically ill patients.
Perioperative use for selected procedures:
•urologic surgery or other surgery on contiguous structures of genitourinary
tract,
•anticipated prolonged surgery duration (removed in post-anesthesia unit),
•anticipated to receive large-volume infusions or diuretics in surgery,
•operative patients with urinary incontinence,
•need to intraoperative monitoring of urinary output.
To assist in healing of open sacral or perineal wounds in incontinent patients.
Requires prolonged immobilization (e.g., potentially unstable thoracic or
lumbar spine)
To improve comfort for end of life care if needed.
Gould C, et al. Infect Control Hosp Epidemiol 2010;31:319-26.
Inappropriate Indications for Indwelling Urinary
Catheter Use
Inappropriate Indications
As a substitute for nursing care of the patient or resident with incontinence
As a means of obtaining urine for culture or other diagnostic tests when the
patient can voluntarily void
For prolonged postoperative duration without appropriate indications (e.g.,
structural repair of urethra or contiguous structures, prolonged effect of
epidural anaesthesia, etc.)
Routinely for patients receiving epidural anesthesia/analgesia.
Gould C, et al. Infect Control Hosp Epidemiol 2010;31:319-26.
Other Reasons and Risk of Urinary Catheters
• Other Reasons
–
–
–
–
–
–
–
Urine output monitoring outside the ICU
Incontinence without skin breakdown/decubitus
Prolonged post-operative use beyond 24 hours
Transfer from ICU to floor
Morbid obesity or immobility
Confusion or dementia
Patient request
• Other Risks
– Secondary bacteremia, sepsis, metastatic
infection
– “One-point restraint” = decreased mobility
• DVT/PE, pressure ulcers
• Fall risk by tripping over catheter
• Deconditioning
– Patient discomfort, need to retrain bladder
32
Perceived
Short term
benefits
Real
cumulative
risks:
•LOS
•Cost
•Mortality
CAUTI Prevention #2: Proper Placement and
Use of Aseptic Insertion Technique
• Use smallest catheter size effective for patient (14
or 16F)
• Ensure that only properly trained persons insert
catheters
• Insert using aseptic technique
– Goal is to avoid contamination of the sterile catheter
during the insertion process
33
CAUTI Prevention #3: Maintenance
• Maintain a closed drainage system
• Maintain unobstructed urine flow
– Free of kinks
– Collecting bag below the bladder
– Empty the bag regularly
• Use routine hygiene, i.e., do not clean the
periurethral area with antiseptics
34
CAUTI Prevention #3: Maintenance
35
CAUTI Prevention #4: Consider Other
Methods for Preventing CAUTI
• Alternatives to the indwelling catheter
– Bladder ultrasound
– Intermittent catheterization
– Condom catheter
• Antimicrobial urinary catheters (?)
36
Program Goals
1. Reduce placement of unnecessary indwelling
urinary catheters
2. Increase prompt removal of indwelling urinary
catheters that are no longer needed
3. Ensure the use of proper insertion technique for
indwelling urinary catheters that are appropriately
indicated
Decrease the risk of hospital-acquired
catheter-associated urinary tract infections
37
How Do We Achieve These Goals?
• Engagement
• Education about the appropriate use and
insertion of urinary catheters
• Execution and Evaluation
– Monitoring and Feedback (aka Data collection)
38
Consistently Using Evidence-Based
Practices Remains a Challenge…
39
Prevailing Themes
1) Prioritization
2) Champions
3) Tailoring
4) Workload and Workflow
5) Leadership
40
(Saint et al. Infect Cont Hosp Epid 2008)
Catheter-associated urinary-tract
infection is a low priority
“I would say there’s a general perception in the
field that urinary tract infections don’t cause a lot
of morbidity and mortality compared to the quote,
sexy topic such as blood stream infection or
surgical site infection or VAP.” (Saint et al. Infect Cont
Hosp Epid 2008)
From an Infection Preventionist:
The main urologist “who everybody knows and
loves thinks the whole Bladder Bundle is just
stupid. There is no one who is passionate about
getting Foley catheters out of our patients.”
41
But . . .timely removal of catheters
considered important by some
A physician administrator from a large private
hospital explained,
42
“the nurses on the geriatrics unit wanted to have
their patients regain mobility or maintain their
mobility at all costs and having a catheter . . .
was one other reason why they never had to get
out of bed . . .the catheters are always removed
on the geriatrics unit but it’s a fight on the other
units to have those catheters taken out because
there’s always an excuse. Like, ‘well, they’re
really big or it’s hard for them to get out of bed or
it’s a two person assist’...”
Identifying a committed
“champion” can facilitate
prevention activities
successful champions tend to be intrinsically
motivated and enthusiastic about the practices
they promote
“I have a certain stature in this hospital…People
know that I’m very passionate about patient care
so…I get positive reinforcement from them…they’re
happy to see me…because …they know that I’m
thinking about what’s best for the patient…”
(Damschroder et al., Qual and Safety in Healthcare 2009)
43
The Importance of Tailoring
•
May need to tailor (i.e. modify or adapt) your
approach to CAUTI given your specific context and
circumstances
•
We saw different solutions at different hospitals;
different solutions within different units at the same
hospital
•
Examples:
–
Educating nurses about urinary catheters
–
Who assesses for catheter appropriateness
–
Focus on insertion or timely removal or both?
Attention to Urinary Catheters:
Workflow and Workload
•
The intervention(s) should become part of the
workflow: both removal (floor) and insertion (ED)
•
For insertion, ED is paramount
– Foleys put in for specimen collection and left
in
– ED nurses may think they’re doing floor
nurses a favor
•
Nursing workload was a big issue - since Foleys
can be easier for the nurses, this may be a
disincentive to remove
The Importance of Leadership
•
Leadership at various levels appears to be
important, especially at the nurse manager level
•
Project leader to help ‘manage’ the process can be
very useful
•
Physician leadership
– Behind-the-scenes (getting buy-in from medical
executive committees and other physicians)
– Front-line (eg, hospitalists, hospital
epidemiologists)
46
Teamwork: Key Roles and
Responsibilities
Role or responsibility Example of personnel
to consider
Project coordinator
Nurse champion (engage
nursing personnel)
Infection Preventionist,
Quality manager, Nurse
manager
Nurse manager, charge
nurse, staff nurse
Medical/physician liaison
Urologist, ID physician,
hospital epidemiologist
Data collection, monitoring,
reporting
Infection Preventionist,
Quality manager, Utilization
manager
Conclusions
• Many reasons to prevent CAUTI
• Implementing change is not easy
• Preventing CAUTI requires understanding both the
“technical” components and the “socio-adaptive”
aspects
• Preventing CAUTI is a Team Sport
• The ultimate objective is to ensure we provide the
safest and most effective care for patients
48
Data Reporting
1)
2)
Understand Why Data is Crucial to the Project
Understand the Project’s Data Elements:
---What Data Do We Collect?
---When Is It Due?
---What Infrastructure Do Teams Need to
Accomplish This?
49
Why is Data Crucial to the Project?
Project’s data elements will help you:
• Track adoption of technical work and CUSP
interventions
• Measure progress of CAUTI reduction
• Identify barriers to teams’ progress
• Keep you on course to achieve BOTH project
goals
50
CAUTI PROJECT DATA ELEMENTS:
• Background/Cultural Data:
---Readiness Assessment
---HSOPS: Baseline and Follow-up
• Ongoing Data Submission:
---Outcome data
---Process Data
---Team Checkup Tool
51
BACKGROUND/CULTURAL DATA:
Readiness Assessment
• Tells us about your unit:
--- size, type, patient demographics
--- prior involvement in any CAUTI
prevention and/or CUSP activities
--- prior patient safety/performance
improvement activities
52
BACKGROUND/CULTURAL DATA:
Readiness Assessment
• Completed ONCE at the start of the project
(May 12-26)
• Done via Survey Monkey
---MHA will email the survey link to each
designated unit lead
---Completed by only ONE person per unit
53
BACKGROUND/CULTURAL DATA:
HSOPS
• Standardized measure of safety culture
on the individual patient care unit (NOT
hospital-wide)
• Done twice:
---at the beginning/after the intervention
• Goal is at least 60% response rate of all staff
that affect patient care on the unit
54
BACKGROUND/CULTURAL DATA:
HSOPS
Infrastructure Needed:
• Each unit needs a survey coordinator who
---registers their unit/estimates # of unit
staff who will take the survey
---educates staff about the survey process
---ensures adequate survey response rate
(at least 60%)
55
BACKGROUND/CULTURAL DATA:
HSOPS
• Dates to remember:
HSOPS Training Webinar: May 20 or 22
Baseline HSOPS:
---pre-notification email sent May 20
---registration starts May 26
---survey runs June 9 – July 4
Follow-up HSOPS:
---15+ months
56
CAUTI PROJECT DATA ELEMENTS:
• Background/Cultural Data:
---Readiness Assessment
---HSOPS: Baseline and Follow-up
 Ongoing Data Submission:
---Outcome data
---Process Data
---Team Checkup Tool
57
ONGOING DATA COLLECTION:
Outcome and Process Data
• OUTCOME DATA: What impact have we made
on our 2 project goals:
1) reducing the CAUTI rate by 25% and
2) improving our unit’s culture of safety
• PROCESS DATA: Are we changing our daily work
activities regarding catheters in a way that
reduces the risk of infection (technical work) and
makes care safer (culture change/CUSP) ?
58
CAUTI OUTCOME DATA:
What Do We Collect?
For the entire month (not just M-F) each
enrolled unit must collect and submit:
• Total # of patient days for that unit
• Total # of indwelling urinary catheter days
for that unit
• Total # of CAUTI’s for that month
Result: CAUTI Rates
Catheter Prevalence
59
CAUTI OUTCOME DATA:
What Infrastructure Do Teams Need?
• Someone to collect the data
---should be knowledgeable about the criteria
---should resolve any “questionable CAUTI”
issues before entering data
---Good resource: ICP
• Someone to enter the data
---Into MHA Care Counts (www.mhacarecounts.org)
---Care Counts training (April 30 or May 7)
60
---Recording will be available at www.onthecuspstophai.org >
Stop CAUTI > Educational Sessions > Onboarding Calls
CAUTI OUTCOME DATA: When is it due?
Starts in MAY, with Three Phases
• BASELINE (Monthly submission)
May, June, July 2014
• IMPLEMENTATION (Monthly submission)
August and September 2014
• SUSTAINABILITY: (Quarterly for 3 periods)
December 2014; March and June 2015
Note: all data is due by the end of the following month
61
OUTCOME DATA: How Do I Enter It?
WHERE?
---MHA Care Counts (www.mhacarecounts.org)
HOW?
---Manual Entry
WHEN?
---Monthly
62
PROCESS DATA: What Do We Collect?
DAILY, following the submission schedule:
•
•
•
•
# of patients on the unit that day
# of catheterized patients on the unit that day
Main reason why patient has a catheter TODAY
Where the catheter was inserted (on the floor, off
the floor, unknown)
Result: Catheter Appropriateness Info
63
CAUTI PROCESS DATA:
What Infrastructure Do Teams Need?
• Have their team in place
--- Crucial: physician leader, nurse leader,
frontline care provider, infection control
practitioner
• Be conversant with HICPAC guidelines as
to appropriate indications for catheters
64
CAUTI PROCESS DATA:
What Infrastructure Do Teams Need?
• Need a rounding process (not record review)
--- IDEAL: piggyback on existing unit rounds
--- use the recommended audit tool
• Need a designated point person to record
data/contact physicians for orders to remove
catheters
65
CAUTI PROCESS DATA:
What Infrastructure Do Teams Need?
• EXPECTATION:
The rounding process goes on daily during
the project, regardless of whether data is to
be submitted on that day!
Remember: This rounding process IS the
intervention!!!
66
CAUTI PROCESS DATA:
What Infrastructure Do Teams Need?
• Need someone to enter the data into MHA
Care Counts
• Data should be entered ASAP
---Ideally enter the same day team rounds
---Teams should be talking about their
findings
67
Process Data Collection Tool
Patient Number
Is Catheter Present? (Yes or No)
If yes, where was Catheter placed? (On the Unit,
Off the Unit, Unknown)
1
2
3
4
5
6
7
8
9
10
Why does the patient have a catheter TODAY? (Check the MAIN reason for the catheter)
APPROPRIATE Indications
Accurate measurement of urinary output in
critically ill patient
Acute urinary retention or obstruction
Assist healing of perineal or sacral wound in an
incontinent patient
Chronic indwelling catheter on admission
Hospice/comfort /palliative care
Hospital approved indication
Perioperative use in selected surgeries
Required immobilization, for trauma or surgery
If none of the above reasons apply, why does the patient have a catheter TODAY? (choose one from the list below):
INAPPROPRIATE Indications
Incontinence WITHOUT a sacral or perineal
pressure sore
Other reason (ICU transfer, morbid obesity,
immobility, confusion/dementia, patient request)
Prolonged post-operative use
Urinary Output Monitoring OUTSIDE the ICU
Does Catheter Have an Appropriate Indication
TODAY? (answer Yes or No)
OPTIONAL: ACTION TAKEN
If catheter does NOT have an appropriate
indication, what action was taken? (check box)
Nurse removed catheter today
Staff contacted dr; dr. ordered removal
Staff contacted dr; dr. did NOT order removal
68action taken
No
11
12
13
14
15
PROCESS DATA: When is it due?
Starts in JULY, with Three Phases
• BASELINE (Daily, M-F for three weeks)
July 7-11, July 14-18, and July 21-25
• IMPLEMENTATION (Daily, M-F for two weeks, then
6 single days of data collection)
Aug. 4-8 and Aug. 11-15, then
Aug. 19, 26, and
Sept. 2, 9, 16, 23
69
PROCESS DATA: When is it due?
• SUSTAINABILITY:
(M-F, 1 week per quarter)
December 15-19, 2014
March 9-13, 2015
June 15-19, 2015
70
PROCESS DATA: How Do I Enter It?
WHERE? MHA Care Counts (not NHSN!)
HOW?
---Use the data collection paper tool as you
do catheter rounds
---Enter manually into MHA Care Counts
---Enter in “real time” (daily or ASAP);
consider laptop/mobile workstation
71
ONGOING DATA COLLECTION:
Quarterly Team Checkup Tool (TCT)
What it assesses:
• Implementation of CUSP and CAUTI
reduction activities
• Team functioning
• Barriers to project progress
72
TCT DATA: How Do I Enter It?
Recommended Way to Complete TCT:
• Team Leader prints copies of the TCT
(available on the national project website)
• Team meets to discuss and reach
consensus on answers
• One person enters the team’s consensus
answers into MHA Care Counts
73
TEAM CHECKUP TOOL: When Is it Due?
Starts in August 2014
• Due Quarterly (note: these are NOT
calendar quarters)
• Reflects the team’s work for the previous
3 months
• Schedule:
Aug. 2014 (reflects work of May-July); then:
Nov. 2014; Feb. and May 2015
74
VALUE OF CAUTI DATA:
Helping Your Teams Track Progress
STANDARD REPORT SET TO RUN:
Review these 3 Categories Monthly:
Data Submission
Outcome Data
Process Data
75
STANDARD REPORTS TO RUN
(from Care Counts)
Data Submission: Run 3 Reports
• Outcome Data Submission Report (1 report)
---shows which units have submitted data,
by project phase
• Process Data Submission Reports (2 reports)
---shows submission rates by project phase,
and for each day of data collection
76
STANDARD REPORTS TO RUN
(from Care Counts)
Outcome Data: Run 3 Reports
• CAUTI Rate Reports (2 reports)
---by Catheter Days (# CAUTI’s/1000 catheter days)
---by Patient Days (#CAUTI’s/10,000 patient days)
---shows your unit’s infection rates
• Catheter Prevalence Report (1 report)
---shows the percent of patients on your unit with a
catheter for that month
77
STANDARD REPORTS TO RUN
(from Care Counts)
Process Data: Run 2 Reports
• Catheter Appropriateness Reports (2 reports)
---Catheter Appropriateness
---shows what % of catheterized patients
had at least one appropriate reason for the
catheter
---Catheter Indicator Breakout
---shows what the reasons were
78
TAKE HOME MESSAGES:
What Data Do We Collect?
• Preliminary Work: Readiness Assessment /HSOPS
• During Project:
Outcome Measures: (Collect/Submit Monthly)
CAUTI Rates and Prevalence
Process Measures: (Submit on Scheduled Days)
Catheter Appropriateness
Team Checkup Tool (TCT): Submit Quarterly
• Follow-up: HSOPS
79
TAKE HOME MESSAGES:
When is Data Due?
Outcome Measures: By end of the next month
Process Measures: Enter in real time, ASAP
TCT: Quarterly
HSOPS: At start of project & after intervention
80
TAKE HOME MESSAGES:
WHY IS DATA IMPORTANT TO THE PROJECT?
• Data submission tracking :
---ensures dataset is robust and findings are reliable
• Process and Outcome Measures:
--- provide continuous monitoring of whether CAUTI
rates and catheter prevalence are decreasing
--- focus attention on which patients inappropriately
have catheters, so education and processes can be
implemented to reduce unnecessary catheter use and
infection risk
81
TAKE HOME MESSAGES:
WHY IS DATA IMPORTANT TO THE PROJECT?
• Quarterly Team Checkup Tool:
--- monitors teams’ implementation of recommended:
1) CUSP activities
2) CAUTI reduction activities
--- identifies barriers to team progress
• HSOPS:
--- assesses units’ culture of safety before and after the
project intervention
82
TAKE HOME MESSAGES:
Anticipatory Guidance
• Data Collection Process:
--- is front-end loaded, but manageable
--- is the primary way to effect change in the use
of inappropriate catheters
• Remember: Rounding for Catheter Prevalence
and Appropriateness IS the intervention!
83
ON THE CUSP: STOP CAUTI
Data Collection
84
ON THE CUSP: STOP CAUTI
DATA REQUIREMENTS
On the CUSP: Stop CAUTI
Data Requirements
The data collection process assists in driving the educational component of the intervention to the frontline staff by
reinforcing the use of appropriate indications for catheters. The submission of accurate and timely data and the regular
review of these data to inform performance improvement are essential for program success. Through utilizing reports in
MHA Care Counts, teams can track their CAUTI outcome rates, process, and prevalence data to drive unit based
improvement activities. The data elements to be submitted include the following:
DATA COLLECTION
LOCATION
SCHEDULE
CAUTI Readiness Assessment
(Technology & Exposure Survey)
[taken once at start of the project]
Survey Monkey Link will be emailed from MHA to the Team
Leader at each unit
Available: 05/12/2014 – 05/26/2014
* Tell us about your unit: size, type, patient
demographics, etc.
Readiness Assessment (PDF) attached
for reference
AHRQ culture survey, Hospital
Survey on Patient Safety (HSOPS)
[taken at the start of the project
and 15+ months; given to all unit
staff]
Unit-specific Links will be emailed from MHA to the Survey
Coordinator at each unit
Sample Survey (PDF) attached for
reference
* Standardized measure of safety culture
for individual patient care unit (NOT
hospital-wide)
CAUTI Outcome (rate) data
 Number of Symptomatic CAUTI’s
attributable to your unit for that month
 Number of urinary catheter days per
month (number of patients with urinary
catheter device is collected daily at the
same time each day and the total is
summed for the month)
Complete by May 26
Baseline:
05/20/2014 – Pre-notification sent
05/26/2014 – Registration sent
06/09/2014 – First day to take survey
07/04/2014 – Last day to take survey
HSOPS Baseline Reports will be distributed by 08/15/2014
Follow-up: 15+ months (June 2015)
Date are due in MHA Care
Counts by the end of the
following month
www.mhacarecounts.org
(MHA will provide username and
password to designated users)
Baseline (2014) – 3 months:
May 1-31; June 1-30; July 1-31
Implementation (2014) – 2 months:
August 1-31; September 1-30
Sustainability – Quarterly (for 3 periods):
December 1-31, 2014
March 1-31, 2015
June 1-30, 2015
 Number of patient days per month
CAUTI Process (urinary catheter
prevalence & appropriateness)
data – data submission is optional
 Assess each patient on the unit for the
presence of a urinary catheter
 Record the reason why the catheter is in
place TODAY
Team Check-Up Tool (TCT)
 Evaluate how the unit-team is
implementing CUSP and CAUTI activities
 Team functioning
 Barriers to project progress
Submit data in MHA Care
Counts as concurrently as
possible
www.mhacarecounts.org
CAUTI Process Data Collection Tool
(.xls)
Submit Quarterly in MHA Care
Counts
www.mhacarecounts.org
TCT Questions (PDF) attached for
reference
Baseline (2014) – Mon-Fri for 3 weeks:
July 7-11; 14-18; 21-25
Implementation (2014) –Mon-Fri for 2 weeks, then 1 per day
for 6 weeks:
August 4-8; 11-15; 19, 26
September 2, 9, 16, 23
Sustainability – Mon-Fri for 1 week per quarter:
December 15-19, 2014
March 9-13, 2015
June 15-19, 2015
Complete and submit starting in August 2014:
Aug 2014 – TCT Q3 (data reflects: May, June, July 2014)
Nov 2014 – TCT Q4 (data reflects: Aug, Sept, Oct 2014)
Feb 2015 – TCT Q1 (data reflects: Nov, Dec 2014 & Jan 2015)
May 2015 – TCT Q2 (data reflects Feb, March, April 2015)
*Please Note: these are NOT calendar quarters
Remember: Data drives change! Daily rounding for catheter presence and appropriateness IS the intervention!
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ON THE CUSP: STOP CAUTI
Next Steps
Hospital units will participate for 18 months:
• Units / team members are registered in MHA Care Counts
(logins have been emailed to unit contacts from MHA)
• Assemble a team to include a team leader
• Implement CAUTI prevention tools and strategies
• Implement CUSP model/tools to improve care
• Submit baseline & monthly CAUTI rate data (outcome)
• Submit urinary catheter (UC) prevalence &
appropriateness data (process)
• Submit quarterly Team Checkup Tool (TCT)
• Develop & implement a sustainability plan
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ON THE CUSP: STOP CAUTI
NEXT STEPS
Next Steps:
• Hold a team meeting
• Listen to the Onboarding and Content calls*
• Team Lead & Data Entry Contact Person – MHA Care Counts
Data Entry and Report Training* (April 30 or May 7)
• Team Lead & Survey Coordinator attend HSOPS training*
(May 20 or 22)
• Review Web site resources, CAUTI Implementation Guide and
CUSP Toolkit
• Collect Outcome data for May
• Team Lead complete Readiness Assessment (May 12-26)
*Recordings available on www.onthecuspstophai.org
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ON THE CUSP: STOP CAUTI
NEXT STEPS
Next Steps (continued):
•
•
•
•
Implement CAUTI prevention tools and strategies
Implement CUSP model/tools to improve care
Submit baseline & monthly CAUTI rate data (outcome)
Submit urinary catheter (UC) prevalence &
appropriateness data (process)
• Complete HSOPS Survey (May 20 pre-notification
email; May 26 registration; June 9 – July 4 survey
window)
• Teamwork Tools - Staff Safety Assessment, Learning
from Defects, Team Check Up Tool
• Develop a sustainability plan
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ON THE CUSP: STOP CAUTI
National Faculty
Expert Faculty:
Sanjay Saint, MD, MPH, and Sarah Krein, RN, PhD
University of Michigan Health System
Mohamad Fakih, MD, MPH
St. John Hospital and Medical Center
Sam Watson, MSA, and Lucy Koivisto
Michigan Health & Hospital Association
Chris Goeschel, RN, ScD
Johns Hopkins Armstrong Institute for Patient Safety and Quality
Linda R. Greene, RN, MPS, CIC
Highland Hospital in Rochester, NY
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ON THE CUSP: STOP CAUTI
FHA & HRET Key Contacts
FHA HEN:
Sally Forsberg, RNC, BSN, MBA, NEA-BC, CPHQ
Director of Quality & Patient Safety
sally@fha.org
407-841-6230
Luanne MacNeill
Quality Initiatives Coordinator
luannem@fha.org
407-841-6230
Kim Streit, FACHE, MBA, MHS
VP/Healthcare Research & Information
kims@fha.org
407-841-6230
Phyllis Byles, RN, BSN, MHSM, BC-NEA
Quality Coordinator
phyllis@fha.org
407-841-6230
HRET:
Barb Edson, RN, MBA, MHA
VP of Clinical Quality
bedson@aha.org
919-530-0080
Tina Adams, RN
Clinical Content Development Lead
tadams@aha.org
919-304-2569
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Important Links
Tools & Resources:
http://www.onthecuspstophai.org/on-the-cuspstop-cauti/toolkits-andresources/
- Cohort Timelines –specific data collection schedules
- Stop CAUTI Implementation Guide (hospital unit tool)
- MHA Care Counts User Manual & Quick Guide CAUTI Reports
- Additional Resources
http://www.catheterout.org
- Key prevention strategies
- Engaging Clinicians & Administrators
- Barriers & Potential Solutions
- Protocols, education tools, supporting evidence, etc.
CUSP Toolkit:
http://www.ahrq.gov/cusptoolkit/
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Important Links
CAUTI Calendar:
http://www.onthecuspstophai.org/on-the-cuspstop-cauti/calendar/
Onboarding Call Series:
http://www.onthecuspstophai.org/on-the-cuspstop-cauti/educational-sessions/onboarding-calls/
National Content Call Series:
http://www.onthecuspstophai.org/on-the-cuspstop-cauti/educational-sessions/contentcalls/
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ON THE CUSP: STOP CAUTI
RESOURCES
93
Questions???
94