Ashley Dobuzinsky, BSN, RN, CCRN Lynn Orser, MSN, RN, CCRN, PCCN St. Vincent’s Medical Center Discuss: Development of the ICU Exit Checklist Implementation Outcomes process To address increasing incidence of HAI among hospitalized patients through the utilization of an ICU Exit checklist To decrease utilization of central venous catheters (CVC) and indwelling catheters Improve team communication among the healthcare Setting 30-bed mixed surgical/medical ICU, inclusive of 6 bed PCU Closed unit-Intensivist led model Pre-implementation data Collected over a 30-day period from August 2012September 2012 on patients transfers from the ICU/PCU. Monitoring for the presence of CVC or indwelling catheters at time of transfer. Of the 84 patients tracked, 23 patients (27%) were transferred with a CVC in place 42 patients (50%) were transferred with an indwelling catheter in place Engaging the multidisciplinary team Expanding goals of checklist to include: Narrowing antibiotic coverage Evaluation of proton pump inhibitor therapy for discontinuation Notification of accepting physician at time of transfer Staff education ICU Exit Checklist Foley Catheter in place? Yes No If yes, indication per MD for continuing __________________ TLC in place? Yes No If yes, indication per MD for continuing __________________ GI prophylaxis continued? Yes No If yes, indication per MD for continuing ___________________ Course of Antibiotics evaluated and Narrowed Discontinued other_______________________________________ Call intensivist to confirm the receiving physician has been notified and received report prior to the patient being transferred. Please return completed forms to folder in the charge nurse area in the SICU ICU Exit Checklist 1. Foley Catheter in place? Yes No Per MD Indication for use: Urinary retention including obstruction and neurogenic bladder. Short perioperative use in selected surgeries (less than 24 hours) and for urologic studies or surgery on contiguous structures. Renal/Urological/Gynecological or Perineal surgical procedures. Hemodynamically unstable Accurate monitoring of intake and output. Assist healing of perineal and sacral wounds in incontinent patients to avoid further deterioration of wound and skin. Required immobilization for trauma or surgery, for example, pelvic or hip fracture. Hospice/comfort care or palliative care, if requested by patient. Chronic indwelling urinary catheter on admission (reason will be clarified by physician). Hematuria/ bladder irrigation or medication instillation. 2. TLC in place? Yes No Per MD Indication for use: Hemodynamic monitoring Administration of specific medications: Vasopressors, Chemotherapy, TPN, Long term antibiotics, 3% normal saline Hemodialysis, plasmapheresis, apheresis Transvenous Cardiac Pacing Very poor peripheral access 3. GI prophylaxis continued? Yes No If yes MD reason for continuing ____________________________________________________ 4. Course of Antibiotics evaluated and Continued Narrowed Discontinued other_________________________ Call intensivist to confirm the receiving physician has been notified and received report prior to the patient being transferred. Please return completed forms to folder in the charge nurse area in the SICU 60 50 40 30 20 10 0 Foley present upon transfer Central line present upon transfer ICU Indwelling Catheter Utilization 37% reduction in utilization from Sept 2012-Nov 2013 No ICU CAUTIs Aug 2013-Oct 2013 ICU CVC 14.5% reduction in patient transfers with CVC in place One reported CLABSI over 12 month period ICU process improvement project Primary goal to decrease HAI by reducing the utilization of CVC and indwelling catheters Involved a multidisciplinary team approach Observations included overall decline in utilization of CVC and indwelling catheters