Leadership Strategy Analysis - Quality Improvement Process
Melissa Hayes
Ferris State University
Abstract
In reviewing this paper, the reader will obtain an understanding of the importance of
preventing Catheter Associated Urinary Tract Infections [CAUTI].
The author will explain in
detail the ways in which she and other members of the CAUTI prevention team are working
together in order to reduce infection rates and prevent loss of reimbursement related to
treating these infections.
Infection prevention is everyone’s job in the healthcare setting.
After reviewing this paper, the reader will have an understanding of how each team member
works toward the goal of zero CAUTI.
Keywords: Infection, Prevention, CAUTI
Leadership Strategy Analysis - Quality Improvement Process
Development of guidelines for the prevention of catheter associated urinary tract infections
(CAUTI) is a quality and safety initiative which is currently being implemented at Covenant
HealthCare. The Centers for Medicare and Medicaid Services (CMS) have mandated that there
will be no additional Medicare payments for treating catheter associated urinary tract infections
for hospital patient discharges occurring after October 1, 2008. The author will describe the ways
in which she, as an infection prevention specialist, lends to improving the rate of CAUTI while
trying to eliminate these infections altogether.
Clinical Need
According to the National Institutes of Health [NIH], “catheter-associated urinary tract
infection is the most frequent healthcare-associated infection in the United States” (2009, p.1,
para. 2).
Without additional reimbursement for these infections from CMS, there is a sense of
urgency for health care providers to work towards reducing if not completely eliminating
CAUTI.
Interdisciplinary Team
A collaborative team which is working toward the common goal of CAUTI prevention
has been developed at Covenant HealthCare. This team is comprised of Infection Prevention
Specialists, Clinical Nurse Specialists, departmental Nurse Educators, unit Coordinators, unit
Managers, and Clinical Resource Managers who work toward achieving core measures on each
inpatient admission.
The specific role of the Infection Prevention Specialist will be described in the next
section of this paper. Clinical Nurse Specialists [CNS] research evidence based findings in
order to facilitate change in practice. Because research indicates that urinary tract infections are
commonly hospital acquired, these individuals are helpful in educational efforts in order to
change the way catheters are used in practice. For example, nurses may have called physicians
in the past to obtain an order for foley catheter placement because their patient was incontinent.
This is no longer acceptable. It is the goal of the CNS to educate caregivers of the importance
of proper incontinence product usage rather than foley catheter placement related to the
increased incidence of hospital acquired UTI.
Departmental Nurse Educators, unit Coordinators and unit Managers work together to
educate staff regarding the importance of timely foley catheter removal. Timely removal of
catheters is the key to preventing a hospital acquired urinary tract infection. Staff may be
resistant to proactive attempts to remove foley catheters as catheter removal will create more
work in toileting and/or changing patients regularly throughout the shift. Because unit based
Educators, Managers, and Coordinators are working in close proximity to staff nurses, they are
instrumental in monitoring timely catheter removal.
Clinical Resource Managers work to progress the patient through hospitalization to
discharge and are often aware of orders for discharge before the floor nurse. They are helpful in
communicating when discharges are likely to occur. Once the RN is aware of a pending
discharge, they can speak with the physician about foley catheter removal. If the catheter is not
something that the patient was admitted with, every effort should be made to remove it as soon
as possible in order to maintain normal bladder function and prevent infection.
Data Collection Method
Currently, a report is generated each morning that lists patients having an indwelling
catheter. The Infection Prevention Specialist handling CAUTI rounds for the day looks up the
patients and reviews the urinary catheter indicator assessment which should be completed on
each catheter patient. The specialist then goes to the inpatient unit and assesses each patient room
to see if there are any catheters which may have been missed. Once all catheters are accounted
for, the specialist speaks with the RN in charge of the catheter patients to ensure that the
catheters are appropriate. If the catheter is not appropriate according to the indicator assessment,
the RN calls the physician in charge of the patient in order to notify him/her of the lack of
necessity according to guidelines and asks for an order to remove the catheter. Because Covenant
HealthCare physicians are aware of the importance of timely catheter removal, this is typically
not a problem. The nurses on each unit have full backing from the unit based Educators,
Coordinators, and Managers and utilize assistance from them when necessary in order to obtain
an order from the physician.
Outcomes
The goal for each department is zero CAUTI. This may seem unrealistic, but provides for
a constant target when not achieving the goal. Hospitals cannot afford to continue consuming
costs for infections related to foley catheters. Patients are put at risk when catheters are
improperly used. Urinary tract infections may lead to sepsis which could potentially result in a
fatality. Patient safety should be the number one focus of each team player who provides
patient care. If this were so, resistance to timely foley catheter removal would be unheard of.
Therefore, resistance to catheter removal should be met with a reminder of why we are in
practice. The answer should undoubtedly be to provide the best care possible for each patient.
If this is not the case, one should reconsider career options and find a more suitable position.
Evaluation
The current process for identifying potential CAUTI and removing catheters in a timely
fashion has proven to be effective. Currently, Infection Prevention Specialists are often
approached regarding foley catheter removals before making mention of these themselves.
Nurses are taking ownership of the responsibility to have catheters removed and are seemingly
proud of the removal when it happens. The use of evidence to show the importance of timely
removal was undoubtedly instrumental in helping this change in practice to occur. It is reported
that often time’s nurses do not even need to make the call for catheter removal as physicians are
approaching them solely to communicate the need for removal. Catheter associated infections
can cost the hospital hundreds of thousands of dollars. No caregiver wants to work in a facility
that is losing money related to something which is preventable.
Conclusion
Covenant HealthCare has seen great success in current practices related to the reduction
of catheter associated infections. Caregivers appear proud of their efforts and are eager to learn
of the latest infection rates when they become available each month. As they should, caregivers
are taking ownership of their duty to protect patient safety and are in most cases eager to obtain
orders to remove foley catheters. The author is proud to be a part of a team which stresses the
importance of patient safety at every level and does not accept anything less than extraordinary
care.
References
Saint, S., Meddings, J. A., Calfee, D., Kowalski, C., & Krein, S. L. (2009). Catheter-associated
Urinary Tract Infection and the Medicare Rule Changes. Retrieved from National
Institutes of Health Public Access website:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2754265/