Utilize the Electronic Health Record (EHR) to improve

nursing process and patient outcomes.

CATHETER ASSOCIATED URINARY TRACT INFECTION (CAUTI):A PREVENTION PLAN

Education created byKristi Noble MSN RN OCNClinical EHR educatorSeptember 2014

Goal of CAUTI

Goal of CAUTI Prevention

Educate RN/LPN’s to prevent and reduce the incidence of a CAUTI by:

• Using the EHR to standardize documentation• Use instructions and indications when inserting

and removing an indwelling urinary catheter • Assessing the need for a urinary catheter daily

Objectives for CAUTI Prevention

1. Recall the importance of standardizing documentation for in and out times and line days.

2. Identify instructions and indications for placing and removing an indwelling urinary catheter.

3. Recall the of use and function of the daily needs assessment form.

4. Identify where to locate policies and protocols for an indwelling urinary catheter within the electronic health record.

Regulations and ReportingDid you know?

Since 2008 The Centers for Medicaid and Medicare Services have not reimbursed the cost of Hospital Acquired infections, such as CAUTI.

Since January of 2013 Munson has been manually reporting the instances of patients developing a CAUTI while in the hospital.

The estimated cost of treating a CAUTI that develops while in the hospital ranges from $1,200 to $2,800.

Importance of documenting indwelling urinary catheters in the EHR

• Improve patient outcomes• Increase patient safety• Better tracking of patients with an indwelling urinary catheter• Able to generate reports for reimbursement• Standardize documentation across the multiple departments and organizations within Munson Healthcare• Standardize order and discontinue process for indwelling urinary catheter• Able to utilize a daily needs assessment form for removal of urinary catheter as soon as possible

Current Foley documentation will be moved to I-view

Will move

to I-view

Ordering indwelling urinary catheter: old to new

Indwelling is new key word. Foley can still

be used.

Nursing must verifying the presence of an active order. If no order present the nurse must obtain one from the provider.

New requirements for indwelling urinary catheter orders: Instructions and Indications

You may

multi-select

by holding

down the

control key

Instructions and indications are mandatory to complete order.

If a provider enters DO NOT REMOVE as instruction or certain indications the daily Needs Assessment form will not fire to the PAL every 24 hours.

Ensure the instructions and indications are as accurate as possible.

If the patient does not meet the criteria, they don’t need a urinary catheter.

The next step after the order is placedGo to PAL

Once the order is placed two tasks will generate on the PAL for the nurse:

1. Insertion task, will take nurse directly to I-view to create the dynamic group.

2. A daily needs assessment task, used to determine if the urinary catheter is still appropriate for the patient, will occur at 8am the day following catheter insertion.

By right clicking and selecting Chart Details the system will take you to I-view for documentation of insertion or daily needs assessment form.

Creating the Dynamic Group for Indwelling Urinary Catheter

Mandatory fields when

creating dynamic group.

The functionality of the charting is the same as other I-view charting.

The insertion date is crucial, allows tracking of line days to begin. Place cursor in date box, press T, date and time

will pull in. Date will

default forward on subsequent

days.

Genitourinary Assessment moving to I view

The GU assessment will be removed from the nursing launcher. In the vacated area a reminder will be in red to have the documentationbe completed in I-view.

In an effort to streamline

documentation the GU

assessment is moving to I-view. It will

have its own band on the navigator.

Nursing Assistants Twice a Day PAL Task for Peri and Catheter Care

Nursing assistants will receive a twice daily task on the PAL for documenting peri and catheter care. RNs will not receive this task on their PAL, but will need to ensure that the care and documentation was completed in I-view.

Nurse Driven Protocol (070.P037)for Removal of Urinary Catheter

When an order is placed for a urinary catheter the provider can have the

removal based on a Nurse Driven Protocol/RN

assessment.

The Nurse Driven Protocol can be located by right clicking on the

order. Policies and procedures are to help guide the RN

for care and removal of the

urinary catheter.

Bladder Scan Protocol

Bladder Protocol (070.P035) is available for nursing to use. It does not need a physician order. It is a standing order that is approved by the Medical Executive Committee.

If a nurse has to straight cath a patient two times, upon the second insertion place a urinary catheter and page the provider for an indwelling catheter order.

Indwelling Urinary Catheter (Foley) Needs Assessment

Once a urinary catheter has been inserted, a daily needs assessment form must be completed. This will come daily task on the PAL, starting at 8am the day after insertion.

If the patient does not meet criteria for the urinary catheter at any other point during the day the needs assessment form can be found in Ad Hoc forms to complete.

Needs Assessment form

In this area the last two indications will be viewable

The form brings in the current order

allowing the RN to see when and

why the catheter was ordered

Needs Assessment Form

Form will be tasked daily at 8am. If the

patient still meets the criteria to keep

catheter RN will select the indication and the form will be complete.

Needs Assessment Form

When the patient no longer meets criteria for catheter RN will

select option to have the catheter discontinued.

By selecting does not meet criteria the system will auto DC the order and send a

task to the PAL for catheter removal.

Reference Text Policies and Protocols

Protocol Reference Text found

by right clicking

inside the window

When Indwelling Urinary Catheter discontinued or no longer needed

The RN may discontinue the urinary catheter either through the order or the needs assessment form. Providers can right click on the order and Cancel/DC or Modify the catheter order.

Providers can DC or Modify the catheter

order.

RNs will DC the

catheter via the needs

assessment form or by right

clicking on the order

and Cancel/DC

When Indwelling Urinary Catheter discontinued or no longer needed

Once the provider or RN discontinues the urinary catheter the RN will get a task on the PAL to remove the catheter.

Right clicking and Chart Details will

take the RN to I-view to

complete the documentation

When Indwelling Urinary Catheter is discontinued or no longer needed

Removal Date/Time

Once charting complet

eRN must

inactivate the

dynamic group

The date and time of removal is captured from time stamp of the column. Remember to chart at the time of removal or back chart the correct time.

Straight/Intermittent Catheterization

For patients who require intermittent straight catheterization, a separate dynamic group needs to be created. The same group may be used for each instance of catheterization during the patients stay.

Documentation occurs

the same as all other

charting in I-view

Viewing Urinary Catheter Assessment

The best place to view the urinary catheter assessment is in Results Review on the Patient Assessment tab in a group format.

Preventing a CAUTI

• Verify there is an active order for the indwelling urinary catheter with indications and instructions.

• Assess the need for indwelling urinary catheter daily.

• Utilize the Nurse Driven/Bladder Scan protocol to remove the indwelling urinary catheter as soon as possible.

• Seek alternatives to using an indwelling urinary catheter whenever necessary.

Preventing a CAUTI

• Empty the catheter drainage bag every 8 hours, if 2/3 full, and prior to transporting a patient.

• Verify that peri and catheter care is performed and documented twice a day in I-view.

• Arrange the catheter drainage bag so it is placed below the patients bladder at all times.

• Assess for the presence of a securement device, i.e. Stat lock, on the patients upper thigh, right or left.

• Document catheter output in I-view.

Adherence to an infection prevention planBladder scan per protocol when urinary catheter removedCondom catheter, access to commode chairsDo not use catheters unless necessaryEarly removal of catheter using the electronic health record as a guide

ABC’S OF CAUTI PREVENTION

Your involvement in ensuring that our patients are safe and free from catheter associated

urinary tract infections is appreciated, and your care to

our patients is invaluable.