Catheter Urinary Tract Infections – The Journey to ...€¦ · What: To reduce catheter...
Transcript of Catheter Urinary Tract Infections – The Journey to ...€¦ · What: To reduce catheter...
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Catheter Urinary Tract Infections –
The Journey to reduce the number
of Catheters at Salford Royal
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2Where are you?
Catheter Urinary Tract Infections –
The Journey to reduce the number
of Catheters at Salford Royal.
John Bellerby – Senior Quality Improvement Lead
Daniel Rowbotham – Quality Improvement Lead
Aims
• Context for Project
• What we have done
• Results
• Future Plans
Why Did we do it?
Strategy 2011 - 14
Phase 2 Projects (2011-14)
This was our reality
• 15-25% pts have a urinary catheter inserted.
Of that 20%
– 38% have documentation
– 24% -41% have a CAUTI
• 60% medical teams unaware of presence of
urinary catheter
• How many patients die from Urinary Sepsis at
SRFT yearly?
Patient View
50 inpatients• 26% found it painful
• 24% found it embarrassing
• 26% found it inconvenient
• 18% of patients didn’t know why they were catheterised
• 70% were not given another option
• 30% felt they could have managed without
• 32% had experience of their catheter leaking
• 76% didn’t know or thought that they didn’t have a care plan
Urinary Catheter
Innocuous device?
OR
Convenient device
that can harm & kill?
How Did we do it?
Phase 1
The first phase ended in December 2012.
What: To reduce catheter associated urinary tract infections
How Much: To achieve a 30% reduction from baseline figure in pilot
wards
By When: December 2012
Outcome: 44% reduction in CaUTI, and successful development of flow
sheet to facilitate data capture
The Breakthrough Series
Collaborative (IHI)
The Break Through Series
Collaborative
The Break Through Series
Collaborative
People are generally better
persuaded by reasons which they
themselves discover,
than those which have come into
their mind by others"
Pascal (1670)
AIM
Source: Associates for Process Improvement
To reduce Catheter associated
Urinary tract infection ( CaUTIs )
by 30% by 31st December 2012
Measurement
Changes
Small tests of
change
Model for Improvement
Aim
MEASUREMENT
Source: Associates for Process Improvement
Measurement
through the data
collected from
the flow sheet.
CaUTI and catheter
days
CHANGES
Source: Associates for Process Improvement
These are the changes the
teams develop in order to
move us to the next phase
A Fact….
All improvement will require change,
but not all change will result in improvement
Therefore we need to ‘test’ change
The PDSA Cycle
Why catheterise at all?
Phase 2
The second phase of the project expanded the
work and ran through until December 2013:
What: To reduce catheter associated urinary
tract infections
How much: By 20% (across the whole Trust)
When: December 2013
Outcome: 12% reduction
Phase 3
• 2014 Aim was to identify the inappropriate
catheters in the organisation
• Was tied into our Harm Free Care CQUIN for
2014/2015
Challenges
• Developed a tool to collect data
– Form was explicit in the rationale for catheterisation
– Agreement on Rationale was a tricky place to get to!
• Aimed to carry out the audit on our senior nurse walkround
– Two a month
– Cover the entire hospital
What Happened
6 Audits
– Variation in results
– Review by clinical
experts showed
inaccuracy of data
– We did not yet have
accurate data for
inappropriate catheters
PDSA Outcomes
• Held two training sessions
• 16 nurses in total completed that training
• Then audited a small group of wards
• Validated by Urology Team
• 2 audits were undertaken showing that
25.57% were inappropriate
• One of our district Nursing teams are now
using the tool on a monthly basis
Bed
Number
Hospital
Number
Patient Consultant No
Catheter
T
Tissue
Viability
If sacral
pressure
sores and
incontinence
(both have to
be present for
a catheter to
be required)
R
Retention
Urine
(i) Unable to
pass urine
spontaneously
(ii) chronic
retention where
there has been
urological input
(evidence
required)
Please include
residual
volume
recorded in
insertion
flowsheet in
comments
A
Acutely
unwell
(i) Currently
requiring level 2 or
3 care or if a
senior decision
maker specifically
mentions the need
for a catheter
clearly in the notes
(specify reason)
P
Patient
Preference
For end of life
patients who
prefer a catheter
to ease distress
(this has been
discussed with
patient and
documented)
P
Peri-op
Max 24 hrs
after
surgery
(please
detail
specific
operation in
comment
box)
Other
If the reason for
catheterisation is
not in TRAPP
please tick
below and
choose one of
the reasons in
the box to the
right
Prolonged
immobilisation
due to spinal
fractures or
trauma
Urological indications
including intra-bladder
treatments, bladder
diagnostic tests &
visible haematuria
1
2
Is this Catheter
In-Situ
appropriately?
Yes or No?
Comments
Please provide:
(1) any additional information on the reason for
catheterisation if not included
(2) Operation details if appropriate
If "other" has been selected
were there any of the
indications below, please tick
as appropropriate
B7Ward
Date of survey
Urinary Catheters
If Patient is catheterised please indicate CURRENT reason for
the patient to be catheterised in the boxes below (We are not
interested in the initial reason for insertion but why the
catheter is still in situ today)
What next?
• The audits have highlighted an enormous
opportunity in hospital
• Wards have started to use the data collection
tool as an intervention tool
• The audits have also been successful in the
community
Catheter Days
Cath
ete
r D
ays
10. Trust Catheter Days
Month
IndividualsIndividualsIndividualsIndividualsSet 2: UCL = 5,059.58, Mean = 4,232.18, LCL = 3,404.79 (16 - 26) (mR = 2)
5299.62
4604.33
3909.04
5059.58
4232.18
3404.79
01/0
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1301
/04/
2013
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/06/
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/08/
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3,000
3,200
3,400
3,600
3,800
4,000
4,200
4,400
4,600
4,800
5,000
5,200
5,400
CaUTI
Trust CaUTI
CHARTrunnerPowered by:
www.chartrunner.com 800-777-3020PQ Systems
incorporated
c chartc chartc chartc chartSet 1: UCL = 44.57, Mean = 28.55, LCL = 12.52 (25 - 35)
UCL = 50.92
Mean = 33.54
LCL = 16.17
UCL = 44.57
Mean = 28.55
LCL = 12.52
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/07/
2012
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50
Data Following
introduction of
Audit tool
% of patients Catheterised
% Patients Catheterised
CHARTrunnerPowered by: PQ Systems
incorporated
p chartp chartp chartp chartSet 5: UCL = 22.38, CTL = 18.06, LCL = 13.73 (38 - 50)
Inspected Mean = 712.31, Counts Mean = 128.62
UCL = 27.05
CTL = 21.98
LCL = 16.91
UCL = 22.38
CTL = 18.06
LCL = 13.73
Scale up to 100% of the organisation
1st Audit of AppropriateCatheterisation
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Community Catheters
Num
ber
of C
ath
ete
rised P
atients
145. Community Catheterised Patients
Month
IndividualsIndividualsIndividualsIndividualsSet 4: UCL = 261.41, Mean = 248.78, LCL = 236.14 (18 - 26) (mR = 2)
UCL = 320.35
Mean = 302.88
LCL = 285.40
UCL = 312.69
Mean = 279.44
LCL = 246.20
UCL = 261.41
Mean = 248.78
LCL = 236.14
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220
240
260
280
300
320
2015 Aim
In the hospital we will aim for:
• A 10% Reduction in Catheter Days by April 2016 in hospital
In the community we will aim for
• A 5% Reduction in Catheterised patients in the community by April 2016
Currently Testing
• Nurse Led Removal
• Support for Intermittent
Catheterisation (Staff
and Patients)
• Taking Formal Consent
• Locking Catheters away
Summary
• The quality improvement approach has
been the driver for the project, this has
been supported by the faculty (with links
to Trust board) providing the senior
leadership
• The Faculty provide direction and the
ideas for change are driven by the front
line teams