Holey Moley! What About That
Foley?!Kathleen Steinmann
Hennepin County Medical CenterSeptember 7, 2012
HCMC CAUTI Team Assessment
• Documentation • Visual audits
– poor securement – poor pericares
• Education: minimal to none• Provider - RN relationship• Evaluate
products/convenience
Plan• Improve EPIC documentation• Develop education tools• Implement trial protocol ICU’s• Convert to Bard Lubricath Tray
– integrated Castile soap, – hand sanitizer and – Statlock stabilizing device
Collaboration• SCIP Team– foley removal by end of POD 2
• LEAN Event– Widened the net and IP recommended protocol– Implement changes housewide– Align report tools
Protocol
Protocol
Education• NURSING– Leadership approval for mandatory RN training– 20 minute lecture– 15 minute insertion skills training– Skills checklist (insertion/cares/stabilization/documentation)– 30 minute skill session during new nursing orientation (new)– Develop standard work for health care assistants– Education alternatives to foleys– Collaborated with skin team
• PROVIDER– All new residents receive insertion training– Presented to Provider Staff Meetings– Found provider champions and to gain one on one support– Emails
Device UtilizationLOOKING GOOD!
0.44 0.41 0.39
0.00.10.20.30.40.50.60.70.80.91.0
2011 2012Q1 2012Q2
HCMC House Urinary Catheter Device Utilization
0.00.10.20.30.40.50.60.70.80.91.0
2011 2012Q1 2012Q2
HCMC ICU (MISIPI) Urinary Catheter Device Utilization
0.94 0.94
0.5
0.6
0.7
0.8
0.9
1.0
Jan-12
Feb-12
Mar-12
Ap
r-12
May-12
Jun-12
Jul-12
MICU Device Utilization
Or maybe not yet?
Success
• Protocol implemented• Improved urine catheter kit• Improved awareness/education• SCIP process measure significant
improvement• CAUTI infection rates: too soon to tell
Challenges
• Implementation Costs– Product – Education
• Accountability Dynamic Issues– Infection vs Prevention measures – Owner
• Someone to “ride herd” until it becomes a habit• Process measure auditing responsibility • Who should manage nursing process in alignment over time
with all training and monitoring
• Audit Fatigue
Challenges• Mixed Messages for Foley– Message can vary depending on “messenger”• Example: SCIP repeated messages on the process; but none
addressing the outcome – need to collaborate!– Who wore out their welcome first?• SCIP measure already in place; focus was only on removal• Difficult now to have staff focus on cares and outcome for all
patient population
• Provider Behaviors– Foley changing “vodoo”– Inventive culture collection techniques
What Next ??
• Defect management (root cause)• Bladder scan benefit• MUST HAVE provider champions – – External push that this is valued and not a burr
• Auditing, auditing, auditing…….
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