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On the CUSP: Stop CAUTI Monthly National Content Webinar

On the CUSP: Stop CAUTI Monthly National Content Webinar

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On the CUSP: Stop CAUTI Monthly National Content Webinar

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  1. On the CUSP: Stop CAUTIMonthly National Content Webinar Welcome to the May Webinar! Today’s Topic: Preventing CAUTI in Specialized Patient Populations: The ICU Access slides, video recording, and transcript of today’s webinar on the national project website: http://www.onthecuspstophai.org/on-the-cuspstop-cauti/educational-sessions/content-calls/

  2. Preventing CAUTI in Specialized Patient Populations: The ICU Hannah Wunsch, MD, MScHerbert Irving Assistant Professor of Anesthesiology and EpidemiologyColumbia University Eugene Chu, MD, FHMDirector of Hospital MedicineBoulder Community Hospital Associate Clinical Professor of Medicine University of Colorado School of Medicine

  3. Learning Objectives • Learn to reduce CAUTI through culture change • Understand the CUSP framework for initiating culture change • Apply culture change theory to urinary catheter culture • Learn about catheter utilization in the ICU setting • Understand unique barriers in the ICU population • Compare reduction of CAUTIs with other similar issues in the care of ICU populations • Hear from an ICU team on overcoming barriers • Using positive incentives to change behavior in regard to catheter use in the ICU • Catheter alternatives, nurse education, and engaging leadership

  4. On the CUSP: Stop CAUTI Culture Change: The 4 E’s and the Elephant

  5. Case

  6. What is the cause of Ms. B’s hypoxia? Aspiration pneumonia Acute coronary syndrome with CHF Pneumothorax Pulmonary embolism

  7. What is the cause of Ms. B’s hypoxia? Aspiration pneumonia Acute coronary syndrome with CHF Pneumothorax Pulmonary embolism

  8. Case Falls? Venous thrombo-embolism? *Saint S, Ann Intern Med 2002; 137: 125-7

  9. Objectives • Understand the CUSP framework for initiating culture change • Apply culture change theory to urinary catheter culture

  10. Organizational Culture …the shared set of social values and beliefs, both explicit and implicit, that guides actions and decisions within the organization

  11. Where do we intervene?

  12. CAUTI ICU Culture CAUTI Indications Orders HICPAC Insertion and Maintenance Technique Competency Removal Process Structure

  13. Leading Change For anything to change, someone has to start acting differently.

  14. Culture Change Theory

  15. Changing Patient Safety Culture

  16. Can you get people to start behaving in a new way? individual

  17. Can you get people to start behaving in a new way? organization

  18. Can you get people to start behaving in a new way? society

  19. Can you get people to start behaving in a new way? educate engage execute and evaluate

  20. Can you get people to start behaving in a new way? educate engage execute and evaluate

  21. Can you get people to start behaving in a new way? educate engage execute and evaluate

  22. Can you get people to start behaving in a new way? educate engage execute and evaluate

  23. Population Health Improvement

  24. Eat Healthy!

  25. Use Skim Milk!

  26. Use Skim Milk!

  27. Can you get people to start behaving in a new way? What looks like resistance is often a lack of clarity.

  28. Education – Direct the Rider • HICPAC guidelines • Appropriate • Inappropriate • Aseptic insertion technique • Maintenance technique • Closed system • Skin care • Equipment usage • Bladder scanner • Condom cath • Female urinals

  29. Taste Test

  30. Which group attempted the puzzle for a longer time before giving up? The group that could eat the cookies The group that could only eat the radishes No difference

  31. Which group attempted the puzzle for a longer time before giving up? The group that could eat the cookies The group that could only eat the radishes No difference

  32. Can you get people to start behaving in a new way? What looks like laziness is often exhaustion.

  33. Engage – Patients Falls? Venous thrombo-embolism? *Saint S, Ann Intern Med 2002; 137: 125-7

  34. Engage – Finances www.catheterout.org

  35. Engage – Vision • Imaginable • Feasible • Desirable • Focused • Flexible • Communicable

  36. Don’t Forget the Cookies

  37. Free Popcorn

  38. What characteristics were different between the groups? Age Gender BMI All of the above None of the above

  39. What characteristics were different between the groups? Age Gender BMI All of the above None of the above

  40. Can you get people to start behaving in a new way? What looks like a people problem is often a situation problem.

  41. Execute – Structure

  42. Execute – Processes • Orders with indications • Nurse driven removal protocol • Acute urinary retention protocol • Insertion and maintenance competency evaluations • ED and OR -> ICU processes • Monitoring and Feedback

  43. Evaluation

  44. Can you get people to start behaving in a new way? educate engage execute and evaluate

  45. Organizational Culture …the shared set of social values and beliefs, both explicit and implicit, that guides actions and decisions within the organization

  46. CAUTI ICU Culture CAUTI Indications Orders HICPAC Insertion and Maintenance Technique Competency Removal Process Structure

  47. Learning Objectives • Understand unique barriers in the ICU population • Compare reduction of CAUTIs with other similar issues in the care of ICU populations

  48. Last patient of the morning (11:45 a.m.) • 75 yo M • Hx of HTN, DM2 • Admitted 24 hours earlier “for monitoring” after a pancreaticoduodenectomy (Whipple) • Doing well, good UOP, no vasopressors Would you remove the urinary catheter as part of your plan for the day?

  49. Why do ICU patients feel ‘special’? • “if you touch them they desaturate” • “they are on high doses of vasopressors and their kidney function is tenuous” • “they are at high risk for a sacral decub” • “they are at risk for abdominal compartment syndrome and I’m monitoring UOP” • They are “sick” and we need to know “ins and outs” every hour The need for urinary catheters in the ICU will never go away

  50. So why is it so hard to change things? • What is YOUR biggest barrier? • The nurse/physicians in the unit want to take the Foley out, but the surgeon/oncologist also caring for the patient wants it in • Everyone still wants ‘ins and outs’every hour • There are so many other things to discuss on rounds