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Urine-8 Project: Next Step

Urine-8 Project: Next Step. Mary A. Petersen, MSN, RN: Director of Professional Nursing Practice Betsy Demarest, BBA, RN, CNOR: Director of Surgical Services Trinity Medical Center – Quad Cities. Urine-8 Committee Members. Michelle Blackmer, MSN, FNP-BC, RN Stan Buck, RN, RNFA

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Urine-8 Project: Next Step

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  1. Urine-8 Project: Next Step Mary A. Petersen, MSN, RN: Director of Professional Nursing Practice Betsy Demarest, BBA, RN, CNOR: Director of Surgical Services Trinity Medical Center – Quad Cities

  2. Urine-8 Committee Members • Michelle Blackmer, MSN, FNP-BC, RN • Stan Buck, RN, RNFA • Pam Elliott, MBA, BFA • Chris Hansen, MS, RN • Diane Laake, RN, CMSRN • Paula Maddox, MSN, RN, CCRN • Kathryn Marhoefer, MBA, RN • Michelle Mathias, BSN, RN • Mary A. Petersen, MSN, RN (Committee Chair)

  3. CAUTI Statistics Nationwide 80% of HA UTIs are caused by urinary catheters 5% deaths from HAIs are urinary catheter associated Cost of a CAUTI is estimated at $500-1000, $2800 if bacteremia Source: Michigan Keystone Project, 2008

  4. Trinity CAUTI Rates

  5. First Step • Determine specific nursing opportunities to decrease foley related UTI’s • Conducted a one-day prevalence study • Primary aims of the study included • Quantify the level of use of indwelling urinary catheters • Determine the level of adherence to guidelines

  6. Methods • 2007, 2008 & 2010 all units on each campus surveyed • List obtained identifying all patients with Foley and RN providing direct care • Data collector directly observed the catheterized patients and interviewed RN • Data was collected on a standardized form • 2011 & 2012 implemented Adaptive Design methodology

  7. Foley Practice Areas Reviewed • Presence of a Foley catheter • Catheter secured to the pt’s abdomen or leg • Tamper Evident Seal intact (TES) • Tubing extended to prevent the development of dependent loops of drainage tubing • Tubing secured to patient bed or chair to prevent pulling on system • Drainage system not touching the floor • Urine bag not over filled with urine

  8. Percentage (%) of Compliance with Total Foley Practice Areas 2007 2008 2010 Percentage %

  9. SBAR

  10. Catheter Associated Urinary Tract Infection (CAUTI) PreventionURINE-8

  11. Trinity CAUTI Rates

  12. Trinity SCIP Data 2009 & Today

  13. Nurse Driven Urinary Catheter Removal Protocol

  14. Lessons Learned • Nurse to Nurse Collaboration is a practiced skill • Physician collaboration is key • Physician and Nurse communication / education is paramount • Adaptive Design and daily monitoring drives successful implementation

  15. Conclusion: • HAI’s represent a direct threat to patient safety, healthcare quality and they are costly. • The Urine-8 project has consistently decreased the infection rate and identified the positive financial impact directly attributed to evidence-based nursing practice. • The next step of adding the nurse driven catheter removal protocol will continue to decrease unnecessary Foley days and serve as a tool to meet SCIP criteria and avoid CAUTI.

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