1 / 13

Cover slide

Cover slide. Reduction in Urinary Catheter Utilization Emory Johns Creek Hospital Marcia Postal-Ranney, RN, CIC, Infection Prevention Karen Tatoy, RN, Shift Nurse Manager Medical Unit Lynn Talmadge, RN, Charge Nurse, Emergency Department . Emory Johns Creek Hospital.

sen
Download Presentation

Cover slide

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Cover slide Reduction in Urinary Catheter Utilization Emory Johns Creek Hospital Marcia Postal-Ranney, RN, CIC, Infection Prevention Karen Tatoy, RN, Shift Nurse Manager Medical Unit Lynn Talmadge, RN, Charge Nurse, Emergency Department

  2. Emory Johns Creek Hospital • 110 Bed Community Hospital in Johns Creek, GA • Opened February 2007 • Medical Unit • Surgical Unit • ICU • Women’s Services with level 3 NICU • Cardiac Catheterization lab with PCI

  3. Team Members • Physician Champion • Brenda Friedman, MD • Administrative Champion- Hassan Shabbir, MD, Chief Quality Officer • 4 Surgical- • Roselyn Laxama • Stephanie Liffick • 3 Medical • Sayea Vardier • Maila Rallos • Karen Tatoy • Anu Thomas • Muta Okparaocha • Women’s Services • Melissa Donovan • Lydia Balbuena • ICU • Allison Tomy • Donna Dyer • Emergency • Lynn Talmadge • Lindsey Meixner • Infection Prevention • Marcia Postal-Ranney • Newnan Hospital • Dr. Karen Clarke

  4. Medical Executive Committee Approval • Physician champion brought indications for indwelling catheter insertion to MEC • Cardiology Chairman approved guidelines for cardiac patients will not require indwelling catheter for accurate I&O outside of the ICU • Nephrology Chairman approved guidelines for dialysis patients to not require indwelling catheter for accurate I&O outside of the ICU • Alternative methods of daily weights and number of wet sheets per day would suffice

  5. Emergency Room Catheter Insertion Indications Indication for urinary catheter insertion (Why are you inserting this catheter) Check all that apply • Hemodynamically unstable • Precise measurement of urinary output needed in ICU • Acute urinary retention or obstruction • Stage three or four sacral decubitus in incontinent patient • Select surgical procedures- urinary and GYN • Prolonged immobilization • End of life care- Hospice • Epidural/ Lumbar catheter in place • Replacement of current indwelling catheter • Continuous bladder irrigation • Other-Obtain from provider_________________

  6. Posters for Approved Use of Indwelling Catheters

  7. Appropriate Reasons for Indwelling Catheter Inappropriate Reasons for Indwelling Catheter Daily Review for Necessity • Hemodynamically unstable- accurate I&O in ICU • Obstruction of urinary tract • Need to monitor accurate urine output in ICU • Preoperative catheterization • Urinary tract hemorrhage • Palliative care • Continuous lumbar epidural anesthesia • Incontinent patient with stage III or IV decubitus • Chronic Foley catheter prior to admission • Nursing convenience • Not checking daily to see if catheter can be discontinued • Urinary incontinence with no skin breakdown • No clear reason for placement of catheter • Intermittent catheterization is possible • Patient request

  8. Laminated card in the patient room explaining the EJCH philosophy for not using an indwelling catheter Patient Brochure

  9. Nurse Attitude • Nurses want to make sure that the patient does not get a CAUTI • Importance of a faster recovery to get the patient up to bedside commode or toilet • Purple pad helps by absorbing one liter of fluid without patient feeling wet. Pads improve ease of changing the bed • SIBR rounds requires nurse to pick a designated indication to keep the indwelling catheter in place

  10. CAUTI Slide

  11. Urinary Catheter Utilization

  12. Nurse-Driven Indwelling Urinary Catheter Removal Algorithm Catheter Removal Diagram • Indwelling Urinary Catheter Alternatives • External catheters • Toileting schedule • Bladder scan • Intermittent catheterization • Symptoms of Urinary Retention • Urinary pain, fullness, or distention • Change in voiding pattern • Failure to void in past 6 hours in spite of adequate hydration • Frequent voiding with volumes <100 ml LR 12-13

  13. Each adult unit is seeing a reduction in catheter utilization Indwelling catheters are not placed immediately in the Emergency Room for every admitted patient Staff convenience is no longer a reason for a catheter Attitudes changed and staff felt truly concerned when a CAUTI occurred Culture was changed to see this and other aspects of preventable harm as a patient safety issue Each employee felt committed to personal responsibility for prevention of hospital acquired conditions. Ultimate Outcome- culture change “Many infections are inevitable; some might be preventable” “Each infection is potentially preventable, unless proven otherwise”

More Related