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On the CUSP: Stop CAUTI ED Intervention

On the CUSP: Stop CAUTI ED Intervention. National ED Office Hours Co Hosted by: Emergency Nurses Association & Health Research and Educational Trust Moderated by: Shannon Davila, New Jersey Hospital Association September 10, 2014 at 10 CT/ 11 ET. ED Office Hours Agenda.

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On the CUSP: Stop CAUTI ED Intervention

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  1. On the CUSP: Stop CAUTI ED Intervention National ED Office Hours Co Hosted by: Emergency Nurses Association & Health Research and Educational Trust Moderated by: Shannon Davila, New Jersey Hospital Association September 10, 2014 at 10 CT/ 11 ET

  2. ED Office Hours Agenda • General Overview • Neel Pathak, HRET • ED Success Story Presentation • Deborah Cioffi, Barnabas Health, NJ • Discuss Utilization Rates and Barriers Specific to the ED Environment • Tina Adams, Clinical Content Development Lead, HRET • Marlene Bokholdt, Nursing Education Editor, ENA • Karen Jones, Infection Prevention and Control, St. John Hospital & Medical Center • ED CAUTI Data Collection: Tips for Success • Shannon Davila, Clinical Quality Improvement Manager, New Jersey Hospital Association • Discuss General Questions/Concerns • National Project Team

  3. The CAUTI Emergency Department Improvement Intervention What is the On the CUSP: STOP CAUTI ED Improvement Intervention? • Expanding the reach of the On the CUSP: STOP CAUTI national collaborative • Instilling a culture of partnership between emergency departments and in-patient units • Broadening exposure to national experts • American College of Emergency Physicians (ACEP) • Emergency Nurses Association (ENA)

  4. ED Improvement Intervention Goals Learning best practice techniques for CAUTI Prevention: Technical change (Process): • Determine catheter appropriateness • Preventing unnecessary placement • Promoting compliance with institutional guidelines • Promoting proper insertion techniques Culture change (CUSP): • Teamwork and communication amongst frontline staff • Identify nurse and physician champions for leadership and buy-in • Collaboration with in-patient units

  5. Decreasing Catheter Use in the Emergency Department Deborah Cioffi, RN, MSN, MSA Administrative Director, Emergency Services Monmouth Medical Center

  6. CAUTI A Call to Reverse the Trend in Emergency Departments

  7. Barnabas System ED’s Joined the-On the Cusp: Stop CAUTI National initiative with AHA/HRET to implement a proven culture change model-Comprehensive Unit –Based Safety Program (CUSP) and Intervention to Prevent Catheter Associated Urinary Tract Infection (CAUTI)

  8. ED Project Timeline

  9. MMC ED Team • Deborah Cioffi, RN, MSN, MSA Administrative Director, Emergency Services • Victor Almeida, DO, FACEP Chairman, Emergency Services • Jean Straker-Darbeau, RN, DNP ED Educator • Caitlin Mahoney, RN Staff Nurse • Kathy Rivera, RN Performance Improvement Coordinator • Carolyn Korotky, RN, BA, BSN, RN-BC, CIC RN Infection Control

  10. Baseline Data Reporting • Number of ED catheter insertions Number of Admissions • Did patient present to ED with a catheter in place? • Was an order present for insertion?

  11. Our Next Steps • Recognized that urimeters are needed for inpatients • Adding urimeters in the storeroom so that they are available to be used to avoid having to • Mechanism to be implemented to ensure proper placement of catheter system on stretchers and wheelchairs to prevent backflow which can lead to a urinary tract infection • Barnabas Health systemwide committee was formed. Meets biweekly. Pat McNamee, Deb Cioffi • All 7 Barnabas Health Hospitals have formed Hospital Based Committee that report up to the Systemwide Steering Committee • The Nurse driven protocol for Catheter insertion and removal was implemented across the system

  12. Polling Question 1 • How is urinary catheter insertion competency in staff assessed in your emergency department? (CHOOSE ONE) a)      Observation during insertion on patient(s) b)      Simulation c)       Written test and/or computerized module d)      There is no competency for ED staff

  13. Polling Question 2 2. What is your data source for tracking urinary catheter insertions in your emergency department? (CHOOSE ONE) a)Nursing insertion documented on paper or electronic medical record b) Physician order documented on paper or electronic medical record c) Supply/stock records d)Laboratory results

  14. Polling Question 3 3. Which component of CAUTI prevention strategy would you like to focus on for your emergency department? (CHOOSE ONE) a)  Insertion practices (i.e., sterile technique, 2-person insertion) b)  Improving communication among ED staff to ensure UCs are placed only when appropriate c) Improving communication among ED and inpatient staff to ensure UCs are placed only when appropriate d) Developing more involved, more visible CUSP CAUTI leaders (physicians & nurses) in the ED

  15. Utilization Rates & Barriers Discuss Utilization Rates and Barriers Specific to the ED Environment

  16. ED CAUTI Data CollectionTips for Success Shannon Davila Clinical Quality Improvement Manager, NJHA

  17. Let’s Review the Measures Required ED metrics: • Number of admits from the ED, including observation patients • Number of admits from the ED, including observation patients with a newly placed indwelling catheter in the ED Additional recommended ED metrics: • Catheter appropriateness • Total number of indwelling catheters placed in the ED

  18. Potential Data Sources • Paper Chart • Electronic Health Record • Nursing documentation • Physician Order Entry • Supply Log • QI checklist/log • Laboratory data

  19. Review Potential Data Sources • Where do nurses document? Do they chart urinary catheter insertion? • Where do physicians place their orders? Do they routinely and consistently order urinary catheters? • Are catheters a charged item? Can you access billing lists or supply records? • Do you collect UA’s on all patients that receive a urinary catheter? Can you isolate those ED pts from lab data records?

  20. Get to know your IT friends! • Find out who in is charge of your ED EHR system • Get this report request in the queue as soon as possible • Be very clear what data points you want to capture (example: indwelling NOT straight cath insertions) • May use this an opportunity to update the ED documentation (add insertion criteria)

  21. Don’t Wait! • Collect and enter data as soon as possible • Know your data collection schedule

  22. Benefit of Collecting Both Measures • Gives a multi dimensional view of what is going on • Will help to show the impact of interventions • Helps to create consistency across hospital units

  23. Share the Wealth • Have a co- lead or data collector • Look for alternative options for data collection • Review data with your team on a regular basis • Share your report template with others

  24. Questions? Other Suggestions?

  25. ED Office Hours General Questions/Concerns?

  26. Quarterly ED Office Hours • Access slides, recording, and transcript of today’s webinar on the national project website: • http://www.onthecuspstophai.org/on-the-cuspstop-cauti/educational-sessions/ed-improvement-intervention-educational-sessions/ • Upcoming Office Hours: • Wednesday, December 10, 2014 at 11 ET/10 CT • Wednesday, March 11, 2015 at 11 ET/10 CT • Wednesday, June 10, 2015 at 11 ET/10 CT

  27. Your Feedback is Important We rely on your opinion to shape future ED Office Hours. Please complete our evaluation using this link:ED Office Hours Evaluation

  28. ED Office Hours Thank you!

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