Date of Graduation

Summer 8-7-2018

Document Type

Project/Capstone

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

First Advisor

Dr. Nancy Taquino

Second Advisor

Dr. Elena Capella

Abstract

Abstract

Problem: The Institute of Medicine’s seminal report on patient safety, To Err Is Human led to widespread effort to improve the safety of patients. Healthcare-associated safety problems, which include healthcare-associated infection (HAI), account for far more considerable morbidity and mortality than “never events”. The first harm to be addressed as part of the “No Preventable Harms” campaign was catheter-associated urinary tract infection (CAUTI).

Context: The microsystem is a 20-bed mixed medical surgical intensive care unit. Unit assessment at the beginning of the quality project indicated that there were 2 CAUTIs attributed to the unit in a span of 6 months. CAUTI is associated with approximately $15,000 to each patient care cost and increase length of hospital stay for an additional 5 to 7 days.

Intervention: To realize effective changes in the ICU and evaluate the action plan, changes are tested by incorporating patient lines on the multidisciplinary rounds (MDR) script to discuss accurate indication and date of insertion of the indwelling catheter. The staff nurse will articulate accurately the indication and confidently obtain an order to remove the catheter if the indication no longer exists during MDR. If the indwelling catheter is clinically indicated, the nurse ensures the bundles are in place such as presence of securement device, maintain an unobstructed flow, maintain drainage bag below level of the bladder, perform hand hygiene before and after patient contact and lastly, provide a labeled collection container for the patient.

Measures: The outcome measure for this project is to decrease the number of CAUTI in the ICU from 2 (April 2017 data) to 0 and further decrease the standardized infection ratio (SIR) of 1.48 by 50%. Compliance with catheter indication and or early removal when indication no longer exists would be the process measure, expecting 90% of compliance through random chart audits and MDR observation.

Results: The percent of ICU patients with accurate indwelling catheter indication during MDR is improving, but not yet stable. This requires on-going monitoring and feedback to ensure a standardized and reliable process. A positive trend indicates that non-indicated catheters are identified and discontinued during MDR and with regards to percent of ICU patients compliant with the CAUTI prevention bundle does not have enough data to establish a trend, but performance is moving in a positive direction indicates increasing compliance to the CAUTI bundle.

Conclusion: The last CAUTI in the unit was in November 2017. Solidifying the interventions into clinical practice will deter the development of CAUTI and supports this positive trend.

Engaging staff and providers to reduce CAUTI rates to near zero requires a multidisciplinary approach and using the MDR as the venue commenced integration of the CAUTI prevention process into the front-line staff’s daily routine. The data shows promise in standardizing the approach during MDR rounds to prevent CAUTI and a potential spread of practice to other units.

In conclusion, the unit aims to decrease the standard standard infection ratio by 50% thus preventing CAUTI respectively.

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