ON THE CUSP: STOP CAUTI Cohort 8 - Getting Started

April 25, 20142-3:30 pm ET

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Agenda• Why Work on CUSP/CAUTI• On the CUSP/Stop CAUTI Overview

– Cohort 8– CUSP – CAUTI Prevention

• Data Reporting• Getting Started- Next Steps

– Resources • FHA CAUTI Cohort 8 Work Plan - Monthly Key Activities• Calls, Webinars, Website, etc.

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Introductions• Introduce yourself (name, hospital, unit)• Describe your unit (e.g. specialty, size, etc.)• Why do you want to participate• What do you hope to gain from participation

– Boca Raton Regional Medical Center• CVICU, MICU, SICU

– Tampa General Hospital• 2D 1 & 2

– University of Miami Hospital• Penthouse North

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ON THE CUSP: STOP CAUTIWHY PARTICIPATE

• Healthcare Associated Infections– Affect 2 Million hospitalized patients each year in the

U.S.• 32% develop UTIs each year• 15% develop pneumonia• 14% develop bloodstream infections

• Annual cost of catheter-associated UTI (CAUTI) is $450 Million

• Up to 380,000 infections and 9000 deaths related to CAUTI per year could be prevented

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ON THE CUSP: STOP CAUTIWHY PARTICIPATE

• Opportunity to implement a proven, effective culture change model

• Hospitals can use the CUSP framework for other process improvement projects

• Opportunity to network and learn from other hospitals• Access to expert faculty• Data collection and monitoring support• Many free resources to support improvement efforts

– www.onthecuspstophai.org– www.catheterout.org

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ON THE CUSP: STOP CAUTIGOALS & EXPECTED OUTCOMES

GOALS:• Reduce mean CAUTI rates in participating clinical units by 25 percent, and • Improve safety culture by disseminating CUSP methodology as evidenced by

improved teamwork and communicationEXPECTED OUTCOMES• Increased awareness of appropriate urinary catheter (UC) use• Reduced use of indwelling UCs• Empower staff to discontinue UC when appropriate • Reduced patient discomfort• Reduced incidence of bacteriuria • Reduced rates of symptomatic UTIs• Shortened LOS and decreased cost per stay• Share lessons with others• Specialized support is available for emergency departments

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ON THE CUSP: STOP CAUTIProgram Overview

Program Requirements:• Work with your hospital team to reduce CAUTI using the

evidence based practice• Collect & Submit Data as scheduled

• Outcome data: CAUTI rates• Process Data: Catheter Prevalence

• Implement the CUSP Program Using the CUSP tools:• Unit Readiness tool• Staff Safety Assessment• Hospital Safety Culture Survey (HSOPS)• Learning from Defects• Team Check Up Tool

• Improve CAUTI rates in your hospital• Develop & implement a Sustainability Plan

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ON THE CUSP: STOP CAUTIREQUIREMENTS

Program Requirements:• Hospital inpatient units need to participate in the

program for 18 months• Learn and implement CUSP and CAUTI prevention

interventions• Meet regularly as a team to review data and monitor

performance improvement• Have at least one or more team members participate in

national content and monthly coaching calls• Share lessons with others

• Collaboration is one of the keys to rapid improvement

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ON THE CUSP: STOP CAUTI RESOURCES

CUSP

CUSP is an intervention to reduce mistakes and improve teamwork and communication

CUSP is a good approach to use whenever there is a gap between evidence based practice and current practice on your unit.

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Why Is CUSP Important?

Culture has been linked to clinical and operational outcomes in healthcare*:

– Wrong site surgeries– Decubitus ulcers– Bloodstream infections– Post-op infections– RN Turnover– VAP *data provided by Bryan Sexton

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Pre CUSP Work

• Create an CUSP CAUTI team– Nurse, physician, administrator, infection control,

others– Assign a team leader

• Measure culture in your clinical unit (HSOPS or other valid process ~discuss with hospital association leader)

• Work with hospital quality leader to have a senior executive assigned to your unit based team

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Comprehensive Unit-based Safety Program (CUSP) An Intervention to Learn from Mistakes and Improve Safety Culture

1. Educate staff on science of safety

2. Staff Safety Assessment ~Identify defects

3. Assign executive to adopt unit

4. Learn from one defect per quarter

5. Implement teamwork tools

Timmel J, et al. Jt Comm J Qual Patient Saf 2010;36:252-260.

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Science of Safety

• Understand the system determines performance

• Use strategies to improve system performance– Standardize– Create independent checks for key process– Learn from mistakes

• Apply strategies to both technical work and team work

• Recognize teams make wise decisions with diverse and independent input

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Identify Defects

• Ask staff how will the next patient be harmed (Does not need to be related to CUSP/CAUTI)

• Ask how they think that harm could be mitigated

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Prioritize Defects

• List all defects• Discuss with staff what are the three

greatest risks• Work with executive and CUSP CAUTI

team to eliminate risks and learn from mistakes

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Executive Partnership

• Executives should become a member of the CUSP CAUTI team

• Executives should meet monthly with the CUSP CAUTI team

• Executives should review defects, ensure the CUSP CAUTI team has resources to reduce risks, and hold team accountable for improving risks and catheter associated urinary tract infections

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Learning from Mistakes

• What happened?

• Why did it happen (system lenses)?

• What could you do to reduce risk?

• How do you know risk was reduced?– Create policy / process / procedure– Ensure staff know policy– Evaluate if policy is used correctly

Pronovost 2005 JCJQI

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To Evaluate Whether Risks were Reduced

• Did you create a policy or procedure?

• Do staff know about the policy?

• Are staff using it as intended?

• Do staff believe risks have been reduced?

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Teamwork Tools

• Daily Goals Checklist• Morning briefing• Shadowing• Culture debriefing• TeamSTEPPS

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Shadowing

• Follow another type of clinician doing their job for between 2 to 4 hours

• Have that person discuss with staff what they will do differently now that they walked in another person’s shoes

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CUSP Lessons Learned• Culture is local

– Implement in a few units, adapt and spread– Include frontline staff on improvement team

• Not linear process– Iterative cycles– Takes time to improve culture

• Couple with clinical focus (eg CUSP CAUTI)– No success improving culture alone– CUSP alone viewed as ‘soft’ – Lubricant for clinical change

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CUSP is a Continuous Journey

• Add science of safety education to orientation

• Learn from one defect per month, share or post lessons (answers to the 4 questions) with others

• Implement teamwork tools that best meet your teams needs

• Details are in the CUSP CAUTI manual

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CUSP & CAUTI Interventions

1. Educate on the science of safety

2. Staff Safety Assessment ~Identify defects

3. Executive adopts the unit

4. Learn from Defects

5. Implement teamwork & communication tools

CUSP CAUTI

1. Care and Removal Intervention

Removal of unnecessary catheters

Proper care for appropriate catheters

2. Placement Intervention

Determination of appropriateness

Sterile placement of catheter

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Core Prevention Strategies

Catheter Use

Insertion Maintenance

• Insert catheters only for appropriate indications• Leave catheters in place only as long as needed

• Ensure that only properly trained persons insert and maintain catheters

• Insert catheters using aseptic technique and sterile equipment (acute care setting)

• Maintain a closed drainage system

• Maintain unobstructed urine flow

Hand Hygiene

http://www.cdc.gov/hicpac/cauti/001_cauti.htmlQuality Improvement Programs

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CAUTI Prevention #1: Make Sure the Patient Really Needs the Catheter

Appropriate indications• Bladder outlet obstruction

• Incontinence and sacral wound

• Urine output monitored

• Patient’s request (end-of-life)

• During or just after surgery (Wong and Hooton - CDC 1983)

Jain. Arch Int Med 9527

http://www.cdc.gov/hicpac/pdf/CAUTI/CAUTIguideline2009final.pdf28

Indications2009 Prevention of CAUTI HICPAC

Guidelines(Gould et al, Infect Control Hosp Epidemiol 2010; 31: 319-326)

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Appropriate Indications forCatheter Use

Appropriate IndicationsPatient has acute urinary retention or obstruction

Need for accurate measurements of urinary output in critically ill patients.

Perioperative use for selected procedures:•urologic surgery or other surgery on contiguous structures of genitourinary tract,•anticipated prolonged surgery duration (removed in post-anesthesia unit),•anticipated to receive large-volume infusions or diuretics in surgery,•operative patients with urinary incontinence,•need to intraoperative monitoring of urinary output.To assist in healing of open sacral or perineal wounds in incontinent patients.

Requires prolonged immobilization (e.g., potentially unstable thoracic or lumbar spine)To improve comfort for end of life care if needed.

Gould C, et al. Infect Control Hosp Epidemiol 2010;31:319-26.

Inappropriate Indications for Indwelling Urinary Catheter Use

Inappropriate Indications

As a substitute for nursing care of the patient or resident with incontinence

As a means of obtaining urine for culture or other diagnostic tests when the patient can voluntarily void

For prolonged postoperative duration without appropriate indications (e.g., structural repair of urethra or contiguous structures, prolonged effect of epidural anaesthesia, etc.)

Routinely for patients receiving epidural anesthesia/analgesia.

Gould C, et al. Infect Control Hosp Epidemiol 2010;31:319-26.

Other Reasons and Risk of Urinary Catheters

• Other Reasons– Urine output monitoring outside the ICU– Incontinence without skin breakdown/decubitus– Prolonged post-operative use beyond 24 hours– Transfer from ICU to floor– Morbid obesity or immobility– Confusion or dementia– Patient request

• Other Risks– Secondary bacteremia, sepsis, metastatic infection– “One-point restraint” = decreased mobility

• DVT/PE, pressure ulcers• Fall risk by tripping over catheter• Deconditioning

– Patient discomfort, need to retrain bladder

Perceived Short term

benefits

Real cumulative

risks:• LOS• Cost

• Mortality

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• Use smallest catheter size effective for patient (14 or 16F)

• Ensure that only properly trained persons insert catheters

• Insert using aseptic technique– Goal is to avoid contamination of the sterile catheter

during the insertion process

CAUTI Prevention #2: Proper Placement and Use of Aseptic Insertion Technique

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CAUTI Prevention #3: Maintenance

• Maintain a closed drainage system• Maintain unobstructed urine flow

– Free of kinks– Collecting bag below the bladder– Empty the bag regularly

• Use routine hygiene, i.e., do not clean the periurethral area with antiseptics

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CAUTI Prevention #3: Maintenance

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• Alternatives to the indwelling catheter

– Bladder ultrasound

– Intermittent catheterization

– Condom catheter

• Antimicrobial urinary catheters (?)

CAUTI Prevention #4: Consider Other Methods for Preventing CAUTI

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Program Goals1. Reduce placement of unnecessary indwelling

urinary catheters2. Increase prompt removal of indwelling urinary

catheters that are no longer needed3. Ensure the use of proper insertion technique for

indwelling urinary catheters that are appropriately indicated

Decrease the risk of hospital-acquired catheter-associated urinary tract infections

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How Do We Achieve These Goals?

• Engagement

• Education about the appropriate use and insertion of urinary catheters

• Execution and Evaluation– Monitoring and Feedback (aka Data collection)

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Consistently Using Evidence-Based Practices Remains a Challenge…

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Prevailing Themes

1) Prioritization

2) Champions

3) Tailoring

4) Workload and Workflow

5) Leadership

(Saint et al. Infect Cont Hosp Epid 2008)40

Catheter-associated urinary-tract infection is a low priority

“I would say there’s a general perception in the field that urinary tract infections don’t cause a lot of morbidity and mortality compared to the quote, sexy topic such as blood stream infection or surgical site infection or VAP.” (Saint et al. Infect Cont Hosp Epid 2008)

From an Infection Preventionist:The main urologist “who everybody knows and loves thinks the whole Bladder Bundle is just stupid. There is no one who is passionate about getting Foley catheters out of our patients.”

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A physician administrator from a large private hospital explained,

“the nurses on the geriatrics unit wanted to have their patients regain mobility or maintain their mobility at all costs and having a catheter . . . was one other reason why they never had to get out of bed . . .the catheters are always removed on the geriatrics unit but it’s a fight on the other units to have those catheters taken out because there’s always an excuse. Like, ‘well, they’re really big or it’s hard for them to get out of bed or it’s a two person assist’...”

But . . .timely removal of catheters considered important by some

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Identifying a committed “champion” can facilitate

prevention activitiessuccessful champions tend to be intrinsically motivated and enthusiastic about the practices they promote

“I have a certain stature in this hospital…People know that I’m very passionate about patient care so…I get positive reinforcement from them…they’re happy to see me…because …they know that I’m thinking about what’s best for the patient…”

(Damschroder et al., Qual and Safety in Healthcare 2009)

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The Importance of Tailoring• May need to tailor (i.e. modify or adapt) your

approach to CAUTI given your specific context and circumstances

• We saw different solutions at different hospitals; different solutions within different units at the same hospital

• Examples:

– Educating nurses about urinary catheters

– Who assesses for catheter appropriateness

– Focus on insertion or timely removal or both?

 

Attention to Urinary Catheters: Workflow and Workload

• The intervention(s) should become part of the workflow: both removal (floor) and insertion (ED)

• For insertion, ED is paramount

– Foleys put in for specimen collection and left in

– ED nurses may think they’re doing floor nurses a favor

• Nursing workload was a big issue - since Foleys can be easier for the nurses, this may be a disincentive to remove

• Leadership at various levels appears to be important, especially at the nurse manager level

• Project leader to help ‘manage’ the process can be very useful

• Physician leadership– Behind-the-scenes (getting buy-in from medical

executive committees and other physicians) – Front-line (eg, hospitalists, hospital

epidemiologists)

The Importance of Leadership

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Teamwork: Key Roles and Responsibilities

Role or responsibility Example of personnel to consider

Project coordinator Infection Preventionist, Quality manager, Nurse manager

Nurse champion (engage nursing personnel)

Nurse manager, charge nurse, staff nurse

Medical/physician liaison Urologist, ID physician, hospital epidemiologist

Data collection, monitoring, reporting

Infection Preventionist, Quality manager, Utilization manager

Conclusions

• Many reasons to prevent CAUTI

• Implementing change is not easy

• Preventing CAUTI requires understanding both the “technical” components and the “socio-adaptive” aspects

• Preventing CAUTI is a Team Sport

• The ultimate objective is to ensure we provide the safest and most effective care for patients

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Data Reporting

1) Understand Why Data is Crucial to the Project2) Understand the Project’s Data Elements: ---What Data Do We Collect? ---When Is It Due? ---What Infrastructure Do Teams Need to Accomplish This?

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Why is Data Crucial to the Project?

Project’s data elements will help you:• Track adoption of technical work and CUSP

interventions• Measure progress of CAUTI reduction• Identify barriers to teams’ progress• Keep you on course to achieve BOTH project

goals50

CAUTI PROJECT DATA ELEMENTS:

• Background/Cultural Data: ---Readiness Assessment ---HSOPS: Baseline and Follow-up • Ongoing Data Submission: ---Outcome data ---Process Data ---Team Checkup Tool

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BACKGROUND/CULTURAL DATA: Readiness Assessment

• Tells us about your unit: --- size, type, patient demographics --- prior involvement in any CAUTI prevention and/or CUSP activities --- prior patient safety/performance improvement activities

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BACKGROUND/CULTURAL DATA: Readiness Assessment

• Completed ONCE at the start of the project (May 12-26)

• Done via Survey Monkey ---MHA will email the survey link to each designated unit lead ---Completed by only ONE person per unit

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BACKGROUND/CULTURAL DATA: HSOPS

• Standardized measure of safety culture on the individual patient care unit (NOT

hospital-wide)• Done twice: ---at the beginning/after the intervention• Goal is at least 60% response rate of all staff

that affect patient care on the unit

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BACKGROUND/CULTURAL DATA: HSOPS

Infrastructure Needed: • Each unit needs a survey coordinator who ---registers their unit/estimates # of unit staff who will take the survey ---educates staff about the survey process ---ensures adequate survey response rate (at least 60%)

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BACKGROUND/CULTURAL DATA: HSOPS

• Dates to remember: HSOPS Training Webinar: May 20 or 22 Baseline HSOPS: ---pre-notification email sent May 20 ---registration starts May 26 ---survey runs June 9 – July 4 Follow-up HSOPS: ---15+ months56

CAUTI PROJECT DATA ELEMENTS:

• Background/Cultural Data: ---Readiness Assessment ---HSOPS: Baseline and Follow-up Ongoing Data Submission: ---Outcome data ---Process Data ---Team Checkup Tool

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ONGOING DATA COLLECTION:Outcome and Process Data

• OUTCOME DATA: What impact have we made on our 2 project goals:

1) reducing the CAUTI rate by 25% and 2) improving our unit’s culture of safety • PROCESS DATA: Are we changing our daily work

activities regarding catheters in a way that reduces the risk of infection (technical work) and makes care safer (culture change/CUSP) ?

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CAUTI OUTCOME DATA: What Do We Collect?

For the entire month (not just M-F) each enrolled unit must collect and submit:

• Total # of patient days for that unit• Total # of indwelling urinary catheter days

for that unit• Total # of CAUTI’s for that month Result: CAUTI Rates Catheter Prevalence59

CAUTI OUTCOME DATA: What Infrastructure Do Teams Need?

• Someone to collect the data ---should be knowledgeable about the criteria ---should resolve any “questionable CAUTI” issues before entering data ---Good resource: ICP

• Someone to enter the data ---Into MHA Care Counts (www.mhacarecounts.org) ---Care Counts training (April 30 or May 7)

---Recording will be available at www.onthecuspstophai.org >Stop CAUTI > Educational Sessions > Onboarding Calls

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CAUTI OUTCOME DATA: When is it due?Starts in MAY, with Three Phases

• BASELINE (Monthly submission) May, June, July 2014• IMPLEMENTATION (Monthly submission) August and September 2014• SUSTAINABILITY: (Quarterly for 3 periods) December 2014; March and June 2015Note: all data is due by the end of the following month

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OUTCOME DATA: How Do I Enter It?

WHERE? ---MHA Care Counts (www.mhacarecounts.org)

HOW? ---Manual Entry WHEN? ---Monthly

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PROCESS DATA: What Do We Collect?

DAILY, following the submission schedule: • # of patients on the unit that day• # of catheterized patients on the unit that day• Main reason why patient has a catheter TODAY• Where the catheter was inserted (on the floor, off

the floor, unknown) Result: Catheter Appropriateness Info

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CAUTI PROCESS DATA: What Infrastructure Do Teams Need?

• Have their team in place --- Crucial: physician leader, nurse leader,

frontline care provider, infection control practitioner

• Be conversant with HICPAC guidelines as to appropriate indications for catheters

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CAUTI PROCESS DATA: What Infrastructure Do Teams Need?

• Need a rounding process (not record review) --- IDEAL: piggyback on existing unit rounds --- use the recommended audit tool• Need a designated point person to record

data/contact physicians for orders to remove catheters

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CAUTI PROCESS DATA: What Infrastructure Do Teams Need?

• EXPECTATION: The rounding process goes on daily during the project, regardless of whether data is to be submitted on that day!

Remember: This rounding process IS the intervention!!!

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CAUTI PROCESS DATA: What Infrastructure Do Teams Need?• Need someone to enter the data into MHA

Care Counts• Data should be entered ASAP ---Ideally enter the same day team rounds ---Teams should be talking about their findings

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Process Data Collection Tool

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Patient Number 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Is Catheter Present? (Yes or No)

Why does the patient have a catheter TODAY? (Check the MAIN reason for the catheter)

Accurate measurement of urinary output in critically ill patientAcute urinary retention or obstructionAssist healing of perineal or sacral wound in an incontinent patientChronic indwelling catheter on admissionHospice/comfort /palliative careHospital approved indicationPerioperative use in selected surgeriesRequired immobilization, for trauma or surgery

If none of the above reasons apply, why does the patient have a catheter TODAY? (choose one from the list below):

Incontinence WITHOUT a sacral or perineal pressure sore

Other reason (ICU transfer, morbid obesity, immobility, confusion/dementia, patient request)Prolonged post-operative useUrinary Output Monitoring OUTSIDE the ICU

OPTIONAL: ACTION TAKEN

Nurse removed catheter today Staff contacted dr; dr. ordered removal Staff contacted dr; dr. did NOT order removal No action taken

If yes, where was Catheter placed? (On the Unit, Off the Unit, Unknown)

APPROPRIATE Indications

INAPPROPRIATE Indications

Does Catheter Have an Appropriate Indication TODAY? (answer Yes or No)

If catheter does NOT have an appropriate indication, what action was taken? (check box)

PROCESS DATA: When is it due?Starts in JULY, with Three Phases

• BASELINE (Daily, M-F for three weeks)

July 7-11, July 14-18, and July 21-25• IMPLEMENTATION (Daily, M-F for two weeks, then 6 single days of data collection)

Aug. 4-8 and Aug. 11-15, then Aug. 19, 26, and Sept. 2, 9, 16, 23

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PROCESS DATA: When is it due?

• SUSTAINABILITY: (M-F, 1 week per quarter)

December 15-19, 2014 March 9-13, 2015 June 15-19, 2015

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PROCESS DATA: How Do I Enter It?

WHERE? MHA Care Counts (not NHSN!) HOW? ---Use the data collection paper tool as you do catheter rounds ---Enter manually into MHA Care Counts ---Enter in “real time” (daily or ASAP); consider laptop/mobile workstation

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ONGOING DATA COLLECTION:Quarterly Team Checkup Tool (TCT)

What it assesses: • Implementation of CUSP and CAUTI

reduction activities• Team functioning• Barriers to project progress

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TCT DATA: How Do I Enter It?

Recommended Way to Complete TCT: • Team Leader prints copies of the TCT

(available on the national project website)• Team meets to discuss and reach

consensus on answers • One person enters the team’s consensus

answers into MHA Care Counts 73

TEAM CHECKUP TOOL: When Is it Due?Starts in August 2014

• Due Quarterly (note: these are NOT calendar quarters)

• Reflects the team’s work for the previous 3 months

• Schedule: Aug. 2014 (reflects work of May-July); then:

Nov. 2014; Feb. and May 2015 74

VALUE OF CAUTI DATA:Helping Your Teams Track Progress

STANDARD REPORT SET TO RUN: Review these 3 Categories Monthly: Data Submission Outcome Data Process Data

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STANDARD REPORTS TO RUN(from Care Counts)

Data Submission: Run 3 Reports• Outcome Data Submission Report (1 report) ---shows which units have submitted data,

by project phase• Process Data Submission Reports (2 reports) ---shows submission rates by project phase,

and for each day of data collection

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STANDARD REPORTS TO RUN(from Care Counts)

Outcome Data: Run 3 Reports• CAUTI Rate Reports (2 reports) ---by Catheter Days (# CAUTI’s/1000 catheter days) ---by Patient Days (#CAUTI’s/10,000 patient days) ---shows your unit’s infection rates• Catheter Prevalence Report (1 report) ---shows the percent of patients on your unit with a

catheter for that month77

STANDARD REPORTS TO RUN(from Care Counts)

Process Data: Run 2 Reports• Catheter Appropriateness Reports (2 reports) ---Catheter Appropriateness ---shows what % of catheterized patients

had at least one appropriate reason for the catheter

---Catheter Indicator Breakout ---shows what the reasons were 78

TAKE HOME MESSAGES: What Data Do We Collect?

• Preliminary Work: Readiness Assessment /HSOPS• During Project: Outcome Measures: (Collect/Submit Monthly) CAUTI Rates and Prevalence Process Measures: (Submit on Scheduled Days) Catheter Appropriateness Team Checkup Tool (TCT): Submit Quarterly• Follow-up: HSOPS

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TAKE HOME MESSAGES:When is Data Due?

Outcome Measures: By end of the next month

Process Measures: Enter in real time, ASAP

TCT: Quarterly

HSOPS: At start of project & after intervention

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TAKE HOME MESSAGES: WHY IS DATA IMPORTANT TO THE PROJECT?

• Data submission tracking : ---ensures dataset is robust and findings are reliable• Process and Outcome Measures: --- provide continuous monitoring of whether CAUTI

rates and catheter prevalence are decreasing --- focus attention on which patients inappropriately

have catheters, so education and processes can be implemented to reduce unnecessary catheter use and infection risk

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TAKE HOME MESSAGES: WHY IS DATA IMPORTANT TO THE PROJECT?

• Quarterly Team Checkup Tool: --- monitors teams’ implementation of recommended: 1) CUSP activities 2) CAUTI reduction activities --- identifies barriers to team progress

• HSOPS: --- assesses units’ culture of safety before and after the

project intervention82

TAKE HOME MESSAGES:Anticipatory Guidance

• Data Collection Process: --- is front-end loaded, but manageable --- is the primary way to effect change in the use

of inappropriate catheters

• Remember: Rounding for Catheter Prevalence and Appropriateness IS the intervention!

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ON THE CUSP: STOP CAUTIData Collection

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ON THE CUSP: STOP CAUTIDATA REQUIREMENTS

On the CUSP: Stop CAUTI

Data Requirements The data collection process assists in driving the educational component of the intervention to the frontline staff by reinforcing the use of appropriate indications for catheters. The submission of accurate and t imely data and the regular review of these data to inform performance improvement are essential for program success. Through utilizing reports in MHA Care Counts, teams can track their CAUTI outcome rates, process, and prevalence data to drive unit based improvement activities. The data elements to be submitted include the following: DATA COLLECTION LOCATION SCHEDULE

CAUTI Readiness Assessment (Technology & Exposure Survey) [taken once at start of the project] * Tell us about your unit: size, type, patient

demographics, etc.

Survey Monkey Link will be e-mailed from MHA to the Team Leader at each unit Readiness Assessment (PDF) attached for reference

Available: 05/12/2014 – 05/26/2014 Complete by May 26

AHRQ culture survey, Hospital Survey on Patient Safety (HSOPS) [taken at the start of the project and 15+ months; given to all unit staff] * Standardized measure of safety culture

for individual patient care unit (NOT hospital-wide)

Unit-specific Links will be e-mailed from MHA to the Survey Coordinator at each unit Sample Survey (PDF) attached for reference

Baseline: 05/20/2014 – Pre-notification sent 05/26/2014 – Registration sent 06/09/2014 – First day to take survey 07/04/2014 – Last day to take survey HSOPS Baseline Reports will be distributed by 08/15/2014 Follow-up: 15+ months (June 2015)

CAUTI Outcome (rate) data Number of Symptomatic CAUTI’s

attributable to your unit for that month Number of urinary catheter days per

month (number of patients with urinary catheter device is collected daily at the same time each day and the total is summed for the month)

Number of patient days per month

Date are due in MHA Care Counts by the end of the following month www.mhacarecounts.org (MHA will provide username and password to designated users)

Baseline (2014) – 3 months: May 1-31; June 1-30; July 1-31 Implementation (2014) – 2 months: August 1-31; September 1-30 Sustainability – Quarterly (for 3 periods): December 1-31, 2014 March 1-31, 2015 June 1-30, 2015

CAUTI Process (urinary catheter prevalence & appropriateness) data – data submission is optional Assess each patient on the unit for the

presence of a urinary catheter Record the reason why the catheter is in

place TODAY

Submit data in MHA Care Counts as concurrently as possible www.mhacarecounts.org CAUTI Process Data Collection Tool (.xls)

Baseline (2014) – Mon-Fri for 3 weeks: July 7-11; 14-18; 21-25 Implementation (2014) –Mon-Fri for 2 weeks, then 1 per day for 6 weeks: August 4-8; 11-15; 19, 26 September 2, 9, 16, 23 Sustainability – Mon-Fri for 1 week per quarter: December 15-19, 2014 March 9-13, 2015 June 15-19, 2015

Team Check-Up Tool (TCT) Evaluate how the unit-team is

implementing CUSP and CAUTI activities Team functioning Barriers to project progress

Submit Quarterly in MHA Care Counts www.mhacarecounts.org TCT Questions (PDF) attached for reference

Complete and submit starting in August 2014: Aug 2014 – TCT Q3 (data reflects: May, June, July 2014) Nov 2014 – TCT Q4 (data reflects: Aug, Sept, Oct 2014) Feb 2015 – TCT Q1 (data reflects: Nov, Dec 2014 & Jan 2015) May 2015 – TCT Q2 (data reflects Feb, March, April 2015) *Please Note: these are NOT calendar quarters

Remember: Data drives change! Daily rounding for catheter presence and appropriateness IS the intervention!

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ON THE CUSP: STOP CAUTINext Steps

Hospital units will participate for 18 months:• Units / team members are registered in MHA Care Counts

(logins have been emailed to unit contacts from MHA)• Assemble a team to include a team leader• Implement CAUTI prevention tools and strategies• Implement CUSP model/tools to improve care• Submit baseline & monthly CAUTI rate data (outcome)• Submit urinary catheter (UC) prevalence &

appropriateness data (process)• Submit quarterly Team Checkup Tool (TCT)• Develop & implement a sustainability plan

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ON THE CUSP: STOP CAUTINEXT STEPS

Next Steps:• Hold a team meeting• Listen to the Onboarding and Content calls*• Team Lead & Data Entry Contact Person – MHA Care Counts

Data Entry and Report Training* (April 30 or May 7)• Team Lead & Survey Coordinator attend HSOPS training* (May

20 or 22)• Review Web site resources, CAUTI Implementation Guide and

CUSP Toolkit• Collect Outcome data for May• Team Lead complete Readiness Assessment (May 12-26)

*Recordings available on www.onthecuspstophai.org

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ON THE CUSP: STOP CAUTINEXT STEPS

Next Steps (continued):• Implement CAUTI prevention tools and strategies• Implement CUSP model/tools to improve care• Submit baseline & monthly CAUTI rate data (outcome)• Submit urinary catheter (UC) prevalence &

appropriateness data (process)• Complete HSOPS Survey (May 20 pre-notification

email; May 26 registration; June 9 – July 4 survey window)

• Teamwork Tools - Staff Safety Assessment, Learning from Defects, Team Check Up Tool

• Develop a sustainability plan

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ON THE CUSP: STOP CAUTINational Faculty

Expert Faculty:Sanjay Saint, MD, MPH, and Sarah Krein, RN, PhDUniversity of Michigan Health System Mohamad Fakih, MD, MPH St. John Hospital and Medical Center Sam Watson, MSA, and Lucy KoivistoMichigan Health & Hospital Association Chris Goeschel, RN, ScDJohns Hopkins Armstrong Institute for Patient Safety and Quality

Linda R. Greene, RN, MPS, CICHighland Hospital in Rochester, NY

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ON THE CUSP: STOP CAUTIFHA & HRET Key Contacts

FHA HEN:Sally Forsberg, RNC, BSN, MBA, NEA-BC, CPHQDirector of Quality & Patient Safetysally@fha.org407-841-6230

Luanne MacNeillQuality Initiatives Coordinatorluannem@fha.org407-841-6230

HRET:Barb Edson, RN, MBA, MHAVP of Clinical Qualitybedson@aha.org919-530-0080

Kim Streit, FACHE, MBA, MHSVP/Healthcare Research & Information kims@fha.org407-841-6230 Phyllis Byles, RN, BSN, MHSM, BC-NEAQuality Coordinatorphyllis@fha.org 407-841-6230

Tina Adams, RNClinical Content Development Leadtadams@aha.org919-304-2569

Important LinksTools & Resources:http://www.onthecuspstophai.org/on-the-cuspstop-cauti/toolkits-and-resources/

- Cohort Timelines –specific data collection schedules- Stop CAUTI Implementation Guide (hospital unit tool)- MHA Care Counts User Manual & Quick Guide CAUTI Reports- Additional Resources

http://www.catheterout.org- Key prevention strategies- Engaging Clinicians & Administrators- Barriers & Potential Solutions- Protocols, education tools, supporting evidence, etc.

CUSP Toolkit:http://www.ahrq.gov/cusptoolkit/

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Important LinksCAUTI Calendar:http://www.onthecuspstophai.org/on-the-cuspstop-cauti/calendar/

Onboarding Call Series:http://www.onthecuspstophai.org/on-the-cuspstop-cauti/educational-sessions/on-boarding-calls/

National Content Call Series:http://www.onthecuspstophai.org/on-the-cuspstop-cauti/educational-sessions/content-calls/

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ON THE CUSP: STOP CAUTI RESOURCES

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Questions???