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Reduction of Urinary Tract Reduction of Urinary Tract

Infections in a Progressive Infections in a Progressive

Care UnitCare Unit

By By

Lisa Oldak, RN, BSNLisa Oldak, RN, BSN

&&

Linda Hoke, RN, PHD, CCNS, ACNSLinda Hoke, RN, PHD, CCNS, ACNS--BC, CCRNBC, CCRN

Hospital of the University of PennsylvaniaHospital of the University of Pennsylvania

Philadelphia, PAPhiladelphia, PA

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Who We AreWho We Are�� The Hospital of the University of Pennsylvania The Hospital of the University of Pennsylvania

(HUP) is a quaternary academic medical center (HUP) is a quaternary academic medical center

and the lead institution for the University of and the lead institution for the University of

Pennsylvania Health System (UPHS).Pennsylvania Health System (UPHS).

�� Magnet Designated OrganizationMagnet Designated Organization

�� HUP Facts & Figures (FY2009):HUP Facts & Figures (FY2009):

�� 749 licensed patient beds749 licensed patient beds

�� 39,451 adult admissions39,451 adult admissions

�� 4,292 births4,292 births

�� 1.3million outpatient visits1.3million outpatient visits

�� 57,200 emergency room visits57,200 emergency room visits

�� 1,674 physicians1,674 physicians

�� 1,251 professional nurses1,251 professional nurses22

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Objectives

��Discuss the unit based Clinical Nurse Discuss the unit based Clinical Nurse

(CN) champion role in educating the (CN) champion role in educating the

nursing staff in implementing Evidence nursing staff in implementing Evidence

Based Practice (EBP) guidelines to Based Practice (EBP) guidelines to

decrease urinary tract infections (UTIs).decrease urinary tract infections (UTIs).

��Describe tracer methodology and how Describe tracer methodology and how

reviewing the data can decrease UTIs.reviewing the data can decrease UTIs.

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PurposePurpose

�� Investigate causes of UTIs on a 48 bed Investigate causes of UTIs on a 48 bed

progressive care unitprogressive care unit

��Reduce UTI ratesReduce UTI rates

�� Prevent UTIs in vulnerable populationsPrevent UTIs in vulnerable populations

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Why is This Important?Why is This Important?

�� Improvement of nursing care.Improvement of nursing care.

�� 25 UTIs in 2008 despite following standard 25 UTIs in 2008 despite following standard

protocol.protocol.

��Centers for Medicare and Medicaid Centers for Medicare and Medicaid

(CMS) no longer pay for hospital acquired (CMS) no longer pay for hospital acquired

UTI.UTI.

�� Improved patient outcomesImproved patient outcomes

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UTI Rate and Device DaysUTI Rate and Device Days

0

1

2

3

4

5

6

Jul-07

Aug-07

Sep-07

Oct-07

Nov-07

Dec-07

Jan-08

Feb-08

Mar-08

Apr-08

May-08

Jun-08

Jul-08

Aug-08

Sep-08

Oct-08

Nov-08

Dec-08

Jan-09

Feb-09

Mar-09

Apr-09

May-09

Jun-09

Jul-09

Aug-09

Sep-09

Oct-09

Nov-09

Dec-09

Jan-10

Feb-10

Mar-10

Apr-10

May-10

Jun-10

UTI Count

0.000

0.010

0.020

0.030

0.040

0.050

0.060

0.070

0.080

0.090

0.100

Dev D

ay/P

t Day

UTI Dev Day/Pt Day

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How Did We Do It?How Did We Do It?

��Clinical Nurse (CN) model championClinical Nurse (CN) model champion

��Use of tracer methodologyUse of tracer methodology

�� Electronic clinical informatics software Electronic clinical informatics software

surveillance systemsurveillance system

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CN ChampionCN Champion

�� Staff RN chosen to attend institutionStaff RN chosen to attend institution--

based UTI EBP meetings.based UTI EBP meetings.

��Distribute information from the meetings to Distribute information from the meetings to

the unit staff.the unit staff.

��Discuss current: Discuss current:

�� Study findings Study findings

�� Practice changesPractice changes

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Responsibilities of Unit CN Responsibilities of Unit CN

Champion Champion �� Provided on going education to the nursing Provided on going education to the nursing

staff.staff.

�� Provided latest evidence and policy Provided latest evidence and policy

implementation.implementation.

•• EmailEmail

•• Poster presentation Poster presentation

�� Skills verificationSkills verification

•• Maintain staff competenciesMaintain staff competencies

�� AuditingAuditing

•• Relay problems in practiceRelay problems in practice

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AuditingAuditing

�� The CN champion partnered with the Clinical The CN champion partnered with the Clinical

Nurse Specialist (CNS) to trace all UTIs. Nurse Specialist (CNS) to trace all UTIs.

�� Determined unit compliance with EBP Determined unit compliance with EBP

indwelling urinary catheter protocol.indwelling urinary catheter protocol.

�� Data points included:Data points included:

�� Who placed the catheter Who placed the catheter

�� Catheter dwell time (device days)Catheter dwell time (device days)

�� PeriPeri--care care

�� Catheter securityCatheter security

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Catheter Audit ToolCatheter Audit ToolFOLEY

ROUND

DATA

COLLECTI

ON FORM

Sunrise information system Patient/Patient Room Patient's Nurse

Room

#

Patient Name

and (Male or

Female)

Active

order?

Is there a

history of

BPH?

Worklist

documentati

on?

How long

has catheter

been in?

Urinary

Drainage

Bag labeled

with date?

Size (14 Fr,

16 Fr,

other?)

Is catheter

secure?

Is seal

intact?

Is bag off of

the floor?

Are urine

and GI

receptacles

on opposite

sides?

Cannister

label with

name and

effluent

type? # of roadtrips?

Is bag

below

bladder?

Does patient

have

continuous

diarrhea?

Indication

for insertion

(Refer to

legend ) RNs name

Any other

IUC issues

(M/F)

(M/F)

(M/F)

(M/F)

(M/F)

(M/F)

(M/F)

(M/F)

(M/F)

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Tracer MethodologyTracer Methodology

��Real time data analysisReal time data analysis

�� Tracers:Tracers:

�� Who placed the catheterWho placed the catheter

�� Catheter dwell timeCatheter dwell time

�� PeriPeri--carecare

�� Catheter securityCatheter security

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Original Tracer ToolOriginal Tracer Tool

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1515

UTI TableUTI Table

1616

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Tracer SignificanceTracer Significance

�� Tracer methodology exposed the patient Tracer methodology exposed the patient populations most vulnerable to suffer populations most vulnerable to suffer UTIs. UTIs. �� Formed partnership with the nursing team Formed partnership with the nursing team placing the indwelling urinary catheters placing the indwelling urinary catheters (IUCs) and implemented EBP guidelines in (IUCs) and implemented EBP guidelines in this area.this area.•• IUCs emptied prior to transport.IUCs emptied prior to transport.

•• IUCs remained below the stretcher on transport. IUCs remained below the stretcher on transport.

��UA’s sent on all patients admitted to the UA’s sent on all patients admitted to the unit with a preexisting IUC.unit with a preexisting IUC.

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Changes in PracticeChanges in Practice

��Collaboration and teamwork with nursing Collaboration and teamwork with nursing

staffstaff

�� Nursing staff aware of our dashboard Nursing staff aware of our dashboard

numbers.numbers.

�� Reported any breach in practice.Reported any breach in practice.

•• IUC bags transported in the stretcherIUC bags transported in the stretcher

•• Patients arriving with IUC bags full of urine. Patients arriving with IUC bags full of urine.

��Removed IUC as soon a possibleRemoved IUC as soon a possible

�� Sent UA’s on patients arriving to unit with Sent UA’s on patients arriving to unit with

IUCIUC

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UTI Rate FY 08,09,10UTI Rate FY 08,09,10

0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

40.00

Rate

/1,0

00 D

ev D

ays

FY08 FY09 FY10

YTD

Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10

n=9

n=4

n=4

n=1

n=1

n=25

n=1

n=1

2020

ResultsResults

��Reduction in UTIs:Reduction in UTIs:

��FY 2008FY 2008--2009: 64% 2009: 64%

��FY 2009FY 2009--2010: 55%2010: 55%

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Questions

The End