AHRMM is offering a repository for leading and proven supply chain practices, case studies, and toolkits that are developed from a Cost, Quality, and Outcomes (CQO) perspective. The following Catheter Acquired Urinary Tract Infections (CAUTI) leading practice was submitted by:
Saint Clare’s Health System, Denville, NJ
Problem Statement: To reduce CAUTI utilizing evidenced based practices (EBP) in order to improve patient safety, patient outcomes (including CAUTI rates, decrease costs, and length of stay), and patient satisfaction. Review of policies, procedures, and products to facilitate EBP initiatives at Saint Clare’s Health System.
Method: EBP were researched to develop a CAUTI plan and revise policies as needed. Standing orders for indwelling catheter insertion was developed for the physicians. Tied into the standing order was a nurse driven protocol to allow the nurse to remove the catheter 72 hours (now it is at 48 hours) after insertion without having to obtaining a physician’s order. With the conversion to CPOE, our electric medical record will alert the RN when the 48 hours is approaching that the catheter needs to be removed or renewed. Mandatory education was developed for all beside nursing staff (RN, LPN, and NA).
Means: A CAUTI team was formed to review practices, policies, supplies and to develop education plan. Indwelling catheter kits did not change but a new catheter stabilization device was brought in based on recommendation from our urologists. Supply chain assisted with obtaining information and costs about the stabilization device to assist the team in making decisions about the device and bringing the product into our facility. The educational program was presented as one hour session, which was mandatory for all nursing staff. The CAUTI team presented around the clock sessions to facilitate staff attendance. Educational tools in English and Spanish were developed for patients/families. Information was also provided to physicians to get their buy-in and support.
Date Implemented: 2009
Outcomes: Prior to 2008, Saint Clare’s has always monitored CAUTI in the critical care units. In 2008, we began to monitor house-wide infections and began working out the process of collecting house-wide catheter days. In 2009, we had processes in place to begin reporting house wide CAUTI rates. Since implementation of the EBP processes, CAUTI rates have steadily declined:
- CY 2008: 55 CAUTI - no rate
- CY 2009: 29 CAUTIs - rate 2.2
- CY 2010: 14 CAUTIs - rate 0.96
- CY 2011: 6 CAUTIs - rate 0.40
- CY 2012: 4 CAUTIs - rate 0.30
- CY 2013: 5 CAUTIs - rate 0.38
Rate = (# of infections/# of device days) x 1000
Tools: Standing order for catheter insertion developed in April 2009. Now this is all done through electronic medical record (EMR) and removal timeframe is 48 hours. Screen shots enclosed from EMR for catheter insertion and removal documentation.
Saint Clare's 2013 CAUTI Performance Graph
Saint Clare's Catheter Insertion Order Screen Shot from CPOE
Saint Clare's Paper Format Urinary Cath Insertion Standing Order
Saint Clare's Urinary Cath Insertion Electronic Documentation
How Does Your Example Address the Issue from a CQO Perspective?
APIC projects that a CAUTI could add an additional cost of approximately $1,100. Reducing CAUTI will decrease healthcare costs, length of stay, and improve patient safety, patient outcomes, and patient satisfaction. Reducing CAUTIs from a high of 55 in 2008 to five in 2013, yields a savings of approximately $55,400.