Leading Practice: Reduction or Elimination of CAUTI - University of Virginia Health System

By AHRMM

AHRMM is developing 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 CAUTI leading practice was submitted by:

University of Virginia Health System, Charlottesville, VA

Problem Statement: CAUTI rates exceeding national benchmark (NHSN).

Method:

Strong message of need to improve from CNO. COO and CMO charged leadership with rapid improvement to CAUTI rates, 2012 shared with management .
Nursing and interdepartmental committees (NSQI, CPC , IP&C, and NSAC) formulating evidence based approach to improvement based on literature review and data analysis.
Committee elevated to Q17 level with major leadership focus including new EVP for Health System in the fall of 2013. In depth process analysis of workflows and system issues surrounding catheterized patients.
Generated standardized CAUTI supply bundle for insertion, catheter avoidance (female urinals, ultrasorb pads), fecal incontinence containment, adaptive hooks for acute care beds. List vetted through CAUTI Champion group. Stock on units being standardized, spring 2014.
CAUTI Improvement Committee formed under Nursing Quality and IP&C committees with APN and Infection Control Practitioner leadership. Evaluate current and best practices.
Nursing procedures changed, require two-person insertion to assure sterile technique used. OR changed skill level for insertion to RN only.
Heavy practice emphasis on early catheter removal. Combine efforts with SCIP measures group. Epic alerts and order sets tailored for this goal. Daily discussion of necessity built into tools. Device utilization below national benchmarks.
All RNs and PCA/PCT’s who insert Foley catheters had annual demonstrated competency requirement in 2012 and 2013.
CAUTI Champion role and network established. Regular meetings and practice audits across units. Champion for best practices with peers. Great enthusiasm.
Spring 2013 - evidence on CHG bathing in national literature, impact on CLABSI rates. Inter-professional leadership committees fast tracked proposal to CHG bathe all patients with central venous catheters and IUC. Product cost vetted by CNO/CMO. Staff trained, practice rolled out and audited. Positive impact on both CAUTI and CLABSI rates and total number of infections.
Share the data: raw practice audit data to measure best practices adherence; benchmarked data quarterly in public bulletin boards in all units and on dashboard—staff engaged in improvement.
Days since last CAUTI (and other HAC) updated locally on all units weekly, teams celebrate successes.
Pride in Practice Award, annual focus on most improved in CAUTI reduction.
Track product costs via Nursing Scope Team and presentation of data to CNO, CMO, and Chief of Supply Chain.

Means:

CHG bathing product, bag bath
Designated time for CAUTI Champion activities in budget
CAUTI Supply Bundle
Epic EMR tools to drive best practice, decision support

Date Implemented: 2012 and beyond

Outcomes:

Tools:

CAUTI Supply Bundle Sample

How Does Your Example Address the Issue from a CQO Perspective?

Inter-professional approach to standardizing all aspects related to improving a quality/patient safety metric. Collaborative approach with senior leadership, nursing, physicians, IT, laboratory, and supply chain to decrease CAUTI while improving outcomes and saving institutional costs.

UVA has 10 value analysis teams in a program we call SCOPE, Supply Chain Optimization and Performance Excellence. One of those teams is a Nursing SCOPE team in which the Value Management director and staff, along with a Buyer and Senior Contract Coordinator participate.

Any other initiatives outside the formal SCOPE program include the Value Management department director and additional staff.

Value Management works in collaboration with clinical areas from the beginning of projects all the way through final contracts and supply logistics implementation.