National Expansion

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On the CUSP Stop CAUTI
National Expansion Catheter-Associated Urinary
Tract Infection Immersion Call
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Overview of Todays Call

• Why this initiative is important
• Project overview
• Expected outcomes
• What it requires
• Comprehensive Unit-Based Safety Program
• Data requirements
• What are the next steps

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Project Goals

• Reduce CAUTIs in participating units by 25
• Appropriate placement
• Appropriate continuance
• Appropriate utilization
• Improve patient safety culture on participating
  units

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Project Overview

Hospitals or Hospital Systems Hospitals or Hospital Systems Hospitals or Hospital Systems Hospitals or Hospital Systems Hospitals or Hospital Systems

State Hospital Associations State Hospital Associations State Hospital Associations State Hospital Associations State Hospital Associations

National Project Team National Project Team National Project Team National Project Team National Project Team

Project Management Clinical Faculty Data Management CUSP Faculty
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National Project Team
Partner Team Members
Health Research and Educational Trust Steve Hines Marchelle Djordjevic Deb Bohr
Centers for Disease Control and Prevention Carolyn Gould Kathy Allen-Bridson
MHA Keystone Center for Patient Safety Quality Sam Watson Chris George Dr. Sanjay Saint Dr. Mohamad Fakih
Johns Hopkins Quality Safety Research Group Chris Goeschel Sean Berenholtz
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Why This Initiative is Important

• 600,000 patients develop hospital acquired UTIs
  per year
• This accounts for 40 of all hospital acquired
  infections
• Catheter associated infections (CAUTI) comprise
  80 of these cases

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Why This Initiative is Important

• 5 million urinary catheters placed per year (US)
• 80 of UTIs are catheter associated
• Catheter-risk of bacteruria
• Per day 5
• 1 week 25
• 1 month 100

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Why This Initiative Is Important

• Reduction in UC use by about 20 at St. John
  Hospital in Michigan
• Similar levels of reduction seen in hospitals
  across Michigan (unpublished data)

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CUSP CAUTI Interventions
CUSP
CAUTI

• 1. Educate on the science of safety
• 2. Identify defects
• 3. Assign executive to adopt unit
• 4. Learn from Defects
• 5. Implement teamwork communication tools

• 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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Care and Removal at a Glance
Intervention Group (1 - 2 units)
Pre-intervention UC data collection w/analysis
of need
Week 1-3 10 days
Intervention UC data collection w/analysis of
need plus nursing staff education/ intervention.
Rationale given to obtain orders to dc non needed
Foleys with nursing
Week 3-4 10 days
Post-intervention UC data collection w/analysis
of need, once a week for 8 weeks
Week 5-12 8 days
Post-intervention UC data collection w/analysis
of need, once a week each quarter
Quarterly
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Insertion at a Glance
Intervention Group (ED or OR)
Pre-intervention UC data collection w/analysis
of need
Intervention UC data collection w/analysis of
need plus nursing staff education/ intervention.
Rationale given to obtain orders to dc non needed
Foleys with nursing
Post-intervention UC data collection w/analysis
of need, once a week for 8 weeks
Post-intervention UC data collection w/analysis
of need, once a week each quarter
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Expected Outcomes

• Increased awareness of appropriate indications
  for indwelling urinary catheter use
• Reduced use of indwelling urinary catheters
• Improved caregiver accountability to assess need
  and trigger UC discontinuation when UC no longer
  necessary
• Reduced risk of urethral trauma with reduction in
  utilization
• Reduced patient discomfort

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Expected Outcomes

• Reduction in bacteriuria
• Reduction in symptomatic UTIs
• Shortened Length of Stay
• Decreased Cost per stay
• Improved sensitivity to patient dignity

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

• Educate staff on science of safety
  http//www.safercare.net
• Identify defects
• Assign executive to adopt unit
• Learn from one defect per quarter
• Implement teamwork tools

Timmel J, et al. Jt Comm J Qual Patient Saf
201036252-260.

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What Participation Requires Hospital Unit

• The Hospital Unit will need to
• Participate for the length of the project
• Assemble team
• Assign team leader (10 effort)
• Engage executive champion
• Engage physician champion
• Submit data
• Hold monthly patient safety meetings
• Listen to content and coaching calls

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What Participation Requires Data Submission
Intervention Measure Frequency
Organizational Information CAUTI Readiness Assessment Once at start of project
CUSP   HSOPS Baseline and post intervention
CUSP   Team Check-up Tool Quarterly
Care and Removal     Process Prevalence Appropriateness Weekly within Protocol
Care and Removal     Outcome Monthly within Protocol
Care and Removal     - UTI Rate / Device Days Monthly within Protocol
Care and Removal     - UTI Rate / Patient Days Monthly within Protocol
Insertion TBD TBD
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  Cohort 2 PROCESS Cohort 2 PROCESS Cohort 2 PROCESS Cohort 2 PROCESS Cohort 2 PROCESS Cohort 2 PROCESS Cohort 2 PROCESS   Cohort 2 OUTCOME Cohort 2 OUTCOME Cohort 2 OUTCOME Cohort 2 OUTCOME Cohort 2 OUTCOME Cohort 2 OUTCOME Cohort 2 OUTCOME  
  S M T W T F S   S M T W T F S  
BASELINE PERIOD No Data Collected No Data Collected No Data Collected No Data Collected No Data Collected No Data Collected No Data Collected JUN 2011 Baseline Data Collected Baseline Data Collected Baseline Data Collected Baseline Data Collected Baseline Data Collected Baseline Data Collected Baseline Data Collected BASELINE PERIOD
BASELINE PERIOD 1 2 3 4 JUN 2011 1 2 3 4 BASELINE PERIOD
BASELINE PERIOD 5 6 7 8 9 10 11 JUN 2011 5 6 7 8 9 10 11 BASELINE PERIOD
BASELINE PERIOD 12 13 14 15 16 17 18 JUN 2011 12 13 14 15 16 17 18 BASELINE PERIOD
BASELINE PERIOD 19 20 21 22 23 24 25 JUN 2011 19 20 21 22 23 24 25 BASELINE PERIOD
BASELINE PERIOD 26 27 28 29  30 JUN 2011 26 27 28 29  30 BASELINE PERIOD
BASELINE PERIOD No Data Collected No Data Collected No Data Collected No Data Collected No Data Collected No Data Collected No Data Collected JUL 2011 Baseline Data Collected Baseline Data Collected Baseline Data Collected Baseline Data Collected Baseline Data Collected Baseline Data Collected Baseline Data Collected BASELINE PERIOD
BASELINE PERIOD           1 2 JUL 2011           1 2 BASELINE PERIOD
BASELINE PERIOD 3 4 5 6 7 8 9 JUL 2011 3 4 5 6 7 8 9 BASELINE PERIOD
BASELINE PERIOD 10 11 12 13 14 15 16 JUL 2011 10 11 12 13 14 15 16 BASELINE PERIOD
BASELINE PERIOD 17 18 19 20 21 22 23 JUL 2011 17 18 19 20 21 22 23 BASELINE PERIOD
BASELINE PERIOD 24 25 26 27 28 29 30 JUL 2011 24 25 26 27 28 29 30 BASELINE PERIOD
BASELINE PERIOD 31             JUL 2011 31             BASELINE PERIOD
BASELINE PERIOD Baseline Data Collected Baseline Data Collected Baseline Data Collected Baseline Data Collected Baseline Data Collected Baseline Data Collected Baseline Data Collected AUG 2011 Baseline Data Collected Baseline Data Collected Baseline Data Collected Baseline Data Collected Baseline Data Collected Baseline Data Collected Baseline Data Collected BASELINE PERIOD
BASELINE PERIOD 1 2 3 4 5 6 AUG 2011   1 2 3 4 5 6 BASELINE PERIOD
BASELINE PERIOD 7 8 9 10 11 12 13 AUG 2011 7 8 9 10 11 12 13 BASELINE PERIOD
BASELINE PERIOD 14 15 16 17 18 19 20 AUG 2011 14 15 16 17 18 19 20 BASELINE PERIOD
BASELINE PERIOD 21 22 23 24 25 26 27 AUG 2011 21 22 23 24 25 26 27 BASELINE PERIOD
BASELINE PERIOD 28 29 30 31       AUG 2011 28 29 30 31       BASELINE PERIOD
IMPLEMENTATION Intervention Data Collected Intervention Data Collected Intervention Data Collected Intervention Data Collected Intervention Data Collected Intervention Data Collected Intervention Data Collected SEPT 2011 Intervention Data Collected Intervention Data Collected Intervention Data Collected Intervention Data Collected Intervention Data Collected Intervention Data Collected Intervention Data Collected IMPLEMENTATION
IMPLEMENTATION         1 2 3 SEPT 2011         1 2 3 IMPLEMENTATION
IMPLEMENTATION 4 5 6 7 8 9 10 SEPT 2011 4 5 6 7 8 9 10 IMPLEMENTATION
IMPLEMENTATION 11 12 13 14 15 16 17 SEPT 2011 11 12 13 14 15 16 17 IMPLEMENTATION
IMPLEMENTATION 18 19 20 21 22 23 24 SEPT 2011 18 19 20 21 22 23 24 IMPLEMENTATION
IMPLEMENTATION 25 26 27 28 29 30   SEPT 2011 25 26 27 28 29 30   IMPLEMENTATION
SUSTAINABILITY PERIOD 1 Intervention Data Collected Intervention Data Collected Intervention Data Collected Intervention Data Collected Intervention Data Collected Intervention Data Collected Intervention Data Collected OCT 2011 Intervention Data Collected Intervention Data Collected Intervention Data Collected Intervention Data Collected Intervention Data Collected Intervention Data Collected Intervention Data Collected SUSTAINABILITY PERIOD 1
SUSTAINABILITY PERIOD 1             1 OCT 2011             1 SUSTAINABILITY PERIOD 1
SUSTAINABILITY PERIOD 1 2 3 4 5 6 7 8 OCT 2011 2 3 4 5 6 7 8 SUSTAINABILITY PERIOD 1
SUSTAINABILITY PERIOD 1 9 10 11 12 13 14 15 OCT 2011 9 10 11 12 13 14 15 SUSTAINABILITY PERIOD 1
SUSTAINABILITY PERIOD 1 16 17 18 19 20 21 22 OCT 2011 16 17 18 19 20 21 22 SUSTAINABILITY PERIOD 1
SUSTAINABILITY PERIOD 1 23 24 25 26 27 28 29 OCT 2011 23 24 25 26 27 28 29 SUSTAINABILITY PERIOD 1
SUSTAINABILITY PERIOD 1 30 31           OCT 2011 30 31           SUSTAINABILITY PERIOD 1
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SUSTAINABILITY PERIOD 2 No Data Collected No Data Collected No Data Collected No Data Collected No Data Collected No Data Collected No Data Collected NOV 2011 No Data Collected No Data Collected No Data Collected No Data Collected No Data Collected No Data Collected No Data Collected SUSTAINABILITY PERIOD 2
SUSTAINABILITY PERIOD 2     1 2 3 4 5 NOV 2011     1 2 3 4 5 SUSTAINABILITY PERIOD 2
SUSTAINABILITY PERIOD 2 6 7 8 9 10 11 12 NOV 2011 6 7 8 9 10 11 12 SUSTAINABILITY PERIOD 2
SUSTAINABILITY PERIOD 2 13 14 15 16 17 18 19 NOV 2011 13 14 15 16 17 18 19 SUSTAINABILITY PERIOD 2
SUSTAINABILITY PERIOD 2 20 21 22 23 24 25 26 NOV 2011 20 21 22 23 24 25 26 SUSTAINABILITY PERIOD 2
SUSTAINABILITY PERIOD 2 27 28 29 30       NOV 2011 27 28 29 30       SUSTAINABILITY PERIOD 2
SUSTAINABILITY PERIOD 2 No Data Collected No Data Collected No Data Collected No Data Collected No Data Collected No Data Collected No Data Collected DEC 2011 No Data Collected No Data Collected No Data Collected No Data Collected No Data Collected No Data Collected No Data Collected SUSTAINABILITY PERIOD 2
SUSTAINABILITY PERIOD 2         1 2 3 DEC 2011         1 2 3 SUSTAINABILITY PERIOD 2
SUSTAINABILITY PERIOD 2 4 5 6 7 8 9 10 DEC 2011 4 5 6 7 8 9 10 SUSTAINABILITY PERIOD 2
SUSTAINABILITY PERIOD 2 11 12 13 14 15 16 17 DEC 2011 11 12 13 14 15 16 17 SUSTAINABILITY PERIOD 2
SUSTAINABILITY PERIOD 2 18 19 20 21 22 23 24 DEC 2011 18 19 20 21 22 23 24 SUSTAINABILITY PERIOD 2
SUSTAINABILITY PERIOD 2 25 26 27 28 29 30 31 DEC 2011 25 26 27 28 29 30 31 SUSTAINABILITY PERIOD 2
SUSTAINABILITY PERIOD 2 Post-Intervention Data Collected Post-Intervention Data Collected Post-Intervention Data Collected Post-Intervention Data Collected Post-Intervention Data Collected Post-Intervention Data Collected Post-Intervention Data Collected JAN 2012 Post-Intervention Data Collected Post-Intervention Data Collected Post-Intervention Data Collected Post-Intervention Data Collected Post-Intervention Data Collected Post-Intervention Data Collected Post-Intervention Data Collected SUSTAINABILITY PERIOD 2
SUSTAINABILITY PERIOD 2 1 2 3 4 5 6 7 JAN 2012 1 2 3 4 5 6 7 SUSTAINABILITY PERIOD 2
SUSTAINABILITY PERIOD 2 8 9 10 11 12 13 14 JAN 2012 8 9 10 11 12 13 14 SUSTAINABILITY PERIOD 2
SUSTAINABILITY PERIOD 2 15 16 17 18 19 20 21 JAN 2012 15 16 17 18 19 20 21 SUSTAINABILITY PERIOD 2
SUSTAINABILITY PERIOD 2 22 23 24 25 26 27 28 JAN 2012 22 23 24 25 26 27 28 SUSTAINABILITY PERIOD 2
SUSTAINABILITY PERIOD 2 29 30 31         JAN 2012 29 30 31         SUSTAINABILITY PERIOD 2
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Data Collection Schedule
MEASURE DATA COLLECTION SCHEDULE DATES
CAUTI Rates (Outcome) Number of Symptomatic CAUTIs 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 Collect monthly for 5 months beginning in June and quarterly thereafter (June-August will be considered baseline) 2011 June 1-30 July 1-31 August 1-31 September 1-30 October 1-31 2012 January 1-31 April 1-30 July 1-31 October 1-31
Prevalence Appropriateness (Process) Assess each patient on the unit for the presence of a urinary catheter Record the reason for the catheter Baseline Mon-Fri for 3 weeks Baseline August 1-5, 8-12, 15-19, 2011
Prevalence Appropriateness (Process) Assess each patient on the unit for the presence of a urinary catheter Record the reason for the catheter Prospective Mon-Fri for 2 weeks, 1 day per week for 6 weeks then one week per quarter thereafter Prospective September 5-9, 12-16, 20 27 October 4, 11, 18, 25 2012 January 9-13 April 9-13 July 9-13 October 15-19
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What are the Next Steps
Timeline at a glance Timeline at a glance
March 2 Unit attends first immersion call
March -May Unit attends Kick Off Meeting and begins participating in national content/coaching calls
March - May - Participate in content and coaching calls - Collect and report quarterly data to monitor change
June Unit begins base line data collection and exposure survey
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Who to Contact with Questions

• Kristina Davis, Research Specialist, HRET
  kdavis_at_aha.org
• 312-422-2644