Catheter Associated Urinary Tract Infection (CAUTI)

Report
CATHETER ASSOCIATED
URINARY TRACT INFECTION
(CAUTI):
A PREVENTION PLAN
Utilize the Electronic Health
Record (EHR) to improve nursing
process and patient outcomes.
Education created by
Kristi Noble MSN RN OCN
Clinical EHR educator
September 2014
Goal of CAUTI Prevention
Educate RN/LPN’s to prevent and reduce the incidence of a
CAUTI by:
• Using the EHR to standardize documentation
• Use instructions and indications when inserting and
removing an indwelling urinary catheter
• Assessing the need for a urinary catheter daily
Objectives for CAUTI Prevention
1. Recall the importance of standardizing documentation for
in and out times and line days.
2. Identify instructions and indications for placing and
removing an indwelling urinary catheter.
3. Recall the of use and function of the daily needs assessment
form.
4. Identify where to locate policies and protocols for an
indwelling urinary catheter within the electronic health
record.
Regulations and Reporting
Did you know?
Since 2008 The Centers for Medicaid and
Medicare Services have not reimbursed the
cost of Hospital Acquired infections, such
as CAUTI.
Since January of 2013 Munson has been
manually reporting the instances of
patients developing a CAUTI while in the
hospital.
The estimated cost of treating a CAUTI that
develops while in the hospital ranges from
$1,200 to $2,800.
Importance of documenting indwelling urinary
catheters in the EHR
• Improve patient outcomes
• Increase patient safety
• Better tracking of patients with an indwelling urinary catheter
• Able to generate reports for reimbursement
• Standardize documentation across the multiple departments
and organizations within Munson Healthcare
• Standardize order and discontinue process for indwelling urinary
catheter
• Able to utilize a daily needs assessment form for removal of
urinary catheter as soon as possible
Current Foley documentation will be moved to I-view
Will move
to I-view
Ordering indwelling urinary catheter:
old to new
Indwelling is new
key word. Foley
can still be used.
 Nursing must verifying the
presence of an active order. If
no order present the nurse
must obtain one from the
provider.
New requirements for indwelling urinary catheter
orders: Instructions and Indications
You may
multi-select
by holding
down the
control key
 Instructions and indications are mandatory to complete order.
 If a provider enters DO NOT REMOVE as instruction or certain
indications the daily Needs Assessment form will not fire to the
PAL every 24 hours.
 Ensure the instructions and indications are as accurate as possible.
 If the patient does not meet the criteria, they don’t need a urinary
catheter.
The next step after the order is placed
Go to PAL
Once the order is placed two tasks will generate on the PAL for the nurse:
1. Insertion task, will take nurse directly to I-view to create the dynamic group.
2. A daily needs assessment task, used to determine if the urinary catheter is still
appropriate for the patient, will occur at 8am the day following catheter
insertion.
By right clicking and selecting Chart
Details the system will take you to I-view
for documentation of insertion or daily
needs assessment form.
Creating the Dynamic Group for
Indwelling Urinary Catheter
Mandatory fields
when creating
dynamic group.
The insertion date
is crucial, allows
tracking of line
days to begin.
Place cursor in
date box, press T,
date and time will
pull in. Date will
default forward
on subsequent
days.
The functionality of
the charting is the
same as other
I-view charting.
Genitourinary Assessment moving to I view
The GU assessment will be removed from the nursing launcher. In the
vacated area a reminder will be in red to have the documentation
be completed in I-view.
In an effort to
streamline
documentation
the GU
assessment is
moving to I-view.
It will have its
own band on the
navigator.
Nursing Assistants Twice a Day PAL Task
for Peri and Catheter Care
Nursing assistants will receive a twice daily task on the PAL for
documenting peri and catheter care. RNs will not receive this task on
their PAL, but will need to ensure that the care and documentation
was completed in I-view.
Nurse Driven Protocol (070.P037)
for Removal of Urinary Catheter
When an order is placed for a
urinary catheter the provider can
have the removal based on a
Nurse Driven Protocol/RN
assessment.
The Nurse Driven
Protocol can be
located by right
clicking on the order.
Policies and
procedures are to
help guide the RN for
care and removal of
the urinary catheter.
Bladder Scan Protocol
Bladder Protocol (070.P035) is available for nursing to use. It does
not need a physician order. It is a standing order that is approved by
the Medical Executive Committee.
If a nurse has to
straight cath a
patient two times,
upon the second
insertion place a
urinary catheter
and page the
provider for an
indwelling catheter
order.
Indwelling Urinary Catheter (Foley)
Needs Assessment
Once a urinary catheter has been inserted, a daily needs assessment
form must be completed. This will come daily task on the PAL,
starting at 8am the day after insertion.
If the patient does not meet criteria for the urinary catheter at any
other point during the day the needs assessment form can be found
in Ad Hoc forms to complete.
Needs Assessment form
In this area the last two
indications will be viewable
The form brings in
the current order
allowing the RN to
see when and why
the catheter was
ordered
Needs Assessment Form
Form will be tasked daily at
8am. If the patient still
meets the criteria to keep
catheter RN will select the
indication and the form will
be complete.
Needs Assessment Form
When the patient no
longer meets criteria for
catheter RN will select
option to have the
catheter discontinued.
By selecting does not
meet criteria the system
will auto DC the order
and send a task to the
PAL for catheter
removal.
Reference Text
Policies and Protocols
Protocol
Reference
Text found
by right
clicking
inside the
window
When Indwelling Urinary Catheter
discontinued or no longer needed
The RN may discontinue the urinary catheter either through the
order or the needs assessment form. Providers can right click on the
order and Cancel/DC or Modify the catheter order.
Providers can
DC or Modify
the catheter
order.
RNs will DC
the catheter
via the needs
assessment
form or by
right clicking
on the order
and
Cancel/DC
When Indwelling Urinary Catheter
discontinued or no longer needed
Once the provider or RN discontinues the urinary catheter the
RN will get a task on the PAL to remove the catheter.
Right clicking and
Chart Details will
take the RN to
I-view to
complete the
documentation
When Indwelling Urinary Catheter is
discontinued or no longer needed
Removal Date/Time
The date and time of removal is captured
from time stamp of the column.
Remember to chart at the time of removal or
back chart the correct time.
Once
charting
complete
RN must
inactivate
the
dynamic
group
Straight/Intermittent Catheterization
For patients who require intermittent straight catheterization, a
separate dynamic group needs to be created. The same group may
be used for each instance of catheterization during the patients stay.
Documentation
occurs the
same as all
other charting
in I-view
Viewing Urinary Catheter Assessment
The best place to view the urinary catheter assessment is in Results
Review on the Patient Assessment tab in a group format.
Preventing a CAUTI
• Verify there is an active order for the indwelling urinary
catheter with indications and instructions.
• Assess the need for indwelling urinary catheter daily.
• Utilize the Nurse Driven/Bladder Scan protocol to remove
the indwelling urinary catheter as soon as possible.
• Seek alternatives to using an indwelling urinary catheter
whenever necessary.
Preventing a CAUTI
• Empty the catheter drainage bag every 8 hours, if 2/3 full, and
prior to transporting a patient.
• Verify that peri and catheter care is performed and documented
twice a day in I-view.
• Arrange the catheter drainage bag so it is placed below the
patients bladder at all times.
• Assess for the presence of a securement device, i.e. Stat lock, on
the patients upper thigh, right or left.
• Document catheter output in I-view.
ABC’S OF CAUTI
PREVENTION
Adherence to an infection
prevention plan
Bladder scan per protocol when
urinary catheter removed
Condom catheter, access to
commode chairs
Do not use catheters unless
necessary
Early removal of catheter using
the electronic health record as a
guide
Your involvement in ensuring that
our patients are safe and free
from catheter associated urinary
tract infections is appreciated,
and your care to our patients is
invaluable.

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