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 Infection (CAUTI) leading practice was submitted by:
NorthCrest Medical Center, Springfield, TN
Problem Statement: Reduce the number of Foley catheters in use, thereby reducing the risk of a Catheter Associated Urinary Tract Infections (CAUTIs) and the costs involved with maintenance of a Foley catheter.
Method: NorthCrest initiated CAUTI Comprehensive Unit-Based Safety Program (CUSP) team. The team chose to implement evidence based strategies designed to decrease the number of indwelling urinary catheters including outlining specific criteria for insertion, removal, and maintenance.
Means: The CAUTI CUSP team meets once every two weeks, which does incur a small cost in relation to paying staff to attend.
Date Implemented: The efforts to reduce Foley catheter usage have been ongoing since 2008. However, the CAUTI CUSP team was not formed until May 2012. This team is currently in “maintenance mode,” which means the goal of the team was met and maintained for one year.
Outcomes: Clinically speaking, the outcomes have exceeded the original intention. Usage or rather non-usage of Foley catheters has become a hot topic. We not only have nurses and management on board, we also have physicians involved; surgeons have changed their post-op order sets from “discontinue Foley catheters post-op day #2” to “discontinue Foley post-op day #1”. Not only does this mobilize the patient quicker resulting in better post-op outcomes, but it also reduces the chances of a CAUTI by removing the Foley sooner. The emergency room coordinator was onboard to reduce Foley insertions by placing them in the control of the charge nurses. Emergency room utilization has improved greatly. When we first began collecting this data in May 2012, we were consistently inserting 40-50 Foleys per month. By October 2012, we had reduced that number to eight for the entire month.
CAUTI PowerPoint– disseminated to staff via HealthStream (a system used to push out any education to staff in the entire hospital).
Daily Interdisciplinary Patient Care Meeting Form– used as a discussion tool at the morning “huddle” to discuss usage and necessity.
Audit Tool– used to ensure that patients are meeting criteria.
How Does Your Example Address the Issue from a CQO Perspective?
We have decreased our Foley usage therefore decreasing overall cost. By providing quality care and decreasing our Foley days, we are decreasing our patient’s risk of developing a catheter associated urinary tract infections. The patient receives the best outcome when we decrease their risk of readmission to the facility.