What’s New in the Patient Safety World
July 2016
Holy Moly, My Patient has a FOLEY!
In our many columns on avoiding unnecessary use of Foley catheters we’ve often noted that posters or screensavers are helpful tools in achieving reduction of Foley catheter use. At the recent American Geriatrics Society (AGS) 2016 Annual Scientific Meeting one of the poster presentations highlighted a program on a Canadian acute geriatrics unit that successfully reduced urinary catheter use by almost half (Sinha 2016). One of the keys to success was use of a poster that had the headline “Holy Moly, My Patient has a Foley!”. Way back in our May 8, 2007 Patient Safety Tip of the Week “Doctor, when do I get this red rubber hose removed?” (and our many other columns on avoiding CAUTI’s) we’ve talked about how often physicians are surprised to find that their patient had a Foley catheter in place.
Variations of that phrase have been used elsewhere, such as “Holy Moley, Take Out That Foley!” (Ghanem 2015) or “Holey Moley, What About That Foley?” (Steinmann 2012). But what was unique in the Canadian program was that they apparently placed the posters in bathroom stalls “where all staff had ample time to review indications for catheters, associated risks, and ways they could take action to remove them”. What a great concept! We’ve seen that with posters elsewhere or computer screensavers staff tend to block them out after they’ve seen a few. But we like the idea of using the bathroom stall where you have a “captive audience”!
It’s creative programs like this that every healthcare organization can learn from. There are many evidence-based interventions and best practices that we try to disseminate in our organizations. But dissemination of some are more successful than others. It’s often in the way you communicate. And use of a catchy phrase and an even catchier place to put it might really help spread the message. Kudos to Sinha and colleagues for this program!
We’d, of course, be remiss if we failed to mention the results of a recently published, AHRQ-sponsored national project to reduce unnecessary urinary catheter use and CAUTI’s (Saint 2016). Led by Sanjay Saint, whose work on CAUTI reduction we’ve noted in many of our prior columns on CAUTI prevention such as the Michigan Health and Hospital Association (MHA) Keystone Center’s Bladder Bundle Initiative, the national Comprehensive Unit-based Safety Program included dissemination of information to sponsor organizations and hospitals, data collection, and guidance on key technical and socioadaptive factors in the prevention of catheter-associated UTI. Principles from CUSP (Comprehensive Unit-Based Safety Program) programs were utilized in understanding some of those socioadaptive factors (we discussed CUSP principles in our March 2011 What's New in the Patient Safety World column “Michigan ICU Collaborative Wins Big”).
Data were obtained between March 2011 and November 2013 from over 900 units before and after implementation and again at 12 months to assess sustainability. Adjusted CAUTI rates overall fell 14%. For non-ICU units CAUTI rates fell 32%. Catheter use decreased 7% in non-ICU units. Results of both were sustainable over the 12 months of data collection.
Interestingly, neither catheter use nor CAUTI rates fell in ICU’s. The reason for the lack of improvement in ICU’s is not clear, though the authors speculate the need for monitoring urinary output may justify more use of urinary catheters in the ICU setting and several other factors in ICU patients may lead to higher CAUTI rates.
Our December 2015 What's New in the Patient Safety World column “CAUTI Prevention Tools” discussed AHRQ’s “Toolkit for Reducing CAUTI in Hospitals” (AHRQ 2015). The toolkit was developed as part of a multi-hospital project in which CUSP (Comprehensive Unit-based Safety Program) principles were used along with evidence-based CAUTI prevention measures. The toolkit includes multiple tools, including:
- Ways to assess physicians and executives for leadership/champion roles
- Sample catheter appropriateness policies
- Sample bladder scanning policies
- Posters, pocket cards, algorithms, fact sheets
- Sample nurse-driven protocol for catheter removal
- And many others
It also has links to a host of prior AHRQ webinars on preventing CAUTI’s and using CUSP principles. It also has multiple resources for sustaining change and improvement.
Our other columns on urinary catheter-associated UTI’s:
- May 8, 2007 Tip of the Week “Doctor, when do I get this red rubber hose removed?”
- January 8, 2008 Tip of the Week “Urinary Catheter-Associated Infections”
- April 2008 What’s New in the
Patient Safety World column “More
on Nosocomial UTI’s”
- June 24, 2008 Tip of the Week “Urinary Catheter-Related UTI’s: Bladder Bundles”
- April 21, 2009 Tip of the Week “Still Futzing with Foleys?”
- June 9, 2009 Tip of the Week “CDC Update to the Guideline for Prevention of CAUTI”
- March 2010 “IDSA
CAUTI Guidelines”
- February 2011 What’s New in the Patient Safety World column “Catheters Not Needed in C-Sections?”
- January 2012 “CAUTI’s
Still Get No Respect”
- May 2012 “Foley
Catheter Hazards”
- November 2012 “CAUTI
Conundrum”
- December 18, 2012 “Unintended
Consequences of the CAUTI Measure?”
- January 2013 “Silver-Coated
Urinary Catheters Don’t Reduce CAUTI’s”
- June 2013 “Barriers
to CAUTI Prevention”
- November 2013 “Further
Reducing Urinary Catheter Use”
- June 2014 “Updated
HAI Prevention Guidelines from SHEA/IDSA”
- June 30, 2015 “What
Are Appropriate Indications for Urinary Catheters?”
- December 2015 “CAUTI
Prevention Tools”
References:
Sinha S, et al. American Geriatrics Society (AGS) 2016 Annual Scientific Meeting: Abstract P2. Presented May 19, 2016
As presented by Harrison L. Geriatrics Unit Reduces Catheter Use, Reports Fewer Deaths. Medscape Medical News 2016; May 25, 2016
http://www.medscape.com/viewarticle/863837#vp_2
Ghanem A, Artime C, Moser M, et al. Holy Moley! Take out that Foley! Measuring Compliance with a Nurse Driven Protocol for Foley Catheter Removal to Decrease Utilization. Amer J Infect Control 2015; 43(6): Supplement, Page S51
http://www.ajicjournal.org/article/S0196-6553%2815%2900371-5/abstract
Steinmann K. Holey Moley! What About That Foley?! PowerPoint presentation. Hennepin County Medical Center. September 7, 2012
http://www.mnreducinghais.org/documents/Foley_Steinmann_HCMC.ppt
Saint S, Greene MT, Krein SL, et al. A Program to Prevent Catheter-Associated Urinary Tract Infection in Acute Care. N Engl J Med 2016; 374: 2111-2119
http://www.nejm.org/doi/full/10.1056/NEJMoa1504906
AHRQ (Agency for Healthcare Research and Quality). Toolkit for Reducing CAUTI in Hospitals. 2015
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