Evidence-Based Practice Change to Prevent CAUTI: A Team-Based Approach

CAUTI prevention is largely based on nursing awareness regarding best practices in catheter care and timely removal of the catheter.  Nursing practice change is accomplished through development of a safety culture template for change using the Michigan Keystone Project four E’s: engage, educate, execute, and evaluate.

A team of clinical educators and a clinical nurse specialist assembled to reduce hospital-wide CAUTI rates.  The team contained representatives from every hospital nursing specialty.  Key components of the Evidence-Based Advancing Research and Clinical Practice Through Close Collaboration (ARCC) Model, Lean Six Sigma concepts, and the Plan-Do-Study-Act cycle were integrated to develop a practice change model to improve care quality.  The steps of identifying and implementing evidence-based CAUTI prevention practice changes will be discussed, and methods use to engage and educate team members and nursing staff will be highlighted.

An important component of executing and evaluating practice change is setting clear process and outcomes measures and creating a sustainability plan after initial goals are achieved.  The process for establishing both process and outcomes measures for CAUTI prevention will be discussed.  Specifically, the value of clinical educational and compliance audits will be emphasized as a method to sustain practice change, promote continued nursing staff engagement, and provide continuous educational opportunities at the bedside.

References:

Agency for Healthcare Research and Quality. (2014). On the CUSP: stop CAUTI implementation guide.  Retrieved from http://www.hret.org/quality/projects/stop-uti.shtml

Association for Professionals in Infection Control and Epidemiology. (2014). Guide to preventing catheter-associated urinary tract infections. Retrieved from http://apic.org/Resource_/EliminationGuideForm/0ff6ae59-0a3a-4640-97b5-eee38b8bed5b/File/CAUTI_06.pdf

Fink, R., Gilmartin, J., Richard, A., Capezuti, R. Boltz, M. & Wald H. (2012). Indwelling urinary catheter management and catheter-associated urinary tract infection prevention practices in Nurses Improving Care for Healthsystem Elders hospitals. American Journal of Infection Control, 40,715-720.

Halm, M. A. & O’Connor, N. (2014). Do system-based interventions affect catheter-associated urinary tract infection? American Journal of Critical Care, 23(6), 505-509.

Oman, K. S., Makic, M., Fink, R., Schraeder, N., Hulett, T., Keech, T., & Wald, H. (2012). Nurse-directed interventions to reduce catheter-associated urinary tract infections. American Journal of Infection Control, 40, 548-553.