Targeted Rounding Helps Bring CAUTI Rate to Zero

An article in Critical Care Nurse reviews how a PICU improved bundle compliance and decreased CAUTI infection rates.

Daily targeted rounds and real-time training helped Children’s Hospital of Philadelphia (CHOP) achieve a rate of zero catheter-associated urinary tract infections (CAUTIs) and sustain it for more than a year, according to a study published in Critical Care Nurse (CCN).

CAUTIs account for nearly a third of all healthcare-associated infections, with an estimated 45,000 events and 13,000 deaths each year. Despite initial success with lowering infection rates, hospitals have struggled to find long-term solutions to CAUTI prevention.

The journal article, “Preventing Catheter-Associated Urinary Tract Infections in the Pediatric Intensive Care Unit,” discusses how CHOP took a proactive approach to identify and address barriers to CAUTI prevention in its 55-bed pediatric intensive care unit (PICU).

The core of the approach was a multidisciplinary CAUTI work group consisting of an attending physician, nurse practitioner, unit-based clinical nurse specialist, unit-based safety quality specialist, clinical nurse leader, staff nurse, infection control specialist, executive sponsor and data analyst. The team met once or twice each month to track progress and make any needed modifications.

Using a bundle of five specific CAUTI prevention elements, the PICU was able to achieve a compliance rate of 84% and an overall rate of 2.7 infections per 1,000 catheter-days. All patients in the PICU had appropriate indications for catheter placement.

To further improve its CAUTI-related rates, the work group turned to targeted rounds to provide a systematic approach to rounding only for patients with an indwelling urinary catheter. Initially, the PICU CAUTI team leader conducted these rounds, but relying on a single person was not a long-term solution.

In 2016, they formalized a daily targeted rounding plan, assigning each clinical member a day to conduct rounds each week. In addition to checking for bundle compliance, the rounds included real-time training to address any bundle element with an opportunity for improvement.

“Targeted rounding helped take our CAUTI-related outcomes from good to great,” said co-author Megan Snyder, MSN, RN, ACCNS-P, CCRN, director of nursing professional practice at CHOP. “It takes just a few minutes per patient, it focuses on a small population of patients, and many team members can share the responsibility of conducting rounds.”

They developed a special data review dashboard with information from the electronic health record and other sources to more consistently track bundle compliance and access bedside review data. The dashboard allowed anyone in the facility to review compliance data, identify trends and see a clear snapshot of harm metrics in real time.

Between July 2014 and June 2017, bundle compliance in the PICU increased each year, from 77% starting in July 2015 to 84% to 93%. Among the individual bundle elements, compliance with avoiding dependent loops in the drainage tubing was consistently identified as an area for improvement. By significantly increasing compliance with that key element of the bundle, the unit was able to raise overall compliance rates.

As bundle compliance improved, CAUTI rates decreased. Before implementing daily targeted rounds, the unit’s overall CAUTI rate was 2.7 infections per 1,000 catheter-days. Afterward, the PICU sustained a rate of zero CAUTIs for over a year.

Targeted rounds also offered an opportunity to highlight best practices, provide ongoing education and congratulate staff on providing excellent care.

As the American Association of Critical-Care Nurses’ bimonthly clinical practice journal for high-acuity and critical care nurses, CCN is a trusted source of information related to the bedside care of critically and acutely ill patients.

Access the article abstract and full-text PDF by visiting the CCN website at http://ccn.aacnjournals.org.

Source: American Association of Critical-Care Nurses (AACN)

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