Catheter Associated Urinary Tract Infections (CAUTIs) were increasing at Carilion Clinic’s flagship hospital. Despite the usual strategies to educate nursing staff on how to prevent CAUTIs, the SIR (Standardized Infection Ratio) rose to 2.7 times the national benchmark in March 2017. SIR is calculated as:
1=met benchmark
<1=exceeded benchmark
>1=below benchmark
This information reflects the quality of patient care and is reported publicly, influencing the reputation of the hospital in the community, as well as reimbursement rates.
Carilion Clinic developed a 90 day-rapid-cycle education project to address the heightened SIR. A multi-disciplinary team (Learning & Development, Quality Management, Infection Control, Project Management, and most importantly, Nursing leadership) partnered on the design, implementation, and monitoring/reinforcement of outcomes.
Education was created to address:
- Gaps in knowledge: The criteria for insertion and maintenance, nurse autonomy to remove per policy, and documentation requirements
- Gaps in skill: Standardization of clinical practice and ongoing validation of skill
- Gaps in practice: Incorporating into daily practice, communicating barriers in compliance and identifying solutions, implementing teamwork to meet compliance, and documenting accurately to identify deficiencies in practice
The effort to reduce the CAUTI SIR supported Carilion Clinic’s mission to “improve the health of the communities we serve,” as well as alignedwith Carilion’s 2020 vision of consistently delivering high-quality clinical care, decreasing clinical variation, and ensuring financial vitality.
Program Details
The education resources consisted of rounding with Infection Control and Quality staff to focus on clinical documentation and tracking; a “CAUTI Bundle” notebook; and a simulation toolkit for post-education practice during “skills days.”
Two challenges presented with the education:
1. The dispersed audience: 29 units (30 to 50 nurses per unit) working 24/7 shifts, with limited ability to leave patient care for education
2. The fact that nurses, in general, have given feedback that they are overburdened with constant change and constant education.
To improve the engagement and effectiveness of the training, education was delivered in a mobile cart designed to look like a patient room sink. The sink was filled with candy, and there is a sign over the cart reading “Let the Education ‘Sink In.’”
Unit directors were requested to name a unit CAUTI Champion and schedule time for the “Sink In” interactive presentation, which included education on documentation and tracking. After the presentation, the CAUTI Bundle notebook with education material and resources was given to the unit CAUTI Champion to review with his or her team and disseminate to staff who were not present. They also received a simulation toolkit for post-education practice.
Following the CAUTI Bundle education for existing nurses, the education was incorporated into the orientation curriculum for all new hire RNs and Nursing assistants. Unit directors demonstrated their commitment to reducing CAUTIs by presenting compliance/rates of their units semi-annually in Nursing leadership meetings.
Results
In the six months following the completion of the 90-day rapid-cycle project (June to December 2017), the SIR rate dropped from 2.7 to 1.2. This included two months where Carilion Cllinic exceeded the benchmark. Results were maintained in 2018, with the 2018 CAUTI SIR holding at 1.3, or 0.3 from goal.
The format of didactic or interactive education followed by a notebook of educational material and a simulation toolkit for post-training practice was proven effective and is repeatable. L&D since has developed variations of that format for education on naloxone and insulin administration, as well as for defibrillator use. The mobile “Sink In” cart has proven to be an effective tool for high-priority, time-sensitive education and has been used for regulatory/compliance and patient safety training initiatives.
