National Content Series
Overcoming Challenges to Reducing HAIs/CAUTI and Improving Safety Culture
- Identify challenges that you’ve observed in this LTC facility. (Select all that apply.)
□Physician buy-in
□Removing catheters as soon as clinically indicated
□Changing the practice or routine catheter changes
□Understanding the CAUTI definition
□Collecting data
□Reducing unnecessary urine culture orders
□Reducing unnecessary antibiotic use
□Prioritizing the LTC HAIs/CAUTI Program
□No champions to encourage or lead the clinical or cultural change
□Workload and workflow
□Lack of Senior Leader engagement
□Poor communication
□Staff turnover
Other challenges:
Facilitator Notes
Recall the challenges you identified during the core team webinar associated with this training and potential solutions. Be prepared to discuss any of the challenges listed above in a non-punitive manner.
- Mr. Belvidere is a 91-year-old resident of your facility. He has an indwelling catheter due to acute urinary retention. Yesterday his urine was clear and yellow. Today he is fevering and has the chills and shakes, and his urine is pink and smells bad. You need to communicate what you’ve observed with a nurse or prescribing clinician.
- Situation—What is happening?
Mr. Belvidere has had an indwelling urinary catheter for the past four days due to acute urinary retention. This morning, I noticed he had the chills and shakes. His oral temperature was 99.2°F at 7:20 a.m. and 99.3°F at 9:45 a.m.
- Background—What is the background?
Yesterday there were no signs of rigors or a fever and his urine was clear and yellow.
- Assessment—What do I think the problem is?
While I know that his urine being pink and smelling bad isn’t a sign of infection, the fever and rigors are signs of a CAUTI.
- Recommendation—What would I recommend?
Because Mr. Belvidere has signs of an infection and there are no other clinical reasons for these signs, I recommend that we order a urine culture and UA before starting him on antibiotics.
- Think about when you could have used the TeamSTEPPS strategies (i.e., CUS, SBAR, check-back) to improve communication and teamwork among colleagues, residents and their family members. In the space below, describe the situation and how you would communicate using one of the TeamSTEPPS strategies.
Facilitator Notes
Review the SBAR above, as well as the facilitator notes from the presentation slides on CUS, SBAR and check-backs. The January,2015 content webinar, “Communication Strategies to Promote Resident Safety,” more thoroughly reviews the use of CUS, as well. Additionally, you may want to review resources from the TeamSTEPPS® for Long-term Care, Module 6 on mutual supportand Module 7 on communication, and show the video vignettes as a way to promote and encourage staff to use these communication strategies.
- As a group, use the CAUTI Case Review Form or Learn From Defects Tool to discuss how your team could have reduced the risk of a resident at your facilitygetting a CAUTI. What communication or clinical approaches could you have used to reduce CAUTI and/or safety of culture?
Facilitator Pre-work
Prior to initiating this activity, identify a resident who acquired a CAUTI and/or who has an indwelling urinary catheter. Pull the chart(s) on the resident(s) and use the information below to evaluate whether or not each step was documented and followed:
☐A chart review was done prior to urinary catheter insertion to ensure the indication for use met criteria
☐The catheter was removed promptly when the resident no longer met criteria for an indwelling urinary catheter
☐Aseptic technique was used by personnel who were trained in aseptic insertion of indwelling urinary catheters
☐Re-catheterization was avoided as a result of an assessment for alternatives to catheterization
☐A closed drainage system, catheter securement and unobstructed urine flow were maintained
☐Alternatives to Incontinence care were documented prior to insertion of an indwelling urinary catheter
Use your results from the chart review to identify improvement opportunities and develop an improvement plan using one of the tools referenced above to reduce CAUTIs, use of indwelling catheters, and improve safety culture.
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