Introduction & Background

Project Goal:

1. Arora, N., Patel, K., Engell, C., & LaRosa, J. (2014). The effect of interdisciplinary team rounds on urinary catheter and central venous catheter days and rates of infection. American Journal of Medical Quality, 29(4), 329-334. https://doi.org/10.1177/1062860613500519

2. Centers for Disease Control and Prevention. (2009). Catheter-associated urinary tract infections (CAUTI). Retrieved October 9, 2017, from CDC website: https://www.cdc.gov/infectioncontrol/guidelines/cauti/index.html

3. Cload, B., Day, A., & Ilan, R. (2010). Evaluation of unnecessary central venous catheters in critically ill patients: A prospective observational study. Canadian Journal of Anesthesia, 57(9), 830-835. https://doi.org/10.1007/s12630-010-9348-7

4. Freel, A., Shiloach, M., & Weigelt, J. (2008). A process for using existing guidelines to generate best practice recommendations for central venous access. Journal of the American College of Surgeons, 207(5), 676-682. https://doi.org/10.1016/j.jamcollsurg.2008.06.340

5. Greene, M. T., Kiyoshi-Teo, H., Reichert, H., Krein, S., & Saint, S. (2014). Urinary catheter indications in the United States: Results from a national survey of acute care hospitals. Infection Control and Hospital Epidemiology, 35(3). https://doi.org/10.1086/677823

6. Gutmanis, I., Shadd, J., Woolmore-Goodwin, S., Whitfield, P., Byrne, J., & Faulds, C. (2014). Prevalence and indications for bladder catheterization on a palliative care unit: a prospective, observational study [Abstract]. Palliative Medicine, 28(10), 1239-1240. https://doi.org/10.1177/0269216314536090

7. Inelmen, E., Sergi, G., & Enzi, G. (2007). When are indwelling urinary catheters appropriate in elderly patients? [Abstract]. Geriatrics, 62(10), 18-22.

8. O'Mahony, S., Mazur, E., Charney, P., Wang, Y., & Fine, J. (2007). Use of multidisciplinary rounds to simultaneously improve quality outcomes, enhance resident education, and shorten length of stay. Journal of General Internal Medicine, 22(8), 1073-1079. https://doi.org/10.1007/s11606-007-0225-1

9. Rupp, S., & Apfelbaum, J. (2012). Practice guidelines for central venous access: a report by the American Society of Anesthesiologists Task Force on central venous access. Journal of the American Society of Anesthesiologists, 116, 539-573. https://doi.org/10.1097/ALN.0b013e31823c9569

Methods

Reducing CLABSI and CAUTI using Interdisciplinary Rounds: Focusing on Patient Safety in the Continuum of Care

Chad Becnel, Leland Chan, Paul Minetos, Bryce Christensen - Tulane School of MedicineBrandon Mauldin MD, Joyce Roberson RN BSN MSN CIC - Tulane Medical Center

Implementation of a new Interdisciplinary Rounds checklist to foster an environment of uniform and thorough patient care timelines and actions. This project represents the beginning of IDR staff education and proper quality care measures in a multidisciplinary care team.

• Interdisciplinary rounds (IDR) are daily patient safety meetings involving various medical professionals on the care team

• Nosocomial catheter-associated urinary tract infections (CAUTI) and central line-associated bloodstream infections (CLABSI) increase patient duration-of-stay, patient mortality rates, and healthcare costs.

• Reducing utilization-days of indwelling catheters and central line catheters may lead to improved patient outcomes and a decrease in healthcare costs.

• Tulane University Hospital experiences both CAUTI and CLABSI rates that are higher than the national average.

• IDR present an opportunity for multidisciplinary healthcare teams to monitor indwelling and central line catheters as a means of reducing CAUTI and CLABSI rates.

Aim

Reduce the Standardized Infection Rate and StandardizedUsage Rate for central lines and indwelling catheters by 25%in 6 months.

• One of the most difficult aspects to implementing these policies is changing the norm.

• The current IDR culture is more about disposition; future meetings will focus discussion on patient safety first.

• The infection control team at Tulane will champion changes in IDR protocol.

• Each IDR team member is unique in their approach to patient care. Our change in IDR culture should empower each IDR care team member to promote patient safety.

References

Lessons LearnedSustainability

Figure 1 (Above): Algorithm describing indications for an Indwelling Urinary Catheter or Central Line.

Figure 2 (Left): Implementing an Interdisciplinary Round Patient Safety checklist

Protocol Flowchart and Forms

Multidisciplinary Team

• Attending Physicians• Resident Physicians• Infection Control Team• Nursing Staff

• Social Work and Case Management

• Medical Students• Patients

CAUTI and CLABSI Data Prior to Protocol

• This CLABSI and CAUTI project is a high-priority project at Tulane because the risk-adjusted rates have been higher than goal. This project will serve as an example to each team regarding their responsibilities at IDR.

• The universal IDR Checklist will provide individual team members reminders about their specific role in patient safety.

• In the future, the data collected will be used to compare with other hospital units to encourage multidisciplinary rounding throughout Tulane Hospital.

Figure A (Top Left) and Figure B (Bottom Left): Monthlydata on Standardized Infection Rate at Tulane MedicalCenter. Green line is a trend line for the first eightmonths of 2017. Red line is value of 1, the average orexpected data point for the risk-adjusted standard.

Figure C (Above Center) and Figure D (Above Right):Standardized Usage Rate of Central Lines and FoleyCatheters

A

B

C D

1

Education PeriodThe “Reducing CLABSI and CAUTI” protocol was approved for implementation in Tulane Hospital’s Interdisciplinary Rounds beginning November 1, 2017. Nursing, physician, and other care delivery staff were educated on the policy changes prior to implementation date. Staff attending Interdisciplinary Rounds were given the new protocols and checklists.

Implementation AuditAttending physicians and Infection Control staff attending Interdisciplinary Rounds will audit to assess compliance to the “Reducing CLABSI and CAUTI” protocol.

Quarterly Data CollectionMedical student investigators will conduct quarterly data collection and analyze infection rates in the units utilizing the “Reducing CLABSI and CAUTI” protocols.

ReviewChanges and recommendations may be implemented in the interest of patient safety or with recommendation of the attending physicians based on clinical experience and supporting literature