A Washington hospital has greatly reduced catheter-associated urinary tract infections (CAUTIs), improved quality, and yielded a significant savings for the hospital, all the result of a nursing-led initiative that included T-shirts, Starbucks cards, and Skittles.
Nurses at Swedish Medical Center First Hill Campus in Seattle participated in the Clinical Scene Investigator (CSI) Academy, a nurse empowerment and training program sponsored by the American Association of Critical-Care Nurses (AACN). The nurses chose to address CAUTIs at the 42-bed hospital because its CAUTI rate was consistently above the National Healthcare Safety Network benchmark rate, explains Sarah Gattis, RN, CCRN, a critical care nurse at the hospital.
Four nurses made up the CAUTI team, two from each shift. The team sought advice from the hospital’s quality improvement department on what quality indicators to track and use in goal-setting. The primary goal was to improve patient outcomes by decreasing the CAUTI rate by 50% over the nine-month project period. They initially wanted to set an even more ambitious goal, but decided 50% was realistic.
To reach the goal, the team planned to educate 90% of hospital staff by the end of the project on October 31, 2015, as well as establish 25 CAUTI champions. The champions were nurses who, though not formal members of the project team, were knowledgeable and supportive of the effort. They encouraged their fellow nurses and also acted as the eyes and ears of the project, reporting their observations of how the prevention practices were being followed and any challenges that needed to be addressed, Gattis says.
“Our biggest strategy was education. As bedside nurses we really want to do what’s best for our patients, but we also want to know the how and the why,” Gattis explains. “Not just how to reduce CAUTI, but why we’re doing it that way and why we know this will work. So we emphasized evidence-based practices in our education for nurses.”
The team conducted education sessions for both the day and night shifts, providing food to lure the nurses in. The sessions explained the team’s efforts to standardize catheter care, removing catheters in less than 48 hours because the top risk factor for CAUTI is prolonged urinary catheter use. They also established 6 a.m. as catheter removal time, required the use of approved catheter care products, and passed on CAUTI prevention tips and tricks for keeping the catheter clean, making sure it was intact, and checking for proper drainage.
The hospital has three 16-bed ICUs on three different floors, so the team put a tri-fold poster on each floor in the report room that included all the same information presented in the education session. Sign-in sheets were provided with the posters and nurses were asked to sign when they had reviewed the poster information, which helped accommodate busy schedules and those who had not attended the education sessions. The posters were left in place throughout the nine-month project period.
“We monitored the sign-in sheets and compared those to the attendees at our education sessions, then we went to those we had missed and had one-on-one education sessions with them,” Gattis says. “There was no negativity about not having done the session or the poster because we understood that people get busy. But we did try to get to them personally and pass on the information.”
Team members also sought out CAUTI champions and found that branding and a little levity yielded great results. Any nurse who agreed to be a CAUTI champion got a free T-shirt designating him or her as a Cautihawk. The staff are big Seattle Seahawks fans, so the T-shirts used Seahawks colors and similar imagery.
“The T-shirts were really popular and we had approval to wear them while we worked,” Gattis says. “It got people talking about the project and excited, really buying into the project. We also made Cautihawk mouse pads and put them all over, part of trying to get the brand and the message in front of people all the time.”
Skittles in a catheter bag
The team asked all the hospital’s charge nurses to be CAUTI champions and wear the T-shirts once a week. The intensivists on the ICU bought into the project in a big way and were helpful in encouraging participation. Their vocal and visible support made a big difference in how much the staff followed suit, Gattis says. Hospital management also helped by allowing the project team members time off the floor for staff education and other project activities.
A CAUTI leader board was posted in the break room with all the nurses listed, and they received a sticker next to their names for each catheter removed, prompting some lighthearted competition. The CAUTI team also held a weekly drawing for a $5 Starbucks card — a popular prize, as the hospital lobby has a Starbucks. For each catheter nurses removed, they put their names on a slip of paper and dropped it in the CAUTI drawing box. A winner was pulled out every week.
“It was a fun little thing and people loved it,” she says. “Just a little bit goes a long way in getting people excited and keeping their motivation up.”
Another motivational trick was a catheter bag posted prominently in the report room. For each day the hospital went without a catheter infection, the team place a Skittle candy piece — in the Seahawks/Cautihawks colors — in the bag. Staff could see the bag filling with more Skittles over time, providing a reminder and encouragement, Gattis says.
Goals surpassed by wide margins
The quality improvement department helped track CAUTIs and catheter utilization. One of the three-month short-term goals was to reduce the CAUTI rate by 20%. They ended up with zero CAUTIs in that time period, compared to four the previous year. Catheter utilization did change significantly. They also sought to educate 50% of the staff in three months, and achieved 71%. They wanted to establish 10 CAUTI champions by then, and reached 25.
The nine-month long-term goals were to reduce the CAUTI rate 50%. There was one CAUTI in that period, compared to 12 in same time period the previous year. The goal for staff education was 90%, and the team reached 91%. In nine months, the team established more than 50 CAUTI champions, more than twice the goal of 20.
With the estimated cost per CAUTI of $6,913, the project saved $76,043 over nine months, with a projected annual savings of $101,390. The team also expects to see decreased length of stay and increased patient turnover.
The project team had to overcome several challenges, including how to effectively educate float pool staff and travelers, dealing with the increased workload for staff, and sustaining support and enthusiasm. The experience also illustrated the importance of following through on an initiative, Gattis says.
“You can’t just do a big rollout, have a party, educate people, and then let it fizzle out over time,” Gattis says. “You have to continue drumming up support, keep people interested and motivated, and analyze the numbers along the way. It’s important to determine what’s working and what’s not, and change your work accordingly.”
- Sarah Gattis, RN, CCRN, Swedish Medical Center, First Hill Campus, Seattle, WA. Telephone: (206) 215-3406. Email: firstname.lastname@example.org.