eliminating infection-related ventilator-associated complications … · 2018-05-08 · agenda •...
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FHA Call to Action: Eliminating Infection-Related Ventilator-Associated ComplicationsIVAC Bi-Monthly Webinar #2May 3, 2018
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Agenda
• FHA MTC Call to Action for IVAC• Data Review • HRET HIIN Hospital Peer Sharing
– Meryl Montgomery, RN, MSNSonya Floyd, RN, BSN,CICValerie Fox, RRTMedical Center Navicent Health
• Available Resources• Closing Remarks
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SAVE LIVES: Cleaner hands are safer
handsMay 5, 2018
For resources and more information, visit the World Health Organization’s
World Hand Hygiene Day page
http://www.who.int/infection-prevention
http://www.who.int/infection-prevention/campaigns/clean-hands/5may2018/en/http://www.who.int/infection-prevention
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Call to Action
• FHA Quality Committee• FHA Annual Meeting• CEO Call to Action
-
How are We Doing?
Oct2016
Nov2016
Dec2016
Jan2017
Feb2017
Mar2017
Apr2017
May2017
Jun2017
Jul2017
Aug2017
Sep2017
Oct2017
Nov2017
Dec2017
Jan2018
Feb2018
FL Rate 1.75 1.72 2.33 2.42 2.49 2.56 1.95 2.59 1.92 1.50 2.37 2.52 2.43 1.02 1.91 1.25 1.49# Reporting 89 89 90 93 93 93 90 91 92 92 92 92 91 89 86 74 66
0.00
0.50
1.00
1.50
2.00
2.50
3.00
Rat
e pe
r 1,0
00
Baseline Rate = 2.15
Effective date: April 13, 2018
FHA Board Call to Action
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Polling
– Do you round daily to ascertain both bundle compliance?– Do you also assess for appropriative indications during
rounds?– Do you use endotracheal tubes with subglottic secretion
drainage? – Do you investigate each IVAC occurrence?– Which condition is the most frequent contributor to your
IVAC cases?• Trauma• Sepsis• Abdominal Trauma• Thoracic Trauma• Other
-
SONYA FLOYD, RN, BSN, CICVALERIE FOX, RRT
MERYL MONTGOMERY, RN, MSN
H.A.C.ING VAE’S FHA 5.3.18
-
Medical Center Navicent HealthMacon, GA
• 637 beds, 5 adult ICUs (86 beds)• 2015- 94 VAE, 2016- 74 VAE• 2015- 10 VAP, 2016- 8 VAP
-
Aim and BackgroundAim
How much improvement? By when? For whom?
By 9/30/17, decrease Ventilator Associated Events 30% (from 74 to 52) in the five adult ICUs.
BackgroundWhy this project and why now?While VAP rate
-
“But, our PVAP rate is low!”
10
• Resting on our laurels of low VAP for several years →complacency in 5 adult ICUs (86 beds)
• In 2013, CDC criteria changed to VAE= VAC+ IVAC+ PVAP– PVAP no longer the only issue- keeping up with the change
• Impact of bench-marking: – HRET HIIN: our VAE rates nearly double average of hosp average– NDNQI-4Q under-performance
0%
10%
20%
30%
40%
50%
60%
70%
1Q15 2Q15 3Q15 4Q15 1Q16 2Q16
% ICUs that outperform NDNQI >500 bed mean
% out-perform target
-
Methodology• VAE task force with MD, executives,
interdisciplinary• Use of 6 sigma DMAIC and PDSA/ rapid
cycle change• Deep dive RCA trends• Data- benchmark HRET HIIN, NDNQI• Process and outcome measures• Multi-modal education• Front line and leader engagement• Participation in HRET HIIN AI fellowship
-
• Outcome Measures: How is the system performing? What are the results? – VAE incidence overall and by unit– VAC, IVAC, VAP incidence rates– Benchmark comparisons: GHA HEN, HRET HIIN, NDNQI
• Process Measures: Are the parts or steps in the process or system performing as planned? – CLRT, Turn q 2 hr, HOB ≥30◦, CHG, oral hygiene, hi-lo ETT, separate oral/ ETT
suction- observation/ interview/ documentation audit
• Balance Measures: What happened to the system as we improve the outcome and process measures? – Ventilator days– LOS for ventilator patients– Mortality rate for ventilator patients
12
Key Performance Measures
-
Driver Diagram
13
-
Key Changes Since Fall 2016• Re-education• Documentation parameters PEEP FiO2 • Transport protocol• PAD (Pain Agitation Delirium) protocol• Focus on basics- hand hygiene, vent bundle,
mobility• Hardwired accountability• Adequate material resources• Closed ICUs (intensivists)• Standardize all changes across ICUs, services
14
-
VAE Improvement Timeline
-
Data driven timeline
16
-
Communication of “burning platform” of VAE reduction
• Tied to goals in performance review• Post/ review data, transparency• Committees, staff meetings, huddles• Involvement of front line staff in solutions/
engagement• Education of all levels• Paying attention to expected behavior• Administrative, interdisciplinary involvement-
incorporated into rounds- PAD, bundles, mobility, de-escalation, alternatives
• Newsletters, BB, signs, “Potty Training”
-
RCA form
-
Vent Bundle monitoring tool
-
Transport monitoring tool
-
Outcomes
-
KPI: VAE Incidence Rates/month all adult ICUs
8.16 9.16 10.16 11.16 12.16 1.17 2.17 3.17 4.17 5.17 6.17 7.17 8.17 9.17 10.17 11.17 12.17 1.18 2.18 3.18VAE/1000 pt days 12.4 8.2 10.2 2.5 6.4 4.5 5.6 2.8 2.1 2 2.6 0 1 5.4 3.9 0.9 1.8 3.3 0 0
-2
0
2
4
6
8
10
12
14
VAE/
1000
pt
days
VAE Incidence 8/16-3/18
-
#IVAC/PVAP over time
0
5
10
15
20
25
30
35
40
#IVAC #PVAP
#IVAC PVAP 2015-FY18
2015 2016 2017 YTD18
-
ICU mobility:with a smile on his face!
-
Cost savings
• Reduced VAE by 60% (2016-78, 2017-31)
• Met GHA HRET HIIN two year 20% target reduction in year one (our baseline was 84)
• HRET HIIN cost calculator= $ 21,000 /”VAC”• Total estimated savings due to ↓VAE:
$987,000
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Benchmarking
• HRET HIIN benchmarks both IVAC and “VAC” (=CDC VAE definition which includes VAC, IVAC, VAP)– VAC- ↑ FiO2 and/or PEEP for ≥ 2 days– IVAC- ↑ FiO2 and/or PEEP for ≥ 2 days, infection
S/S (T >38, wbc>12,000), antibiotics started in infection window/ continued for 4 days
-
Adult ICU vs HRET HIIN VAE-1
-
HRET HIIN VAE IVAC rate
-
Adult ICU vs NDNQI >500 bed units. N 174 units
4Q15 1Q16 2Q16 3Q16 4Q16 1Q17 2Q17 3Q17 4Q17% out-perform 60% 20% 80% 60% 100% 80% 100% 100% 100%target 51% 51% 51% 51% 51% 51% 51% 51% 51%
0%
20%
40%
60%
80%
100%
120%
% u
nit
s ou
tper
form
ND
NQ
I +
VAE: % Adult ICU outperform NDNQI >500 bed mean rolling 8 quarters
-
Sustaining the drop! #1 accountability
30
• Accountability– Interdisciplinary team
– Interdisciplinary bedside rounds– Nursing leadership rounds- PAD? Mobility?– Intensivist model- 4 of 5 closed units by spring
2018
-
Having what staff need
31
• Portable suction machines• Portable vents- ↓ circuit breaks
• Sufficient suction regulators• Hi/Lo ETT• Cuff manometers
39%
95%
0%
20%
40%
60%
80%
100%
Jan-Jun 2016 2017
% pts transport on vent vs "ambu"
-
Back to the Basics- hand hygiene
32
Chart1
2016
2017
49%↑per audits
hand hygiene
% hand hygiene via mystery shopper
Hand hygiene mystery shopper all adult ICUs
0.67
1
raw data
VAE
# Infections# Vent Days# Infections# Vent Days# Infections# Vent Days# Infections# Vent Days# Infections# Vent Days# Infections# Vent Days# Infections# Vent Days# Infections# Vent Days# Infections# Vent Days# Infections# Vent Days# Infections# Vent Days# Infections# Vent Days
Oct-13Nov-13Dec-13Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-14Aug-14Sep-14
CVICU025212930360038312600327125302610209030602610194
STICU11781202018312330152018411642196117812190150095
NICU0129215801060167015501701120111601240117087181
CCU0103012601420186011001411139099191012811050120
MICU1167120301651206115331942184117001430950870170
28295982095621175283031016686048422745186516901660
CLABSI - Adult Critical Care Central Line Associated Blood Stream Infections
# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days
Oct-13Nov-13Dec-13Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-14Aug-14Sep-14
CVICU045234930485253104330515038904550462154704490299
STICU020701420149025201651245120402230233118411490196
NICU013602191121019201461196013102110130015101340177
CCU014801420177026101410154018901260152015711460174
MICU122812430230027902240256025912901245123602660199
TOTAL111714123911162215150110921366111721130511222312752114401045
CLABSI - Adult Central Line Associated Blood Stream Infections
# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days
Oct-13Nov-13Dec-13Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-14Aug-14Sep-14
E306305014501202111090062060086074074090
W3125302650231017802080228121302660247031302340163
E40130090010501300147053011101520207011301510163
M4030502770258029302600302021802901334027102730133
E513609908305301090109099097061088036078
M5011701760174219701180169013101870232019811540151
M60120065011801900136011507301270134011301271107
M7080120802103000160102014024011
M8019302020214118702410204023522280208018902680222
M9036703060374030003240295034103040353338403871342
H509609107008106909108807301350147062061
H6052048065096077073051060064064026036
17401681174518461803172916381845196818161557
M3MN/AN/AN/AN/AN/AN/AN/AN/A01N/AN/AN/A
2064
H7087111101180430107010109507301080148095085
TOTAL2182711792`01863318892191001830117332191812172321161191121642
CLABSI - NNICU 2500 gm Infection Rate
# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days
Oct-13Nov-13Dec-13Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-14Aug-14Sep-14
750 gm0114011011101119075062183175060160165188
751-1000 gm066032045074075060163111901030650132059
1001-1500 gm09305701010600900500133079112401220137039
1501-2500 gm05901306105013903106020024041057011
>2500 gm0160230500750340804013021028059047
TOTAL ICN034802351367137813130211228923061332131614501244
CLABSI - Pediatric Infection Rate
# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days
Oct-13Nov-13Dec-13Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-14Aug-14Sep-14
PICU1100016201621132098031069013308509511180121
PIMCU13704505004504400166144013031068037
TOTAL PCC1372072121771423113517798126186158
C3M059040093012001440128081069083089070036
219602470305129702860159121612460181021512560194
CAUTI - Pediatric Infection Rate
# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days
Oct-13Nov-13Dec-13Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-14Aug-14Sep-14
PICU0160560162052033031112070033017011069
PIMCU010000000000000000000100
TOTAL PCC1756162523331127033171169
C3M000206020302050103020405
017058016805403603311707103601901574
CAUTI - Adult Critical Care Catheter Associated Urinary Tract Infections
# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days
Oct-13Nov-13Dec-13Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-14Aug-14Sep-14
CVICU148425182499055324203534242934811377343634542313
STICU222612651247130112210275125002951232025711780205
NICU026323201306133102532295226632772269128822221268
CCU013002200194330111882208020602120168021721820177
MICU122803001308132722610302121812761241126422690225
5133151623515546181361343716146136971541512875146210130531188
CAUTI - Adult Catheter Associated Urinary Tract Infections
# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days
Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14
E3016801340117163012008901611761126
W30970810610870651104012011231102
E4026812310186020812602294030022693221
M40119084075073096111309711050109
E5019211900172018121951136316401321116
M5023601752189318511892236022402010206
M6127212360205118512161165120302271281
M701080109088093076084090098093
M8228202140255125612460227017401750243
M9027922371276120312571272020412011238
H50720640820730820117080179163
H6048135137039037148038049014
H701260137010601871210014111520900140
3226761927418497183382049102026520077182591952
CAUTI rates by unit
#CAUTI rates by unit
CVICU
Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Sep-15Oct-15Nov-15
#CAUTI3322311212110211
# UC days436454313470536477477468528549539437340362440379341
STICU
Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Sep-15Oct-15Nov-15
#CAUTI0100100000101301
# UC days257178205267261259259297273239301244192241222212217
NICU
Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Sep-15Oct-15Nov-15
#CAUTI12132224011111110
# UC days228222268289292267267319317309316203196223259232220
CCU
Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Sep-15Oct-15Nov-15
#CAUTI0200111011001000
# UC days217182177216220220220238216183165128155144150168150
MICU
Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Sep-15Oct-15Nov-15
#CAUTI1202022130000000
# UC days264269225292280253253278297272219196207189189191193
E3
Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15
#CAUTI0111100000000
# UC days161762614411610611212294115779412057
W3Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Sep-15Oct-15
#CAUTI0110100101000002
# UC days1201231021059996115977989723926403695
E4Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15
#CAUTI0230001310001
# UC days300269221227165266215212162135151163131198
M4Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15
#CAUTI0100010000011
# UC days971051098495127113919611885986672
E5Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15
#CAUTI3013110100100
# UC days16413211614211611616114311394145937380
M5Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15
#CAUTI0001000010101
# UC days22420120617620620322424018017915012496145
M6Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15
#CAUTI1011001000100
# UC days168227281210136173194157228149198166225174
M7Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Jul-14Aug-14
#CAUTI0000000000000
# UC days93839283847610987828159719098
M8Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Sep-15Oct-15Nov-15
#CAUTI0003111010000000
# UC days174175243291244258217195189189152162122101127192117
M9Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Sep '15Oct '15Nov '15Dec '15Jan '16
#CAUTI0110010000011100000
# UC days204201238245232239216197207195197166189160215271157241219
H5Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15
#CAUTI0111000000000
# UC days80796352929271120808699859778
H6Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15
#CAUTI0000001000000
# UC days38491432499480481168139675625
H7Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15
#CAUTI1000000010000
# UC days152901407317613713510985101112758483
PICU
PCCJul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15
#CAUTI0000000000000
# UC days1711697372364351283928372215
C3MJul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15
#CAUTI000000000000
# UC days245030371245
all unit CAUTI
ALL UNITSJul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Sep-15Oct-15Nov-15Dec-15Jan-16Feb-16Mar-16Apr-16May-16Jun-16
#CAUTI10171217111010119564794653
# UC days345331453215347134833506345934663398321331312663251325272610279524912797
Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15
#CAUTI
# UC days
M8 CY 2014
M8Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14
#CAUTI2001100003110.75
# UC days282214255256246227174175243291244258238.75
M8Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14
#CAUTI200110000311
M8Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14
#CAUTI200110000311
#CLABSI100020000001
#HAPU prev1121
M8Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14
#CAUTI200110000311
M8Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14
# UC days282214255256246227174175243291244258
ALL UNITSSep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15
#CAUTI121711101011956479
ALL UNITSSep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15
# UC days321534713483350634593466339832133131266325132527
% reduction in UC days Jul-Nov 2014 vs 2015
% ↓ UC DAYS
MICU27%
CCU24%
CVICU17%
STICU7%
NICU7%
Critical Care vs NDNQI
4Q131Q142Q143Q144Q141Q152Q153Q154Q151Q16
% outperform40%40%60%60%0%40%60%0%20%20%
target51%51%51%51%51%51%51%51%51%51%
ALL UNITSJul-14Aug-14Sep-14Oct-14Nov-14Dec-14
#CAUTI101712171110
# UC days345331453215347134833506
2014
SIR1.615
SIRgoal0.801
SIRgoal
20141.6150.801
20151.130.845
20142015
SIR1.6151.13
goal0.8010.845
2015
SIR1.13
goal0.845
adult ICU CAUTI
1Q132Q133Q134Q131Q142Q143Q144Q14
% out-perform40%100%20%80%80%40%40%40%
target51%51%51%51%51%51%51%51%
20142015
SIR1.6151.13
goal0.8010.845
2014
% > goal50.4%
20142015% improve.
% > goal50.4%25.2%50%
% improvement in adult CC
# CAUTI# UCSIR
14 vs '1536%11%50%
↓36%↓11%↓50%
Critical Care #UC days and # CAUTI 2014
Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14
#UC days/mo173913431614136915411287146213051188153415811605
#CAUTI6676755103787
Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Sep-15Oct-15
3111010000000
291244258217195189189152162122101127192
M8Jul-14Aug-14Sep-14Oct-14
#CAUTI0003
# UC days174175243291
M8Jul-15Aug-15Sep-15Oct-15
#CAUTI0000
# UC days122101127192
UC utilization ratio 2015 by unit
unitUC util ratio
STIC0.77
CVI0.663
ICU ave0.66
NICU0.658
CCU0.628
MICU0.597
average0.25
M90.202
E40.181
M50.171
E30.169
M60.168
E50.168
M80.159
MS ave0.15
W30.129
M40.124
H70.115
H60.07
% units outperform NDNQI >500 bed mean
1Q142Q143Q144Q141Q152Q153Q154Q151Q162Q163Q164Q16
% outperform68%29%62%40%43%45%43%43%48%45%62%75%
target51%51%51%51%51%51%51%51%51%51%51%51%
CAUTI rate/1000 cath days 2015
unitCAUTI rate
W36
E54.39
E44.09
NICU3.96
STICU3.05
CCU2.9
CVI2.68
AVERAGE2.66
M52.53
MICU2.21
M42.07
M61.99
E31.82
H61.6
M81.06
H70.9
M90.83
M8 1 year prior and 1 year of ID rounds
M8Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-16Aug-14Sep-14Oct-14Nov-14Dec-14
#CAUTI200110000311
# UC days282214255256246227174175243291244258
month3/144/145/146/147/148/149/1410/1411/1412/141/152/153/154/155/156/15IMP.7/158/159/1510/1511/1512/151/162/163/164/165/166/167/168/169/1610/16
#CAUTI01100003111010000000000000100000
UC days2552562462241741752432912442582172011891521521621221011271921171241009293128828458937135
ALL UNITSJul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Sep-15Oct-15Nov-15Dec-15Jan-16Feb-16Mar-16Apr-16May-16Jun-16Jul-16Aug-16Sep-16
# UC days345331453215347134833506345934663398321331312663251325272610279524912631241524372441226422401847169517251568
#CAUTI10171217111010119564794656454220541
comparison to HEN HRET co hort
CAUTI incidenceUrinary catheter days
Jan-Dec '15Jan-Jun '16Jan-Dec '15Jan-Jun '16
CCU50%100%CCU67%100%
CVICU83%67%CVICU58%83%
MICU75%83%MICU67%83%
NICU75%83%NICU50%100%
STICU50%83%STICU92%83%
Overall83%83%Overall60%100%
ALL UNITSOct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Sep-15Oct-15Nov-15Dec-15Jan-16Feb-16Mar-16Apr-16May-16Jun-16Jul-16Aug-16Sep-16
# UC days347134833506345934663398321331312663251325272610279524912631241524372441226422401847169517251568
#CAUTI17111010119564794656454220541
FY15avesums
347134833506345934663398321331312663251325272610312037440
171110101195647948.6103
FY16
279524912631241524372441226422401847169517251568221226549
6564542205413.744
Oct-14Nov-14
34713483% ↓ UC d29%
1711% ↓ CAUTI57%
ALL UNITSDec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Sep-15Oct-15Nov-15Dec-15Jan-16Feb-16Mar-16Apr-16May-16Jun-16Jul-16Aug-16Sep-16Oct-16Nov-16Dec-16Jan-17Feb-17Mar-17Apr-17May-17Jun-17
# UC days3506345934663398321331312663251325272610279524912631241524372441226422401847169517251568161615771678180717171930173518571808
#CAUTI1010119564794656454220541112313211
avesums
3120UC d FY1537440
8.5833333333CAUTI FY151003
2212.4166666667UC d FY1626549
3.6666666667CAUTI FY1644
UC d#CAUTI
FY1537440103
FY162654944
FY15FY16
UC d3744026549
#CAUTI10344
Service DateService DateService DateService DateService DateService DateService DateService DateService DateService DateService DateService Date
FY 2016FY 2016FY 2016FY 2016FY 2016FY 2016FY 2016FY 2016FY 2016FY 2016FY 2016FY 2016
Location Cd (group)OctoberNovemberDecemberJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptember
C3M345319453336322288275264318275245246
E3533515438550498491515506462473464496
E4864857863921798870855866782837825811
E5575538571577539551520562535574574550
E6386358345369304360344310323302301316
H5N398381374385366398365353323339381357
H5S385358374387338391368359344327357351
H6N337307320339329296317267254240302272
H6S223221189294292308279275302245303271
H7N401394390410374414404375383371415393
H7S388377392434387418378365394357400392
M4677569658681620628602575633545629559
M4N1294285261300300333289307283261254290
M4N2342347323370362372321343290325330307
M51000940946978886934934972892947937882
M6N509504499492461513474499483502503471
M6S525507486511475518503474483505497475
M7287382303279265336310322317263347321
M8103210009961011893961920928916943906772
M9958895893941894937924922914958955858
PICU232288325260248199203185125159207157
W2E278275274289267280271285270262265265
W2S391396381384372386373406384389395372
W2W299311322331312344325344318319314299
W3593587569581543581536569543588568531
W3W64538571542644221411
W4381363375400370396386387387387372382
Grand Total150461446714652152111402814718141221412713734138001430913407
UC d263022952631234322032252226422401867169517251568
0.17479728830.15863689780.17956592960.15403326540.15704305670.15300991980.16031723550.15856161960.13594000290.1228260870.12055349780.1169538301
M4N1294285261300300333289307283261254290
M4N2342347323370362372321343290325330307
W2E278275274289267280271285270262265265
W2S391396381384372386373406384389395372
W2W299311322331312344325344318319314299
W4381363375400370396386387387387372382
pt days198519771936207419832111196520721932194319301915
UC d11821121118711221102108310221224932852821684
59.5%56.7%61.3%54.1%55.6%51.3%52.0%59.1%48.2%43.8%42.5%35.7%
ICUOct '15Nov '15Dec '15Jan'16Feb '16Mar '16Apr '16May '16Jun '16Jul '16Aug '16Sep '16
UC days/mo11821121118711221102108310221224932852821684
% UC util.60%57%61%54%56%51%52%59%48%44%43%36%
MCNHOct '15Nov '15Dec '15Jan'16Feb '16Mar '16Apr '16May '16Jun '16Jul '16Aug '16Sep '16
UC d/mo.263022952631234322032252226422401867169517251568
% UC util17%16%18%15%16%15%16%16%14%12%12%12%
MS
Location Cd (group)OctoberNovemberDecemberJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptember
C3M345319453336322288275264318275245246
E3533515438550498491515506462473464496
E4864857863921798870855866782837825811
E5575538571577539551520562535574574550
E6386358345369304360344310323302301316
H5N398381374385366398365353323339381357
H5S385358374387338391368359344327357351
H6N337307320339329296317267254240302272
H6S223221189294292308279275302245303271
H7N401394390410374414404375383371415393
H7S388377392434387418378365394357400392
M4677569658681620628602575633545629559
M51000940946978886934934972892947937882
M6N509504499492461513474499483502503471
M6S525507486511475518503474483505497475
M7287382303279265336310322317263347321
M8103210009961011893961920928916943906772
M9958895893941894937924922914958955858
W3593587569581543581536569543588568531
W3W64538571542644221411
Grand Total10480100621014410547963810219986797659622959199139335
#UC days14481174144412211101116912421016915843904884
0.13816793890.1166766050.14235015770.11576751680.11423531850.11439475490.12587412590.10404505890.09509457490.08789490150.09119338240.0946973755
MS UC utilizationOct '15Nov '15Dec '15Jan'16Feb '16Mar '16Apr '16May '16Jun '16Jul '16Aug '16Sep '16
#UC days144811741444122111011169124210169158439048841113.4166666667
MS UC utilization14%12%14%12%11%11%13%10%10%9%9%9%11%
ICUOct '15Nov '15Dec '15Jan'16Feb '16Mar '16Apr '16May '16Jun '16Jul '16Aug '16Sep '16
UC days/mo118211211187112211021083102212249328528216841027.6666666667
% UC util.60%57%61%54%56%51%52%59%48%44%43%36%52%
MCNHOct '15Nov '15Dec '15Jan'16Feb '16Mar '16Apr '16May '16Jun '16Jul '16Aug '16Sep '16
UC d/mo.2630229526312343220322522264224018671695172515682142.75
% UC util17%16%18%15%16%15%16%16%14%12%12%12%15%
month3/144/145/146/147/148/149/1410/1411/1412/141/152/153/154/155/156/15
#CAUTI0110000311101000
UC days255256246224174175243291244258217201189152152162
2552562462241741752432912442582172011892973
01100003111019
M8 post inc rate
7/158/159/1510/1511/1512/151/162/163/164/165/166/167/168/169/1610/16
00000000001000001
12210112719211712410092931288284589371351619
all ICU + MS inc rate
Nov-15Dec-15Jan-16Feb-16Mar-16Apr-16May-16Jun-16Jul-16Aug-16Sep-16Oct-16
24912631241524372441226422401847169517251568161625370
56454220541139
pre= 2014, post=2016, YTD 2017= Oct-Apr.
pre vs post CAUTI incidence rate
adult ICUsM8all units
baseline4.37%3.03%3.71%
FY20161.72%0.62%1.54%
YTD20171.08%
all units
baseline3.71%
FY20161.54%
YTD20171.08%
% pts w UC ICU + MED SURG
FY14FY15FY16
# UC days401393676425370
% pts w UC29.226.118.1
cath days from monthly auto generated Cerner report. Joseph Horner
cath days401393676425370
pt days137605140692140215
0.29169724940.261308390.1809364191
formulat: cath days/ pt days
ICU % cath utilization
FY14FY15FY16
# UC days176091705912518
% pts w UC81.268.952.5
cath days176091705912518
pt days21,68224,76323,824
cath days/ pt days
device ut0.81214832580.68889068370.5254365346
%71.70%75.90%53.50%
Med surg % cath utilization
FY14FY15FY16
# UC days225301970512852
% pts w UC19.417.011.0
cath days225301970512852
pt days115,923115,929116,391
cath days/ pt days
device ut0.19435314820.16997472590.1104209088
INCIDENCE ICU+ MED SURG
FY14FY15FY16
# CAUTI1499239
Incidence3.712.501.54
CAUTI/ cath days x1000
total cath days401393676425370
formula: CAUTI/ cath days x1000
INCIDENCE ICU
FY14FY15FY16
#CAUTI685925
incidence3.863.462
total cath days176091705912518
incidence med surg (ICU+MED minus ICU)
#CAUTI813314
incidence med surg3.61.671.09
# cath days225301970512852
ALL UNITSOct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Sep-15Oct-15Nov-15Dec-15Jan-16Feb-16Mar-16Apr-16May-16Jun-16Jul-16Aug-16Sep-16Oct-16Nov-16Dec-16Jan-17
# UC days3471348335063459346633983213313126632513252726102795249126312415243724412264224018471695172515681616157716781807
#CAUTI171110101195647946564542205411223
ALL UNITS# UC days#CAUTI
May-1531316
Jun-1526634
Jul-1525137
Aug-1525279
Sep-152610431316same time fram May-Jan
Oct-152795631311
Nov-152491560.67104426011
Dec-1526316
Jan-1624154
Feb-1624375
Mar-1624414
Apr-1622642
May-1622402
Jun-1618470
Jul-1616955
Aug-1617254
Sep-1615681
Oct-1616161
Nov-1615772
Dec-1616782
Jan-1718072
ALL UNITS# UC days#CAUTI
Oct-14347117347117
Nov-1434831134711
Dec-14350610170.84703975261
Jan-15345910
Feb-15346611
Mar-1533989
Apr-1532135
May-1531316
Jun-1526634
Jul-1525137
Aug-1525279
Sep-1526104
Oct-1527956
Nov-1524915
Dec-1526316
Jan-1624154
Feb-1624375
Mar-1624414
Apr-1622642
May-1622402
Jun-1618470
Jul-1616955
Aug-1617254
Sep-1615681
Oct-1616161
Nov-1615772
Dec-1616782
Jan-1718072
ALL UNITS# UC days#CAUTIMay 15 to Jan 16
May-1531316May16-Jan17
Jun-1526634
Jul-152513731316
Aug-152527931311
Sep-152610460.69161895741
Oct-1527956
Nov-1524915
Dec-1526316
Jan-1624154SUMMARY OUTPUT
May-1622402
Jun-1618470Regression Statistics
Jul-1616955Multiple R0.6916189574
Aug-1617254R Square0.4783367822
Sep-1615681Adjusted R Square0.4435592343
Oct-1616161Standard Error1.7989879623
Nov-1615772Observations17
Dec-1616782
Jan-1718072ANOVA
dfSSMSFSignificance F
Regression144.513458200644.513458200613.75418371020.00210147
Residual1548.54536532883.2363576886
Total1693.0588235294
ALL UNITS5/15-1/165/16-1/17dbarCoefficientsStandard Errort StatP-valueLower 95%Upper 95%Lower 95.0%Upper 95.0%
May31312240891Intercept-4.02666913252.1456883045-1.8766328380.0801604275-8.60009549410.5467572291-8.60009549410.5467572291
Jun2663184781631310.00363902890.00098122393.7086633320.002101470.00154759980.00573045810.00154759980.0057304581
Jul25131695818
Aug25271725802
Sep261015681042
Oct279516161179
Nov24911577914
Dec26311678953
Jan24151807608
891.4444444444ave
st dev
ALL UNITS5/15-1/165/16-1/17dbar
May624
Jun404
Jul752
Aug945
Sep413
Oct615
Nov523
Dec624
Jan422
3.5555555556ave
st dev
CAUTI gender over time pre/post Purewick
20142015Jan-Apr2016May-Dec2016Jan-Mar 2017Apr-Jun 2017
male33.6%43.0%37.5%52.6%67.0%0.0%
female66.4%57.0%62.5%47.3%33.0%100.0%
recalculating CAUTI by Q
1Q152Q153Q154Q151Q162Q163Q164Q161Q172Q17
% units outperform40%55%45%60%60%85%50%75%60%68%
target51%51%51%51%51%51%51%51%51%51%
urine cultures/ month
Nov-15Dec-15Jan-16Feb-16Mar-16Apr-16May-16Jun-16Jul-16Aug-16Sep-16Oct-16Nov-16Dec-16Jan-17Feb-17Mar-17Apr-17
#Ucx/mo1031011098410152919273675751485450404646
May-15Jun-15Jul-15Aug-15Sep-15Oct-15Nov-15Dec-15Jan-16Feb-16Mar-16Apr-16May-16IMP. PWJun-16Jul-16Aug-16Sep-16Oct-16Nov-16Dec-16Jan-17Feb-17Mar-17Apr-17May-17
UC util/ mo3131266325132527261027952491263124152437244122642240184716951725156816161577167818071717193017351808
ALL UNITSJul-15Aug-15Sep-15Oct-15Nov-15Dec-15Jan-16Feb-16Mar-16Apr-16May-16Jun-16Jul-16Aug-16Sep-16Oct-16Nov-16Dec-16Jan-17Feb-17Mar-17Apr-17May-17Jun-17Jul-17Aug-17Sep-17
# UC days251325272610279524912631241524372441226422401847169517251568161615771678180717171930173518571808143715691632
#CAUTI794656454220541112313211301
# pt days
Indications for UC
16-Dec17-Jan17-Feb17-Mar17-Apr17-Jul17-Aug17-Sep
ICU vaso5%10%7%7%10%3%11%8%
pre/post op18%15%31%35%30%38%30%23%
retention49%43%34%32%38%38%40%45%
urology9%15%10%12%10%5%11%6%
16-Dec17-Jan17-Feb17-Mar17-Apr17-Jul17-Aug17-Sep
retention49%43%34%32%38%38%40%45%
pre/post op18%15%31%35%30%38%30%23%
urology9%15%10%12%10%5%11%6%
ICU vaso5%10%7%7%10%3%11%8%
retentionpre/post opurolICU vaso
12.1649%18%9%5%
1.1743%15%15%10%
2.1734%31%10%7%
3.1732%35%12%7%
4.1738%30%10%10%
7.1738%38%8%3%
8.1740%30%11%11%
9.1745%23%6%8%
ALL UNITSJul-15Aug-15Sep-15Oct-15Nov-15Dec-15Jan-16Feb-16Mar-16Apr-16May-16Jun-16Jul-16Aug-16Sep-16Oct-16Nov-16Dec-16Jan-17Feb-17Mar-17Apr-17May-17Jun-17Jul-17Aug-17
# UC days25132527261027952491263124152437244122642240184716951725156816161577167818071717193017351857180814371569
#CAUTI79465645422054111231321130
CAUTI incid0.00278551530.00356153540.0015325670.00214669050.0020072260.00228050170.00165631470.00205170290.00163867270.00088339220.000892857100.00294985250.00231884060.00063775510.00061881190.00063411540.00119189510.00166021030.00058241120.00155440410.00115273780.0005385030.00055309730.00208768270
CAUTI incid2.793.561.532.152.012.281.662.051.640.880.890.002.952.320.640.620.631.191.660.581.551.150.540.552.090.00
DateJul-15Aug-15Sep-15Oct-15Nov-15Dec-15Jan-16Feb-16Mar-16Apr-16May-16Jun-16Jul-16Aug-16Sep-16Oct-16Nov-16Dec-16Jan-17Feb-17Mar-17Apr-17May-17Jun-17Jul-17Aug-17
CAUTI incid2.793.561.532.152.012.281.662.051.640.880.890.002.952.320.640.620.631.191.660.581.551.150.540.552.090.00
CAUTI rates by unit
#CAUTI
# UC days
# CAUTI
CVICU CAUTI and UC days 15months
Sheet1
#CAUTI
# UC days
#CAUTI
STICU CAUTI and UC days 15 months
Histogram
#CAUTI
# UC days
#CAUTI
NICU CAUTI and UC days 15months
CLABSI by unit
#CAUTI
# UC days
#CAUTI
CCU #CAUTI and UC days 12 months
HAI vs target
#CAUTI
# UC days
#CAUTI
MICU #CAUTI and UC days 12months
VAE
#CAUTI
# UC days
#CAUTI
W3 #CAUTI and UC days 12 months
Sheet26
#CAUTI
# UC days
#CAUTI
E4 #CAUTI and UC days 12 months
Sheet23
#CAUTI
# UC days
#CAUTI
PCC #CAUTI and UC days 12 months
Sheet20
#CAUTI
# UC days
#CAUTI
C3M #CAUTI and UC days 12 months
Sheet18
#CAUTI
# UC days
#CAUTI
ALL INPT Units #CAUTI and UC days
Sheet22
#CAUTI
# UC days
E3 #CAUTI and UC days 12 months
Sheet12
#CAUTI
# UC days
M4 # UC days and # CAUTI
Sheet3
#CAUTI
# UC days
E5 # UC days and # CAUTI 12 months
Sheet14
#CAUTI
# UC days
M5 # UC days and CAUTI
Sheet11
#CAUTI
# UC days
M6 # UC days and CAUTI 12 months
Sheet8
implement pilot 7/6
#CAUTI
# UC days
M8 # UC days and # CAUTI
Sheet5
#CAUTI
# UC days
M9 # UC days and # CAUTI 12 months
Sheet10
#CAUTI
# UC days
H5 # UC days and # CAUTI 12 months
Sheet13
#CAUTI
# UC days
H6 #UC days and # CAUTI 12 months
Sheet16
#CAUTI
# UC days
H7 # UC days and # CAUTI 12months
Sheet17
#CAUTI
# UC days
# UC days/ month
M7 # UC days and CAUTI rolling 12 months
Sheet9
#CAUTI
# UC days
# UC days/ # CAUTI
M8 2014 # urinary catheter days and # CAUTI by month bar graph
Sheet25
#CAUTI
#CAUTI
M8 baseline CAUTI/ month line graph
Sheet28
#CAUTI
#CLABSI
#HAPU prev
# HAC
M8 # HAC 2014 : CAUTI, CLABSI and HAPU (quarterly prevalence study)
XbarR (2)
# UC days
# UC days
bar chart # urinary catheter days/ month M8 2014
Sheet7
# UC days
# Urinary catheter days/ month
XbarR
#CAUTI
#CAUTI/ month
Sheet4
% ↓ UC DAYS
Adult Critical Care %↓ UC days 2015-2016
Sheet2
% outperform
target
% outperform NDNQI
CAUTI adult ICU vs NDNQI >500 bed critical care units: % units outperform NDNQI
#CAUTI
# UC days
#CAUTI
# UC days
# CAUTI (BLUE), # UC days (RED)
# UC days and # CAUTI prior to 2015
SIR
goal
CAUTI SIR rate vs 50th percentile goal
% out-perform
target
% out-perform NDNQI benchmark
% adult ICUs out-perform NDNQI >500 bed benchmark
2014
SIR rate and goal
2014 CAUTI SIR rate for NH vs 50th percentile goal
2015
SIR rate and goal
2015 CAUTI SIR rate for NH vs 50th %ile goal
% > goal
2014 CC CAUTI SIR % > goal
% > goal
2015 vs 2014 CC SIR % > goal, % improved
14 vs '15
Adult CC improvements 2014 vs 2015
#UC days/mo
#CAUTI
# UC days and # CAUTI/ month
Critical Care # UC days and # CAUTI/ month in 2014
#CAUTI
# UC days
# CAUTI and UC days Jul-Aug 2014
UC util ratio
UC utilization ratio 2015
UC util ratio
UC days/ pt days/ 2015
UC utilization ratio by unit for 2015
% outperform
target
% units out-perform NDNQI
CAUTI: % units out-perform NDNQI >500 bed mean
CAUTI rate
#cauti/1000 catheter days
CAUTI rate/ unit for 2015
Implement M8 inter-disciplinary rounds 7/6/15
#CAUTI
UC days
M8: # urinary catheter days before and after interdisciplinary rounds
Purewick go live May 2016
# UC days
#CAUTI
#UC days and #CAUTI/1000 cath days
ICU/ med surg #CAUTI and # urinary catheter days/ month 7/14-6/16
#UC d CAUTI/1000 cath days
TOTAL #CAUTI/1000 cath days and Urinary Catheter days rolling Dec '14-Mar '17
UC days↓29%.CAUTI↓57%
UC d
#CAUTI
# UC days CAUTI/1000 cath days
FY 15 vs FY16 UC days and CAUTI/ 1000 cath days
UC days/mo
% UC util.
# UC d/ mo. % UC util (UC d/pt d)
Adult ICU % UC utilization FY '16
mean UC days=1113. Mean % UC utilization 11%
#UC days
MS UC utilization
# UC days and % UC utilization
FY 16 NHMC med surg unit #UC days/month and % UC utilization (UC d/pt days)
mean UC d= 1028.mean % UC util.=52%
UC days/mo
% UC util.
# UC days and % UC utilization
FY 16 adult ICU #UC days/month and % UC utilization (UC d/pt days)
mean UC days= 2143. Mean % UC util 15%
UC d/mo.
% UC util
# UC days and % UC utilization
FY 16 NHMC ICU + MS #UC days/month and % UC utilization (UC d/pt days)
#CAUTI
UC days
Unit XX # Urinary Catheter days and #CAUTI/1000 catheter days pre project implementation
baseline
FY2016
CAUTI incidence rate pre vs post implementation
# UC days
% pts w UC
total UC days and % pts with UC
ICU + MS ave # UC/mo and % pts with UC FY14-16
# UC days
% pts w UC
total UC days and % pts with Urinary catheters
Adult ICU cath days/mo and % patients with UC FY14-16
# UC days
% pts w UC
total UC days and % pts with Urinary catheters
Adult Med Surg cath days/mo and % patients with UC FY14-16
# CAUTI
Incidence
#CAUTI and incidence/1000 pt days
ICU+MS CAUTI incidence FY 14-16
#CAUTI
incidence
#CAUTI and incidence/1000 pt days
ICU CAUTI incidence FY 14-16
#CAUTI
incidence med surg
#CAUTI and incidence/1000 pt days
Med Surg CAUTI incidence FY 14-16
male
female
% of CAUTI
Gender by % of CAUTI pre/post Purewick
Pure-wick
% units outperform
target
% outperformance
CAUTI outperformance compared to NDNQI >500 bed benchmark. N=1170 units
↓overall incidence 71%
all units
CAUTI incidence all units baseline vs YTD17
#Ucx/mo
# Urine Cultures/ month 11/15-4/17
Purewick(R) implementation
UC util/ mo
# urinary cath/ month
Medical Center Navicent Health Urinary Catheter utilization pre/post Purewick(R)
# UC days
#CAUTI
#UC d CAUTI/1000 cath days
TOTAL #CAUTI/1000 cath days and Urinary Catheter days 2015-YTD '17
# UC days
#CAUTI
#UC days/ # CAUTI
# UC days/ CAUTI all units rolling 2 years
12.16
1.17
2.17
3.17
4.17
7.17
8.17
9.17
% of indications
Indications for urinary catheter/ month (random day) all units 12.16-9.17
CAUTI incid
(#CAUTI/UC days) x1000
CAUTI incidence rolling 2 years all units
0-2.250.0033030862
0-2.18939393940.0040068615
0-2.12878787880.0048414653
0.0 to
-
Transport protocol audits
33
• RRT supv audit use of transport protocol• 79% ↓ in VAE correlated with transport
pre implement post implement# VAE w transports 31 3% VAEs 72% 15%
0%
10%
20%
30%
40%
50%
60%
70%
80%
0
5
10
15
20
25
30
35
#/%
VA
E p
ts w
tran
spor
ts o
ff u
nit
#/% of patients w VAEs with transports off unit within 4 days of event
-
How about bundle compliance?
34
• Average of 200 vent pts/ week are audited – observation/ documentation review- all units
• Average 98%, minimum 92.% compliance
Chart1
HOB ≥ 30◦
SBT
CLRT
separ.sx
turn q2hr
oral care
% comp
% compliance N=1,129 pts
% compliance ventilator bundle all ICUs 2017
1
1
1
0.993
0.963
0.926
raw data
VAE
# Infections# Vent Days# Infections# Vent Days# Infections# Vent Days# Infections# Vent Days# Infections# Vent Days# Infections# Vent Days# Infections# Vent Days# Infections# Vent Days# Infections# Vent Days# Infections# Vent Days# Infections# Vent Days# Infections# Vent Days
Oct-13Nov-13Dec-13Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-14Aug-14Sep-14
CVICU025212930360038312600327125302610209030602610194
STICU11781202018312330152018411642196117812190150095
NICU0129215801060167015501701120111601240117087181
CCU0103012601420186011001411139099191012811050120
MICU1167120301651206115331942184117001430950870170
28295982095621175283031016686048422745186516901660
CLABSI - Adult Critical Care Central Line Associated Blood Stream Infections
# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days
Oct-13Nov-13Dec-13Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-14Aug-14Sep-14
CVICU045234930485253104330515038904550462154704490299
STICU020701420149025201651245120402230233118411490196
NICU013602191121019201461196013102110130015101340177
CCU014801420177026101410154018901260152015711460174
MICU122812430230027902240256025912901245123602660199
TOTAL111714123911162215150110921366111721130511222312752114401045
CLABSI - Adult Central Line Associated Blood Stream Infections
# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days
Oct-13Nov-13Dec-13Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-14Aug-14Sep-14
E306305014501202111090062060086074074090
W3125302650231017802080228121302660247031302340163
E40130090010501300147053011101520207011301510163
M4030502770258029302600302021802901334027102730133
E513609908305301090109099097061088036078
M5011701760174219701180169013101870232019811540151
M60120065011801900136011507301270134011301271107
M7080120802103000160102014024011
M8019302020214118702410204023522280208018902680222
M9036703060374030003240295034103040353338403871342
H509609107008106909108807301350147062061
H6052048065096077073051060064064026036
17401681174518461803172916381845196818161557
M3MN/AN/AN/AN/AN/AN/AN/AN/A01N/AN/AN/A
2064
H7087111101180430107010109507301080148095085
TOTAL2182711792`01863318892191001830117332191812172321161191121642
CLABSI - NNICU 2500 gm Infection Rate
# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days
Oct-13Nov-13Dec-13Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-14Aug-14Sep-14
750 gm0114011011101119075062183175060160165188
751-1000 gm066032045074075060163111901030650132059
1001-1500 gm09305701010600900500133079112401220137039
1501-2500 gm05901306105013903106020024041057011
>2500 gm0160230500750340804013021028059047
TOTAL ICN034802351367137813130211228923061332131614501244
CLABSI - Pediatric Infection Rate
# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days# Infections# Line Days
Oct-13Nov-13Dec-13Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-14Aug-14Sep-14
PICU1100016201621132098031069013308509511180121
PIMCU13704505004504400166144013031068037
TOTAL PCC1372072121771423113517798126186158
C3M059040093012001440128081069083089070036
219602470305129702860159121612460181021512560194
CAUTI - Pediatric Infection Rate
# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days
Oct-13Nov-13Dec-13Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-14Aug-14Sep-14
PICU0160560162052033031112070033017011069
PIMCU010000000000000000000100
TOTAL PCC1756162523331127033171169
C3M000206020302050103020405
017058016805403603311707103601901574
CAUTI - Adult Critical Care Catheter Associated Urinary Tract Infections
# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days
Oct-13Nov-13Dec-13Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-14Aug-14Sep-14
CVICU148425182499055324203534242934811377343634542313
STICU222612651247130112210275125002951232025711780205
NICU026323201306133102532295226632772269128822221268
CCU013002200194330111882208020602120168021721820177
MICU122803001308132722610302121812761241126422690225
5133151623515546181361343716146136971541512875146210130531188
CAUTI - Adult Catheter Associated Urinary Tract Infections
# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days# InfectionsFoley Days
Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14
E3016801340117163012008901611761126
W30970810610870651104012011231102
E4026812310186020812602294030022693221
M40119084075073096111309711050109
E5019211900172018121951136316401321116
M5023601752189318511892236022402010206
M6127212360205118512161165120302271281
M701080109088093076084090098093
M8228202140255125612460227017401750243
M9027922371276120312571272020412011238
H50720640820730820117080179163
H6048135137039037148038049014
H701260137010601871210014111520900140
3226761927418497183382049102026520077182591952
CAUTI rates by unit
#CAUTI rates by unit
CVICU
Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Sep-15Oct-15Nov-15
#CAUTI3322311212110211
# UC days436454313470536477477468528549539437340362440379341
STICU
Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Sep-15Oct-15Nov-15
#CAUTI0100100000101301
# UC days257178205267261259259297273239301244192241222212217
NICU
Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Sep-15Oct-15Nov-15
#CAUTI12132224011111110
# UC days228222268289292267267319317309316203196223259232220
CCU
Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Sep-15Oct-15Nov-15
#CAUTI0200111011001000
# UC days217182177216220220220238216183165128155144150168150
MICU
Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Sep-15Oct-15Nov-15
#CAUTI1202022130000000
# UC days264269225292280253253278297272219196207189189191193
E3
Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15
#CAUTI0111100000000
# UC days161762614411610611212294115779412057
W3Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Sep-15Oct-15
#CAUTI0110100101000002
# UC days1201231021059996115977989723926403695
E4Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15
#CAUTI0230001310001
# UC days300269221227165266215212162135151163131198
M4Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15
#CAUTI0100010000011
# UC days971051098495127113919611885986672
E5Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15
#CAUTI3013110100100
# UC days16413211614211611616114311394145937380
M5Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15
#CAUTI0001000010101
# UC days22420120617620620322424018017915012496145
M6Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15
#CAUTI1011001000100
# UC days168227281210136173194157228149198166225174
M7Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Jul-14Aug-14
#CAUTI0000000000000
# UC days93839283847610987828159719098
M8Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Sep-15Oct-15Nov-15
#CAUTI0003111010000000
# UC days174175243291244258217195189189152162122101127192117
M9Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Sep '15Oct '15Nov '15Dec '15Jan '16
#CAUTI0110010000011100000
# UC days204201238245232239216197207195197166189160215271157241219
H5Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15
#CAUTI0111000000000
# UC days80796352929271120808699859778
H6Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15
#CAUTI0000001000000
# UC days38491432499480481168139675625
H7Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15
#CAUTI1000000010000
# UC days152901407317613713510985101112758483
PICU
PCCJul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15
#CAUTI0000000000000
# UC days1711697372364351283928372215
C3MJul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15
#CAUTI000000000000
# UC days245030371245
all unit CAUTI
ALL UNITSJul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Sep-15Oct-15Nov-15Dec-15Jan-16Feb-16Mar-16Apr-16May-16Jun-16
#CAUTI10171217111010119564794653
# UC days345331453215347134833506345934663398321331312663251325272610279524912797
Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15
#CAUTI
# UC days
M8 CY 2014
M8Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14
#CAUTI2001100003110.75
# UC days282214255256246227174175243291244258238.75
M8Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14
#CAUTI200110000311
M8Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14
#CAUTI200110000311
#CLABSI100020000001
#HAPU prev1121
M8Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14
#CAUTI200110000311
M8Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14
# UC days282214255256246227174175243291244258
ALL UNITSSep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15
#CAUTI121711101011956479
ALL UNITSSep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15
# UC days321534713483350634593466339832133131266325132527
% reduction in UC days Jul-Nov 2014 vs 2015
% ↓ UC DAYS
MICU27%
CCU24%
CVICU17%
STICU7%
NICU7%
Critical Care vs NDNQI
4Q131Q142Q143Q144Q141Q152Q153Q154Q151Q16
% outperform40%40%60%60%0%40%60%0%20%20%
target51%51%51%51%51%51%51%51%51%51%
ALL UNITSJul-14Aug-14Sep-14Oct-14Nov-14Dec-14
#CAUTI101712171110
# UC days345331453215347134833506
2014
SIR1.615
SIRgoal0.801
SIRgoal
20141.6150.801
20151.130.845
20142015
SIR1.6151.13
goal0.8010.845
2015
SIR1.13
goal0.845
adult ICU CAUTI
1Q132Q133Q134Q131Q142Q143Q144Q14
% out-perform40%100%20%80%80%40%40%40%
target51%51%51%51%51%51%51%51%
20142015
SIR1.6151.13
goal0.8010.845
2014
% > goal50.4%
20142015% improve.
% > goal50.4%25.2%50%
% improvement in adult CC
# CAUTI# UCSIR
14 vs '1536%11%50%
↓36%↓11%↓50%
Critical Care #UC days and # CAUTI 2014
Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14
#UC days/mo173913431614136915411287146213051188153415811605
#CAUTI6676755103787
Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Sep-15Oct-15
3111010000000
291244258217195189189152162122101127192
M8Jul-14Aug-14Sep-14Oct-14
#CAUTI0003
# UC days174175243291
M8Jul-15Aug-15Sep-15Oct-15
#CAUTI0000
# UC days122101127192
UC utilization ratio 2015 by unit
unitUC util ratio
STIC0.77
CVI0.663
ICU ave0.66
NICU0.658
CCU0.628
MICU0.597
average0.25
M90.202
E40.181
M50.171
E30.169
M60.168
E50.168
M80.159
MS ave0.15
W30.129
M40.124
H70.115
H60.07
% units outperform NDNQI >500 bed mean
1Q142Q143Q144Q141Q152Q153Q154Q151Q162Q163Q164Q16
% outperform68%29%62%40%43%45%43%43%48%45%62%75%
target51%51%51%51%51%51%51%51%51%51%51%51%
CAUTI rate/1000 cath days 2015
unitCAUTI rate
W36
E54.39
E44.09
NICU3.96
STICU3.05
CCU2.9
CVI2.68
AVERAGE2.66
M52.53
MICU2.21
M42.07
M61.99
E31.82
H61.6
M81.06
H70.9
M90.83
M8 1 year prior and 1 year of ID rounds
M8Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-16Aug-14Sep-14Oct-14Nov-14Dec-14
#CAUTI200110000311
# UC days282214255256246227174175243291244258
month3/144/145/146/147/148/149/1410/1411/1412/141/152/153/154/155/156/15IMP.7/158/159/1510/1511/1512/151/162/163/164/165/166/167/168/169/1610/16
#CAUTI01100003111010000000000000100000
UC days2552562462241741752432912442582172011891521521621221011271921171241009293128828458937135
ALL UNITSJul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Sep-15Oct-15Nov-15Dec-15Jan-16Feb-16Mar-16Apr-16May-16Jun-16Jul-16Aug-16Sep-16
# UC days345331453215347134833506345934663398321331312663251325272610279524912631241524372441226422401847169517251568
#CAUTI10171217111010119564794656454220541
comparison to HEN HRET co hort
CAUTI incidenceUrinary catheter days
Jan-Dec '15Jan-Jun '16Jan-Dec '15Jan-Jun '16
CCU50%100%CCU67%100%
CVICU83%67%CVICU58%83%
MICU75%83%MICU67%83%
NICU75%83%NICU50%100%
STICU50%83%STICU92%83%
Overall83%83%Overall60%100%
ALL UNITSOct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Sep-15Oct-15Nov-15Dec-15Jan-16Feb-16Mar-16Apr-16May-16Jun-16Jul-16Aug-16Sep-16
# UC days347134833506345934663398321331312663251325272610279524912631241524372441226422401847169517251568
#CAUTI17111010119564794656454220541
FY15avesums
347134833506345934663398321331312663251325272610312037440
171110101195647948.6103
FY16
279524912631241524372441226422401847169517251568221226549
6564542205413.744
Oct-14Nov-14
34713483% ↓ UC d29%
1711% ↓ CAUTI57%
ALL UNITSDec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Sep-15Oct-15Nov-15Dec-15Jan-16Feb-16Mar-16Apr-16May-16Jun-16Jul-16Aug-16Sep-16Oct-16Nov-16Dec-16Jan-17Feb-17Mar-17Apr-17May-17Jun-17
# UC days3506345934663398321331312663251325272610279524912631241524372441226422401847169517251568161615771678180717171930173518571808
#CAUTI1010119564794656454220541112313211
avesums
3120UC d FY1537440
8.5833333333CAUTI FY151003
2212.4166666667UC d FY1626549
3.6666666667CAUTI FY1644
UC d#CAUTI
FY1537440103
FY162654944
FY15FY16
UC d3744026549
#CAUTI10344
Service DateService DateService DateService DateService DateService DateService DateService DateService DateService DateService DateService Date
FY 2016FY 2016FY 2016FY 2016FY 2016FY 2016FY 2016FY 2016FY 2016FY 2016FY 2016FY 2016
Location Cd (group)OctoberNovemberDecemberJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptember
C3M345319453336322288275264318275245246
E3533515438550498491515506462473464496
E4864857863921798870855866782837825811
E5575538571577539551520562535574574550
E6386358345369304360344310323302301316
H5N398381374385366398365353323339381357
H5S385358374387338391368359344327357351
H6N337307320339329296317267254240302272
H6S223221189294292308279275302245303271
H7N401394390410374414404375383371415393
H7S388377392434387418378365394357400392
M4677569658681620628602575633545629559
M4N1294285261300300333289307283261254290
M4N2342347323370362372321343290325330307
M51000940946978886934934972892947937882
M6N509504499492461513474499483502503471
M6S525507486511475518503474483505497475
M7287382303279265336310322317263347321
M8103210009961011893961920928916943906772
M9958895893941894937924922914958955858
PICU232288325260248199203185125159207157
W2E278275274289267280271285270262265265
W2S391396381384372386373406384389395372
W2W299311322331312344325344318319314299
W3593587569581543581536569543588568531
W3W64538571542644221411
W4381363375400370396386387387387372382
Grand Total150461446714652152111402814718141221412713734138001430913407
UC d263022952631234322032252226422401867169517251568
0.17479728830.15863689780.17956592960.15403326540.15704305670.15300991980.16031723550.15856161960.13594000290.1228260870.12055349780.1169538301
M4N1294285261300300333289307283261254290
M4N2342347323370362372321343290325330307
W2E278275274289267280271285270262265265
W2S391396381384372386373406384389395372
W2W299311322331312344325344318319314299
W4381363375400370396386387387387372382
pt days198519771936207419832111196520721932194319301915
UC d11821121118711221102108310221224932852821684
59.5%56.7%61.3%54.1%55.6%51.3%52.0%59.1%48.2%43.8%42.5%35.7%
ICUOct '15Nov '15Dec '15Jan'16Feb '16Mar '16Apr '16May '16Jun '16Jul '16Aug '16Sep '16
UC days/mo11821121118711221102108310221224932852821684
% UC util.60%57%61%54%56%51%52%59%48%44%43%36%
MCNHOct '15Nov '15Dec '15Jan'16Feb '16Mar '16Apr '16May '16Jun '16Jul '16Aug '16Sep '16
UC d/mo.263022952631234322032252226422401867169517251568
% UC util17%16%18%15%16%15%16%16%14%12%12%12%
MS
Location Cd (group)OctoberNovemberDecemberJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptember
C3M345319453336322288275264318275245246
E3533515438550498491515506462473464496
E4864857863921798870855866782837825811
E5575538571577539551520562535574574550
E6386358345369304360344310323302301316
H5N398381374385366398365353323339381357
H5S385358374387338391368359344327357351
H6N337307320339329296317267254240302272
H6S223221189294292308279275302245303271
H7N401394390410374414404375383371415393
H7S388377392434387418378365394357400392
M4677569658681620628602575633545629559
M51000940946978886934934972892947937882
M6N509504499492461513474499483502503471
M6S525507486511475518503474483505497475
M7287382303279265336310322317263347321
M8103210009961011893961920928916943906772
M9958895893941894937924922914958955858
W3593587569581543581536569543588568531
W3W64538571542644221411
Grand Total10480100621014410547963810219986797659622959199139335
#UC days14481174144412211101116912421016915843904884
0.13816793890.1166766050.14235015770.11576751680.11423531850.11439475490.12587412590.10404505890.09509457490.08789490150.09119338240.0946973755
MS UC utilizationOct '15Nov '15Dec '15Jan'16Feb '16Mar '16Apr '16May '16Jun '16Jul '16Aug '16Sep '16
#UC days144811741444122111011169124210169158439048841113.4166666667
MS UC utilization14%12%14%12%11%11%13%10%10%9%9%9%11%
ICUOct '15Nov '15Dec '15Jan'16Feb '16Mar '16Apr '16May '16Jun '16Jul '16Aug '16Sep '16
UC days/mo118211211187112211021083102212249328528216841027.6666666667
% UC util.60%57%61%54%56%51%52%59%48%44%43%36%52%
MCNHOct '15Nov '15Dec '15Jan'16Feb '16Mar '16Apr '16May '16Jun '16Jul '16Aug '16Sep '16
UC d/mo.2630229526312343220322522264224018671695172515682142.75
% UC util17%16%18%15%16%15%16%16%14%12%12%12%15%
month3/144/145/146/147/148/149/1410/1411/1412/141/152/153/154/155/156/15
#CAUTI0110000311101000
UC days255256246224174175243291244258217201189152152162
2552562462241741752432912442582172011892973
01100003111019
M8 post inc rate
7/158/159/1510/1511/1512/151/162/163/164/165/166/167/168/169/1610/16
00000000001000001
12210112719211712410092931288284589371351619
all ICU + MS inc rate
Nov-15Dec-15Jan-16Feb-16Mar-16Apr-16May-16Jun-16Jul-16Aug-16Sep-16Oct-16
24912631241524372441226422401847169517251568161625370
56454220541139
pre= 2014, post=2016, YTD 2017= Oct-Apr.
pre vs post CAUTI incidence rate
adult ICUsM8all units
baseline4.37%3.03%3.71%
FY20161.72%0.62%1.54%
YTD20171.08%
all units
baseline3.71%
FY20161.54%
YTD20171.08%
% pts w UC ICU + MED SURG
FY14FY15FY16
# UC days401393676425370
% pts w UC29.226.118.1
cath days from monthly auto generated Cerner report. Joseph Horner
cath days401393676425370
pt days137605140692140215
0.29169724940.261308390.1809364191
formulat: cath days/ pt days
ICU % cath utilization
FY14FY15FY16
# UC days176091705912518
% pts w UC81.268.952.5
cath days176091705912518
pt days21,68224,76323,824
cath days/ pt days
device ut0.81214832580.68889068370.5254365346
%71.70%75.90%53.50%
Med surg % cath utilization
FY14FY15FY16
# UC days225301970512852
% pts w UC19.417.011.0
cath days225301970512852
pt days115,923115,929116,391
cath days/ pt days
device ut0.19435314820.16997472590.1104209088
INCIDENCE ICU+ MED SURG
FY14FY15FY16
# CAUTI1499239
Incidence3.712.501.54
CAUTI/ cath days x1000
total cath days401393676425370
formula: CAUTI/ cath days x1000
INCIDENCE ICU
FY14FY15FY16
#CAUTI685925
incidence3.863.462
total cath days176091705912518
incidence med surg (ICU+MED minus ICU)
#CAUTI813314
incidence med surg3.61.671.09
# cath days225301970512852
ALL UNITSOct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Sep-15Oct-15Nov-15Dec-15Jan-16Feb-16Mar-16Apr-16May-16Jun-16Jul-16Aug-16Sep-16Oct-16Nov-16Dec-16Jan-17
# UC days3471348335063459346633983213313126632513252726102795249126312415243724412264224018471695172515681616157716781807
#CAUTI171110101195647946564542205411223
ALL UNITS# UC days#CAUTI
May-1531316
Jun-1526634
Jul-1525137
Aug-1525279
Sep-152610431316same time fram May-Jan
Oct-152795631311
Nov-152491560.67104426011
Dec-1526316
Jan-1624154
Feb-1624375
Mar-1624414
Apr-1622642
May-1622402
Jun-1618470
Jul-1616955
Aug-1617254
Sep-1615681
Oct-1616161
Nov-1615772
Dec-1616782
Jan-1718072
ALL UNITS# UC days#CAUTI
Oct-14347117347117
Nov-1434831134711
Dec-14350610170.84703975261
Jan-15345910
Feb-15346611
Mar-1533989
Apr-1532135
May-1531316
Jun-1526634
Jul-1525137
Aug-1525279
Sep-1526104
Oct-1527956
Nov-1524915
Dec-1526316
Jan-1624154
Feb-1624375
Mar-1624414
Apr-1622642
May-1622402
Jun-1618470
Jul-1616955
Aug-1617254
Sep-1615681
Oct-1616161
Nov-1615772
Dec-1616782
Jan-1718072
ALL UNITS# UC days#CAUTIMay 15 to Jan 16
May-1531316May16-Jan17
Jun-1526634
Jul-152513731316
Aug-152527931311
Sep-152610460.69161895741
Oct-1527956
Nov-1524915
Dec-1526316
Jan-1624154SUMMARY OUTPUT
May-1622402
Jun-1618470Regression Statistics
Jul-1616955Multiple R0.6916189574
Aug-1617254R Square0.4783367822
Sep-1615681Adjusted R Square0.4435592343
Oct-1616161Standard Error1.7989879623
Nov-1615772Observations17
Dec-1616782
Jan-1718072ANOVA
dfSSMSFSignificance F
Regression144.513458200644.513458200613.75418371020.00210147
Residual1548.54536532883.2363576886
Total1693.0588235294
ALL UNITS5/15-1/165/16-1/17dbarCoefficientsStandard Errort StatP-valueLower 95%Upper 95%Lower 95.0%Upper 95.0%
May31312240891Intercept-4.02666913252.1456883045-1.8766328380.0801604275-8.60009549410.5467572291-8.60009549410.5467572291
Jun2663184781631310.00363902890.00098122393.7086633320.002101470.00154759980.00573045810.00154759980.0057304581
Jul25131695818
Aug25271725802
Sep261015681042
Oct279516161179
Nov24911577914
Dec26311678953
Jan24151807608
891.4444444444ave
st dev
ALL UNITS5/15-1/165/16-1/17dbar
May624
Jun404
Jul752
Aug945
Sep413
Oct615
Nov523
Dec624
Jan422
3.5555555556ave
st dev
CAUTI gender over time pre/post Purewick
20142015Jan-Apr2016May-Dec2016Jan-Mar 2017Apr-Jun 2017
male33.6%43.0%37.5%52.6%67.0%0.0%
female66.4%57.0%62.5%47.3%33.0%100.0%
recalculating CAUTI by Q
1Q152Q153Q154Q151Q162Q163Q164Q161Q172Q17
% units outperform40%55%45%60%60%85%50%75%60%68%
target51%51%51%51%51%51%51%51%51%51%
urine cultures/ month
Nov-15Dec-15Jan-16Feb-16Mar-16Apr-16May-16Jun-16Jul-16Aug-16Sep-16Oct-16Nov-16Dec-16Jan-17Feb-17Mar-17Apr-17
#Ucx/mo1031011098410152919273675751485450404646
May-15Jun-15Jul-15Aug-15Sep-15Oct-15Nov-15Dec-15Jan-16Feb-16Mar-16Apr-16May-16IMP. PWJun-16Jul-16Aug-16Sep-16Oct-16Nov-16Dec-16Jan-17Feb-17Mar-17Apr-17May-17
UC util/ mo3131266325132527261027952491263124152437244122642240184716951725156816161577167818071717193017351808
ALL UNITSJul-15Aug-15Sep-15Oct-15Nov-15Dec-15Jan-16Feb-16Mar-16Apr-16May-16Jun-16Jul-16Aug-16Sep-16Oct-16Nov-16Dec-16Jan-17Feb-17Mar-17Apr-17May-17Jun-17Jul-17Aug-17Sep-17
# UC days251325272610279524912631241524372441226422401847169517251568161615771678180717171930173518571808143715691632
#CAUTI794656454220541112313211301
# pt days
Indications for UC
16-Dec17-Jan17-Feb17-Mar17-Apr17-Jul17-Aug17-Sep
ICU vaso5%10%7%7%10%3%11%8%
pre/post op18%15%31%35%30%38%30%23%
retention49%43%34%32%38%38%40%45%
urology9%15%10%12%10%5%11%6%
16-Dec17-Jan17-Feb17-Mar17-Apr17-Jul17-Aug17-Sep
retention49%43%34%32%38%38%40%45%
pre/post op18%15%31%35%30%38%30%23%
urology9%15%10%12%10%5%11%6%
ICU vaso5%10%7%7%10%3%11%8%
retentionpre/post opurolICU vaso
12.1649%18%9%5%
1.1743%15%15%10%
2.1734%31%10%7%
3.1732%35%12%7%
4.1738%30%10%10%
7.1738%38%8%3%
8.1740%30%11%11%
9.1745%23%6%8%
ALL UNITSJul-15Aug-15Sep-15Oct-15Nov-15Dec-15Jan-16Feb-16Mar-16Apr-16May-16Jun-16Jul-16Aug-16Sep-16Oct-16Nov-16Dec-16Jan-17Feb-17Mar-17Apr-17May-17Jun-17Jul-17Aug-17
# UC days25132527261027952491263124152437244122642240184716951725156816161577167818071717193017351857180814371569
#CAUTI79465645422054111231321130
CAUTI incid0.00278551530.00356153540.0015325670.00214669050.0020072260.00228050170.00165631470.00205170290.00163867270.00088339220.000892857100.00294985250.00231884060.00063775510.00061881190.00063411540.00119189510.00166021030.00058241120.00155440410.00115273780.0005385030.00055309730.00208768270
CAUTI incid2.793.561.532.152.012.281.662.051.640.880.890.002.952.320.640.620.631.191.660.581.551.150.540.552.090.00
DateJul-15Aug-15Sep-15Oct-15Nov-15Dec-15Jan-16Feb-16Mar-16Apr-16May-16Jun-16Jul-16Aug-16Sep-16Oct-16Nov-16Dec-16Jan-17Feb-17Mar-17Apr-17May-17Jun-17Jul-17Aug-17
CAUTI incid2.793.561.532.152.012.281.662.051.640.880.890.002.952.320.640.620.631.191.660.581.551.150.540.552.090.00
CAUTI rates by unit
#CAUTI
# UC days
# CAUTI
CVICU CAUTI and UC days 15months
Sheet1
#CAUTI
# UC days
#CAUTI
STICU CAUTI and UC days 15 months
Histogram
#CAUTI
# UC days
#CAUTI
NICU CAUTI and UC days 15months
CLABSI by unit
#CAUTI
# UC days
#CAUTI
CCU #CAUTI and UC days 12 months
HAI vs target
#CAUTI
# UC days
#CAUTI
MICU #CAUTI and UC days 12months
VAE
#CAUTI
# UC days
#CAUTI
W3 #CAUTI and UC days 12 months
Sheet26
#CAUTI
# UC days
#CAUTI
E4 #CAUTI and UC days 12 months
Sheet23
#CAUTI
# UC days
#CAUTI
PCC #CAUTI and UC days 12 months
Sheet20
#CAUTI
# UC days
#CAUTI
C3M #CAUTI and UC days 12 months
Sheet18
#CAUTI
# UC days
#CAUTI
ALL INPT Units #CAUTI and UC days
Sheet22
#CAUTI
# UC days
E3 #CAUTI and UC days 12 months
Sheet12
#CAUTI
# UC days
M4 # UC days and # CAUTI
Sheet3
#CAUTI
# UC days
E5 # UC days and # CAUTI 12 months
Sheet14
#CAUTI
# UC days
M5 # UC days and CAUTI
Sheet11
#CAUTI
# UC days
M6 # UC days and CAUTI 12 months
Sheet8
implement pilot 7/6
#CAUTI
# UC days
M8 # UC days and # CAUTI
Sheet5
#CAUTI
# UC days
M9 # UC days and # CAUTI 12 months
Sheet10
#CAUTI
# UC days
H5 # UC days and # CAUTI 12 months
Sheet13
#CAUTI
# UC days
H6 #UC days and # CAUTI 12 months
Sheet16
#CAUTI
# UC days
H7 # UC days and # CAUTI 12months
Sheet17
#CAUTI
# UC days
# UC days/ month
M7 # UC days and CAUTI rolling 12 months
Sheet9
#CAUTI
# UC days
# UC days/ # CAUTI
M8 2014 # urinary catheter days and # CAUTI by month bar graph
Sheet25
#CAUTI
#CAUTI
M8 baseline CAUTI/ month line graph
Sheet28
#CAUTI
#CLABSI
#HAPU prev
# HAC
M8 # HAC 2014 : CAUTI, CLABSI and HAPU (quarterly prevalence study)
XbarR (2)
# UC days
# UC days
bar chart # urinary catheter days/ month M8 2014
Sheet7
# UC days
# Urinary catheter days/ month
XbarR
#CAUTI
#CAUTI/ month
Sheet4
% ↓ UC DAYS
Adult Critical Care %↓ UC days 2015-2016
Sheet2
% outperform
target
% outperform NDNQI
CAUTI adult ICU vs NDNQI >500 bed critical care units: % units outperform NDNQI
#CAUTI
# UC days
#CAUTI
# UC days
# CAUTI (BLUE), # UC days (RED)
# UC days and # CAUTI prior to 2015
SIR
goal
CAUTI SIR rate vs 50th percentile goal
% out-perform
target
% out-perform NDNQI benchmark
% adult ICUs out-perform NDNQI >500 bed benchmark
2014
SIR rate and goal
2014 CAUTI SIR rate for NH vs 50th percentile goal
2015
SIR rate and goal
2015 CAUTI SIR rate for NH vs 50th %ile goal
% > goal
2014 CC CAUTI SIR % > goal
% > goal
2015 vs 2014 CC SIR % > goal, % improved
14 vs '15
Adult CC improvements 2014 vs 2015
#UC days/mo
#CAUTI
# UC days and # CAUTI/ month
Critical Care # UC days and # CAUTI/ month in 2014
#CAUTI
# UC days
# CAUTI and UC days Jul-Aug 2014
UC util ratio
UC utilization ratio 2015
UC util ratio
UC days/ pt days/ 2015
UC utilization ratio by unit for 2015
% outperform
target
% units out-perform NDNQI
CAUTI: % units out-perform NDNQI >500 bed mean
CAUTI rate
#cauti/1000 catheter days
CAUTI rate/ unit for 2015
Implement M8 inter-disciplinary rounds 7/6/15
#CAUTI
UC days
M8: # urinary catheter days before and after interdisciplinary rounds
Purewick go live May 2016
# UC days
#CAUTI
#UC days and #CAUTI/1000 cath days
ICU/ med surg #CAUTI and # urinary catheter days/ month 7/14-6/16
#UC d CAUTI/1000 cath days
TOTAL #CAUTI/1000 cath days and Urinary Catheter days rolling Dec '14-Mar '17
UC days↓29%.CAUTI↓57%
UC d
#CAUTI
# UC days CAUTI/1000 cath days
FY 15 vs FY16 UC days and CAUTI/ 1000 cath days
UC days/mo
% UC util.
# UC d/ mo. % UC util (UC d/pt d)
Adult ICU % UC utilization FY '16
mean UC days=1113. Mean % UC utilization 11%
#UC days
MS UC utilization
# UC days and % UC utilization
FY 16 NHMC med surg unit #UC days/month and % UC utilization (UC d/pt days)
mean UC d= 1028.mean % UC util.=52%
UC days/mo
% UC util.
# UC days and % UC utilization
FY 16 adult ICU #UC days/month and % UC utilization (UC d/pt days)
mean UC days= 2143. Mean % UC util 15%
UC d/mo.
% UC util
# UC days and % UC utilization
FY 16 NHMC ICU + MS #UC days/month and % UC utilization (UC d/pt days)
#CAUTI
UC days
Unit XX # Urinary Catheter days and #CAUTI/1000 catheter days pre project implementation
baseline
FY2016
CAUTI incidence rate pre vs post implementation
# UC days
% pts w UC
total UC days and % pts with UC
ICU + MS ave # UC/mo and % pts with UC FY14-16
# UC days
% pts w UC
total UC days and % pts with Urinary catheters
Adult ICU cath days/mo and % patients with UC FY14-16
# UC days
% pts w UC
total UC days and % pts with Urinary catheters
Adult Med Surg cath days/mo and % patients with UC FY14-16
# CAUTI
Incidence
#CAUTI and incidence/1000 pt days
ICU+MS CAUTI incidence FY 14-16
#CAUTI
incidence
#CAUTI and incidence/1000 pt days
ICU CAUTI incidence FY 14-16
#CAUTI
incidence med surg
#CAUTI and incidence/1000 pt days
Med Surg CAUTI incidence FY 14-16
male
female
% of CAUTI
Gender by % of CAUTI pre/post Purewick
Pure-wick
% units outperform
target
% outperformance
CAUTI outperformance compared to NDNQI >500 bed benchmark. N=1170 units
↓overall incidence 71%
all units
CAUTI incidence all units baseline vs YTD17
#Ucx/mo
# Urine Cultures/ month 11/15-4/17
Purewick(R) implementation
UC util/ mo
# urinary cath/ month
Medical Center Navicent Health Urinary Catheter utilization pre/post Purewick(R)
# UC days
#CAUTI
#UC d CAUTI/1000 cath days
TOTAL #CAUTI/1000 cath days and Urinary Catheter days 2015-YTD '17
# UC days
#CAUTI
#UC days/ # CAUTI
# UC days/ CAUTI all units rolling 2 years
12.16
1.17
2.17
3.17
4.17
7.17
8.17
9.17
% of indications
Indications for urinary catheter/ month (random day) all units 12.16-9.17
CAUTI incid
(#CAUTI/UC days) x1000
CAUTI incidence rolling 2 years all units
0-2.250.0033030862
0-2.18939393940.0040068615
0-2.12878787880.0048414653
0.0 to
-
Celebrating milestones• Respiratory staff and managers- Pay for
performance- BPR goals• Individual and group “Good Catch,”
+feedback re posted data• Admin and leadership rounds- observations
and feedback• Huddles, staff meetings, interdisciplinary
rounds• Pizza party for overall reduction in VAE and
bundle compliance
-
Goal vs Outcome
36
Goal Results Status
↓VAE in five adult ICUs by 25% in 12 months
• ↓ by 44.6% (from 74 to 41) met
↓transport-related VAE by 25% ↓ by 79% met
Achieve ventilator bundle compliance >90%
Average 98%. Lowest at 92.6% compliance.
met
Out-perform benchmark NDNQI the majority of quarters from 4Q16-4Q17
Out-performed the past 6 quarters
met
Out-perform benchmark HRET HIIN majority of months since October 2016
Out-performed all project organizations 13 of 16 mos.
met
-
• Lessons LearnedReflections/ Lessons Learned
• Lessons Learned
Overcoming key barriers• build in EMR- refocus IT and engage Executive Sponsors• cultural change to embrace need to reduce VAE- leadership change, benchmark
comparison, reporting through HARM Committee structure• prior unsuccessful attempt to implement mobility and PAD- nurse-driven mobility
protocol, PAD in EMR
Surprises• Key clinical leaders reluctant to adopt changes• Failure of timely documentation triggered VAEs• Insufficient working suction regulators, bedside patient chairs, among others• LOS and vent days did NOT drop as VAE rate decreased. We did see a 12%↓in vent≥3d mortality
Advice• Complete RCAs and establish trends, use national benchmarks to drive
initiatives• Evaluate documentation to assure not causative of VAE • Develop transport protocol to eliminate procedure related breaks in circuit• Keep an eye on all KPIs
37
-
• Firm up PAD utilization via intensivists, Pharmacy, Nursing staff
• Implement mobility protocol • Build EMR reports for PAD/ mobility• Expand usage of hi-lo ETT.• Regular status check with front line
staff re barriers and needed resources.
38
2018 action items:
-
2018 continued
• Real time hip phone for alerts for vent setting changes in PEEP and FiO2
• Expand electronic hand hygiene monitoring system from CVICU to all ICUs
• Ongoing education and monitoring• Intensivist model, including NP, expanded
to 3 of 5 ICU’s• Dedicated ICU PT’s to support mobility
-
Questions? Contact us!
• Sonya Floyd Floyd.sonya@navicenthealth.org
• Valerie FoxFox.Valerie@navicenthealth.org
• Meryl MontgomeryMontgomery.Meryl@navicenthealth.org
-
http://www.fha.org/health-care-issues/quality-and-safety/ir-vac.aspx
FHA IVAC Resource Toolkit
http://www.fha.org/health-care-issues/quality-and-safety/ir-vac.aspx
-
We are here to help!HIIN@fha.org407-841-6230
SAVE THE DATE!IVAC Bi-Monthly Webinar #3
July 5 @ 12pm ETRegistration: https://cc.readytalk.com/r/edqq2ie567np&eom
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Slide Number 1AgendaSlide Number 3Call to ActionHow are We Doing?PollingSonya Floyd, RN, BSN, CIC�Valerie fox, RRT�Meryl Montgomery, RN, MSNMedical Center Navicent Health�Macon, GAAim and Background“But, our PVAP rate is low!”Methodology Key Performance MeasuresDriver DiagramKey Changes Since Fall 2016VAE Improvement TimelineData driven timelineCommunication of “burning platform” of VAE reductionRCA form Vent Bundle monitoring toolTransport monitoring toolOutcomesKPI: VAE Incidence Rates/month all adult ICUs#IVAC/PVAP over timeICU mobility:�with a smile on his face!Cost savingsBenchmarkingAdult ICU vs HRET HIIN VAE-1HRET HIIN VAE IVAC rateAdult ICU vs NDNQI >500 bed units. N 174 unitsSustaining the drop! �#1 accountabilityHaving what staff needBack to the Basics- hand hygieneTransport protocol auditsHow about bundle compliance?Celebrating milestonesGoal vs OutcomeReflections/ Lessons Learned2018 action items:2018 continuedQuestions? Contact us!http://www.fha.org/health-care-issues/quality-and-safety/ir-vac.aspxSlide Number 42
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