eliminating infection-related ventilator-associated complications … · 2018-05-08 · agenda •...

FHA Call to Action: Eliminating Infection-Related Ventilator-Associated ComplicationsIVAC Bi-Monthly Webinar #2May 3, 2018

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

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

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

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

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


CVICU045234930485253104330515038904550462154704490299

STICU020701420149025201651245120402230233118411490196

NICU013602191121019201461196013102110130015101340177

CCU014801420177026101410154018901260152015711460174

MICU122812430230027902240256025912901245123602660199

TOTAL111714123911162215150110921366111721130511222312752114401045

CLABSI - Adult Central Line Associated Blood Stream Infections



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



750 gm0114011011101119075062183175060160165188

751-1000 gm066032045074075060163111901030650132059

1001-1500 gm09305701010600900500133079112401220137039

1501-2500 gm05901306105013903106020024041057011

>2500 gm0160230500750340804013021028059047

TOTAL ICN034802351367137813130211228923061332131614501244

CLABSI - Pediatric Infection Rate



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


PICU0160560162052033031112070033017011069

PIMCU010000000000000000000100

TOTAL PCC1756162523331127033171169

C3M000206020302050103020405

017058016805403603311707103601901574

CAUTI - Adult Critical Care Catheter Associated Urinary Tract Infections



CVICU148425182499055324203534242934811377343634542313

STICU222612651247130112210275125002951232025711780205

NICU026323201306133102532295226632772269128822221268

CCU013002200194330111882208020602120168021721820177

MICU122803001308132722610302121812761241126422690225

5133151623515546181361343716146136971541512875146210130531188

CAUTI - Adult Catheter Associated Urinary Tract Infections


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


#CAUTI0100100000101301

# UC days257178205267261259259297273239301244192241222212217

NICU


#CAUTI12132224011111110

# UC days228222268289292267267319317309316203196223259232220

CCU


#CAUTI0200111011001000

# UC days217182177216220220220238216183165128155144150168150

MICU


#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


#CAUTI3013110100100

# UC days16413211614211611616114311394145937380


#CAUTI0001000010101

# UC days22420120617620620322424018017915012496145


#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


#CAUTI0000001000000

# UC days38491432499480481168139675625


#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


#CAUTI

# UC days

M8 CY 2014

M8Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14

#CAUTI2001100003110.75

# UC days282214255256246227174175243291244258238.75


#CAUTI200110000311


#CAUTI200110000311

#CLABSI100020000001

#HAPU prev1121


#CAUTI200110000311


# UC days282214255256246227174175243291244258

ALL UNITSSep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15

#CAUTI121711101011956479


# 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


#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


#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


#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


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%


UC days/mo118211211187112211021083102212249328528216841027.6666666667

% UC util.60%57%61%54%56%51%52%59%48%44%43%36%52%


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


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


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


# 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%


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


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


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.


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


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


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


ICU CAUTI incidence FY 14-16

#CAUTI

incidence med surg


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


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


CVICU025212930360038312600327125302610209030602610194

STICU11781202018312330152018411642196117812190150095

NICU0129215801060167015501701120111601240117087181

CCU0103012601420186011001411139099191012811050120

MICU1167120301651206115331942184117001430950870170

28295982095621175283031016686048422745186516901660

CLABSI - Adult Critical Care Central Line Associated Blood Stream Infections



CVICU045234930485253104330515038904550462154704490299

STICU020701420149025201651245120402230233118411490196

NICU013602191121019201461196013102110130015101340177

CCU014801420177026101410154018901260152015711460174

MICU122812430230027902240256025912901245123602660199

TOTAL111714123911162215150110921366111721130511222312752114401045

CLABSI - Adult Central Line Associated Blood Stream Infections



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



750 gm0114011011101119075062183175060160165188

751-1000 gm066032045074075060163111901030650132059

1001-1500 gm09305701010600900500133079112401220137039

1501-2500 gm05901306105013903106020024041057011

>2500 gm0160230500750340804013021028059047

TOTAL ICN034802351367137813130211228923061332131614501244

CLABSI - Pediatric Infection Rate



PICU1100016201621132098031069013308509511180121

PIMCU13704505004504400166144013031068037

TOTAL PCC1372072121771423113517798126186158

C3M059040093012001440128081069083089070036

219602470305129702860159121612460181021512560194

CAUTI - Pediatric Infection Rate



PICU0160560162052033031112070033017011069

PIMCU010000000000000000000100

TOTAL PCC1756162523331127033171169

C3M000206020302050103020405

017058016805403603311707103601901574

CAUTI - Adult Critical Care Catheter Associated Urinary Tract Infections



CVICU148425182499055324203534242934811377343634542313

STICU222612651247130112210275125002951232025711780205

NICU026323201306133102532295226632772269128822221268

CCU013002200194330111882208020602120168021721820177

MICU122803001308132722610302121812761241126422690225

5133151623515546181361343716146136971541512875146210130531188

CAUTI - Adult Catheter Associated Urinary Tract Infections



E3016801340117163012008901611761126

W30970810610870651104012011231102

E4026812310186020812602294030022693221

M40119084075073096111309711050109

E5019211900172018121951136316401321116

M5023601752189318511892236022402010206

M6127212360205118512161165120302271281

M701080109088093076084090098093

M8228202140255125612460227017401750243

M9027922371276120312571272020412011238

H50720640820730820117080179163

H6048135137039037148038049014

H701260137010601871210014111520900140

3226761927418497183382049102026520077182591952

CAUTI rates by unit

#CAUTI rates by unit

CVICU


#CAUTI3322311212110211

# UC days436454313470536477477468528549539437340362440379341

STICU


#CAUTI0100100000101301

# UC days257178205267261259259297273239301244192241222212217

NICU


#CAUTI12132224011111110

# UC days228222268289292267267319317309316203196223259232220

CCU


#CAUTI0200111011001000

# UC days217182177216220220220238216183165128155144150168150

MICU


#CAUTI1202022130000000

# UC days264269225292280253253278297272219196207189189191193

E3


#CAUTI0111100000000

# UC days161762614411610611212294115779412057

W3Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Sep-15Oct-15

#CAUTI0110100101000002

# UC days1201231021059996115977989723926403695


#CAUTI0230001310001

# UC days300269221227165266215212162135151163131198


#CAUTI0100010000011

# UC days971051098495127113919611885986672


#CAUTI3013110100100

# UC days16413211614211611616114311394145937380


#CAUTI0001000010101

# UC days22420120617620620322424018017915012496145


#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


#CAUTI0111000000000

# UC days80796352929271120808699859778


#CAUTI0000001000000

# UC days38491432499480481168139675625


#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


#CAUTI

# UC days

M8 CY 2014


#CAUTI2001100003110.75

# UC days282214255256246227174175243291244258238.75


#CAUTI200110000311


#CAUTI200110000311

#CLABSI100020000001

#HAPU prev1121


#CAUTI200110000311


# UC days282214255256246227174175243291244258


#CAUTI121711101011956479


# 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


#UC days/mo173913431614136915411287146213051188153415811605

#CAUTI6676755103787

Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Sep-15Oct-15

3111010000000

291244258217195189189152162122101127192


#CAUTI0003

# UC days174175243291


#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


#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


# 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


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%


UC days/mo11821121118711221102108310221224932852821684

% UC util.60%57%61%54%56%51%52%59%48%44%43%36%


UC d/mo.263022952631234322032252226422401867169517251568

% UC util17%16%18%15%16%15%16%16%14%12%12%12%

MS


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%


UC days/mo118211211187112211021083102212249328528216841027.6666666667

% UC util.60%57%61%54%56%51%52%59%48%44%43%36%52%


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


formula: CAUTI/ cath days x1000

INCIDENCE ICU

FY14FY15FY16

#CAUTI685925

incidence3.863.462


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


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


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


# UC days251325272610279524912631241524372441226422401847169517251568161615771678180717171930173518571808143715691632

#CAUTI794656454220541112313211301

# pt days

Indications for UC


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%


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


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


Sheet12

#CAUTI

# UC days


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


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


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


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.


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


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


Adult ICU cath days/mo and % patients with UC FY14-16

# UC days

% pts w UC


Adult Med Surg cath days/mo and % patients with UC FY14-16

# CAUTI

Incidence


ICU+MS CAUTI incidence FY 14-16

#CAUTI

incidence


ICU CAUTI incidence FY 14-16

#CAUTI

incidence med surg


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


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 [email protected]

• Valerie [email protected]

• Meryl [email protected]

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 [email protected]

SAVE THE DATE!IVAC Bi-Monthly Webinar #3

July 5 @ 12pm ETRegistration: https://cc.readytalk.com/r/edqq2ie567np&eom

Contact Us

mailto:[email protected]://cc.readytalk.com/r/edqq2ie567np&eom

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

eliminating infection-related ventilator-associated complications … · 2018-05-08 · agenda •...

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