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Reducing harm from urinary catheters: a
collaborative approach in south London
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@HINSouthLondon
www.hin-southlondon.org
Reducing Catheter-
Associated Urinary
Tract Infections
(CAUTIs) Adrian Hopper, Clinical Director – Patient Safety
Health Innovation Network
Deputy Medical Director for Patient Safety
Guy’s & St. Thomas’ NHS foundation Trust
@hopperah
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@HINSouthLondon www.hin-southlondon.org
https://vimeo.com/156234954
Watch and share our CAUTI animation
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@HINSouthLondon www.hin-southlondon.org
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@HINSouthLondon www.hin-southlondon.org
How CAUTIs link to value in
healthcare
30/05/2017 5
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@HINSouthLondon www.hin-southlondon.org
Overview of our
programme
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@HINSouthLondon www.hin-southlondon.org
Sites involved
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@HINSouthLondon www.hin-southlondon.org
Our Aims
Reduce the rate of CAUTIs amongst patients in hospital by 30%
Improve Catheter practice
Promote the spread of good practice in
London
Establish a culture of safety
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The challenges: a complex
healthcare system
9
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@HINSouthLondon www.hin-southlondon.org
Our Driver Diagram
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@HINSouthLondon www.hin-southlondon.org
Our bundle of interventions
• Insertion and early removal
• Maintenance • Learning from infections
• Transition home – plan for removal of catheter etc.
• Out of hospital management
• Campaigning and awareness
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@HINSouthLondon www.hin-southlondon.org
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@HINSouthLondon www.hin-southlondon.org
Unplanned admissions in south
London
• Approx. 850-1000 ED attendances per year per Trust
• Around 30% patients admitted
• Over 80% of admissions are for 24-48h (mainly for IV antibiotics)
• A minority of patients will go onto developing serious infections and complications resulting in prolonged hospitalisation and delayed discharge
30/05/2017 13
1 1%
16 25%
18 28%
20 31%
10 15%
Outcome of ED attendance
left department
referred to OPD
admitted
discharged home
GP follow up
£1- 2M is spent on unplanned catheter admissions per acute hospital per year
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@HINSouthLondon www.hin-southlondon.org
Cost of unplanned admissions
Cost to NHS • £650 per patient per ED attendance
• £1000 per patient per 24h admission
• £3000 for 3-4 days admission
This does not include: prolonged admissions, delayed discharges, 999 services, GP, community services and other additional costs
Cost to patient • Disruptive for patients, families and carers
• Suffering, pain, distressing, disorientating
• Loss of independence and self-care
30/05/2017 14
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@HINSouthLondon www.hin-southlondon.org
Measurements
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@HINSouthLondon www.hin-southlondon.org
Measurements
Nationally the proportion of patients with a catheter in situ has been fairly consistent with just a single very slight but statistically significant increase from 12.8% to 13.0%. Over this same time frame, the South London region has decreased from 15.4% to 13.5%.
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@HINSouthLondon www.hin-southlondon.org
Catheter Care Awareness Week:
Increasing the Profile of Catheter Safety
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@HINSouthLondon www.hin-southlondon.org
Organisations Involved
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@HINSouthLondon www.hin-southlondon.org
Approaches
Digital pack
Twitter campaign
Merchandise pack
Local events
#cathetercare
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Catheter Care Awareness Week: our reach
966 healthcare
professionals
256 patients and
carers
11 urology
industry partners
20 formal face-
to-face events
Our CAUTI animation was
viewed 500 times
Our Catheter Care HIN webpage was
viewed 550 times
We had 14 million Twitter
impressions & 475 Twitter
participants
&
attended
that were supported by
561 individual
pledges were made to
improve catheter care
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@HINSouthLondon www.hin-southlondon.org
A comprehensive approach to encouraging
best practice in catheter care
Insertion and early removal
Maintenance
Avoid unnecessary placement and inappropriate insertion Ensure prompt removal
Learning from infections
Securement guidelines Catheter valve guidelines Improve dating drainage bags
Rapid review of incidents Post infection review and assessment tools
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@HINSouthLondon www.hin-southlondon.org
A comprehensive approach to encouraging
best practice in catheter care
Transition home
Out of hospital management
Trial without catheter (TWOC) Catheter passport
Campaigning and awareness
Catheter passport Patient information and education to encourage self care
Raise awareness of the risks associated with urinary catheters Catheter Care Awareness Week Local patient advocate groups
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@HINSouthLondon
www.hin-southlondon.org
Spread, Scale and
Sustainability Eric Barratt, Senior Project Manager – Patient Safety
Health Innovation Network
@Eric_Barratt
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@HINSouthLondon www.hin-southlondon.org
Scale, Spread & Sustainability Scale-up: “Overcoming The structural issues that arise during spread”
Spread: “deliberate efforts to increase the impact of innovations successfully
tested in pilot or experimental projects so as to benefit more people
and to foster policy and program development on a lasting basis”
Diffusion: "the process in which an innovation is communicated through
certain channels over time among the members of a
social system”
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@HINSouthLondon www.hin-southlondon.org
Scale, Spread & Sustainability Scale-up: “Overcoming The structural issues that arise during spread”
Spread: “deliberate efforts to increase the impact of innovations successfully
tested in pilot or experimental projects so as to benefit more people
and to foster policy and program development on a lasting basis”
Diffusion: "the process in which an innovation is communicated through
certain channels over time among the members of a
social system”
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@HINSouthLondon www.hin-southlondon.org
We want to make a significant contribution
to transforming catheter-care nationally
Our scale and spread goals, based on outcomes achieved in 5 south London trusts to date is by 2019, we want to:
SCALE:
Reduce the rate of CAUTI amongst patients in hospital by 30% and improve catheter practice in 5 NHS trusts
SPREAD:
Develop an improvement campaign, resources and an active community that escalates spread of the programme to a national level
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@HINSouthLondon www.hin-southlondon.org
Our ambition is to make it Easy, Attractive,
Social and Timely (EAST framework)
A digital social network to enable peer engagement
nationally
Sustainable online area of tailorable resources and tools
A ramping up of communications to include awareness raising amongst health professionals and social movement aimed at patients and carers
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@HINSouthLondon www.hin-southlondon.org
A comprehensive approach to encouraging
best practice in catheter care
Catheter care bundle
Catheter passport
Avoiding unnecessary placement Securement & rompt removal Rapid review of incidents Quality improvement - out of hospital mgmt.
Catheter-care campaign
Co-produced with patients Improves comms between acute and community services Provides patient information and education
Aim is to raise awareness of the risks associated with urinary catheters Catheter Care Awareness Week Local patient advocate groups
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@HINSouthLondon www.hin-southlondon.org
The interventions will be tested and refined
to ensure they are ready for spread
We will be applying the latest insights from behavioural science to fully understand, and subsequently adapt, the process of implementing these interventions and their tools prior to spread.
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@HINSouthLondon www.hin-southlondon.org
May-Jun Jul-Aug
Timeline for scaling this work throughout
2017/18
Sep-Oct Nov-Dec Jan-Feb Mar-Apr
Identify partners
1 Review, refine and test Adapt and spread
2 3
We are here
Carry out self-assessment
Gap analysis and idea generation
Implementation planning
Consider resource needs
Soft launch of tools & resources
Prepare for national spread
Key Events Recruit Assess Test Launch
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@HINSouthLondon www.hin-southlondon.org
We are recruiting 5 trusts to
work with us to scale the
programme
All you need to do is:
Email [email protected] Tweet @Eric_Barratt Speak to us after this presentation
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@HINSouthLondon www.hin-southlondon.org
Catheter Care Awareness Week
19-23 June 2017
‘If in doubt, take it out!’
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@HINSouthLondon www.hin-southlondon.org
Questions