reducing harm from urinary catheters: a collaborative ... · how cautis link to value in healthcare...

Reducing harm from urinary catheters: a

collaborative approach in south London

@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

@HINSouthLondon www.hin-southlondon.org

https://vimeo.com/156234954

Watch and share our CAUTI animation




How CAUTIs link to value in

healthcare

30/05/2017 5


Overview of our

programme


Sites involved


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

The challenges: a complex

healthcare system

9


Our Driver Diagram


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


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


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


Measurements


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%.


Catheter Care Awareness Week:

Increasing the Profile of Catheter Safety


Organisations Involved


Approaches

Digital pack

Twitter campaign

Merchandise pack

Local events

#cathetercare

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


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




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

@HINSouthLondon

www.hin-southlondon.org

Spread, Scale and

Sustainability Eric Barratt, Senior Project Manager – Patient Safety

Health Innovation Network

@Eric_Barratt


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”


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


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




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


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.


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


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


Catheter Care Awareness Week

19-23 June 2017

‘If in doubt, take it out!’


Questions

reducing harm from urinary catheters: a collaborative ... · how cautis link to value in healthcare...

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