1248 / Catheter Associated Urinary Tract Infection (CAUTI) prevention in Long-Term Care facilities

ITALY
Classification of the PSP
Type of Patient Safety Practice Safe
 
Clinical Risk Management Practice (CRMP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Implementation of Patient Safety initiatives / Activities
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Topic of the reported practice
Patient safety system
Aim and the benefit of the Patient Safety Practice
 
In Italy, 20.8% of healthcare associated infections (HAIs) are represented by urinary tract infection (UTI). The UTIs percentage increases from 20.8% to 22.3% when taking into consideraiton the long-term care facilities ( LTCs). The vast majority of urinary tract infection (UTI) episodes (96,7%), are associated with the use of the convenient, often unnecessary urinary catheter. The "catheter associated urinary tract infections " (CAUTI), therefore, are part of the infections related to critical quality issues and are, therefore, preventable through appropriate procedures. In the Post Acute Units of the ASL of Sassari, there has been a significant reduction of the incidence of CAUTI (from 12,05% to 0 between January and June 2014) thanks to the experimental introduction of " Urinary Catheter checklist”. This result led us to draft an ad hoc procedure with the aim of setting out rules to manage the whole process of the Urinary Catheter, from insertion to removal, and the surveillance system for monitoring urinary tract infections related to the use of the catheter.
Description of the Patient Safety Practice
 
The “CAUTI prevention” procedure is essentially divided into 2 phases: 1. urinary catheter management 2. Cauti Monitoring. Each of these phases consists of Operating Instructions (OI) governing all the "sub-processes of the Procedure": A. Labelling for appropriate use of urinary catheter B. Correct positioning of urinary catheter C. Proper "in situ" maintenance of the urinary catheter D. Proper removal of the urinary catheter related to the "urinary catheter management” E. CAUTI Assessment F. Correct urine sample in the patient catheterized G. Surveillance Regarding the CAUTI Surveillance system. The main tools to support the application of this procedure are: - Urinary Catheter (U.C.) Check List ; - The "Patient evaluation" "CAUTI Monitoring System" forms to support the sub-steps related to the CAUTI's surveillance (from assessment to monitoring). This practice has been implemented in the LTC’s of ASL, given the particular CAUTI's incidence that characterizes them. Below are described the methods that will be used for the assessment of the correct application of the Procedure: in the U.C. management phase, the"Urinary Catheter Check List" will be used. Another tool will be the Form "CAUTI Scorecard for patient hospitalized in Post Acute Units" and the "CAUTI Surveillance System" form. Results will be assessed based on the following indicators: Process indicators: QUANTITATIVES: %application U.C. Check List= n° U.C.; Check List filled in / n° catheterizations x month QUALITATIVES %completeness U.C. Check List= n° U.C. Check List correctly filled in / n° Check List filled in Result indicator: % CAUTI monthly rate (n° CAUTI / n° days catheter x 1000) /t0 – CAUTI monthly rate (n° CAUTI / n° days catheter x 1000)/t1.
Attachment of relevant written information and/or photos, as appropriate
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Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Unit or ward level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
Yes
A measurement after full implementation of the reported practice was obtained
Yes
Evaluation of a "positive" effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Both/mixed (qualitative and quantitative)
Enclosure of a reference or attachment in case of published evaluation's results
There is no specified text here
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Health care context where the Patient Safety Practices was implemented
 
Hospital
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
No
Specification of implementation in another health care setting(s)
There is no specified text here
Successful implementation's level  of this Patient Safety Practice across settings
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Involved health care staff
 
Physicians
Nurses
Health care assistants
Pharmacists
Administrative support (secretary, clerk, receptionist etc.)
Risk manager
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
Yes
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
Patient(s)
Point of time in which service user or their reprasentatives' involvement takes place
During the application of the Patient Safety Practice
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
No
Short description of the service users' level of involvement
Collaboration, such as co-designing a Patient Safety Practice or active partnership in implementation
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
Yes
List of sources where public information is accessible
http://buonepratiche.agenas.it/questionnaire.aspx?id=5369
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
No
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
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List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
Other
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
No
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
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Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
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Contact information
 
Name: Rosamaria Marchi, Donatella Rodella, Caterina Brundu, Maria Laura Fiori
Country: ITALY
Organisation: ASL SASSARI
E-mail: rmarchi@aslsassari.it
Phone: There is no specified text here
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