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Missouri University Health Care

MU Health Care limits infections by reducing catheter use

Clinicians at University of Missouri Health Care in Columbia, Mo., are using their electronic medical record (EMR) to treat and prevent the most common type of hospital-acquired infection. 

For decades, health care professionals have struggled to avoid catheter-associated urinary tract infections (CAUTIs). Unnecessary and prolonged use of catheters has caused complications, leading to longer hospital stays, higher healthcare costs and increased morbidity and mortality.

But clinicians throughout University Hospital’s 550-bed system are reducing CAUTIs by limiting catheter use.

“It’s really being preventative,” said Deb Pasch, chief nursing officer. “We are using our electronic medical record to help us to think through and not miss or forget … that person [who] has a catheter — maybe they don’t need it.”

Using a prompt in the organization’s EMR, PowerChart®, together with extensive nurse education and other promotion efforts, MU Health Care has lowered its catheter use from 34 percent to 20 percent in only one year.

Simultaneously, the number of CAUTIs has also dropped. In the previous fiscal year, MU Health had 5.55 CAUTIs per 10,000 patient days. In the present fiscal year, which started July 1, the organization has had 4.76 CAUTIs per 10,000 patient days.

The successful process improvement project started in March 2013 and has been led by Eileen Phillips, RN, MSN, an infection control professional who focused on CAUTI prevention in her master’s degree research.

Phillips and her team started in the adult intensive care units, where most CAUTIs occur. They added a requirement that nurses indicate in the EMR all the reasons why the patient has a catheter.

If the nurse checks the first option, “None, pursue discontinuation,” he or she is required to notify the patient’s physician and get an order to remove the catheter.

“For the most part, they are agreeable because a lot of times, the physicians don’t know a catheter is present,” Phillips said.

Along with these EMR adjustments, the team also used surveys, frequent communication, education on the modified catheter criteria, skin care for incontinent patients, regular updates on CAUTI rates and catheter utilization — even gift cards and congratulatory emails to promote awareness.

Initially, the team targeted nurses, but in March 2014, it started requiring physicians to chart reasons for catheter use in the EMR.

Recently, some units at University Hospital have started to allow nurses to discontinue catheters without calling physicians for an order.

“That’s what we are shooting for next,” Phillips said.

CAUTI prevention is also a 2015 goal of the Joint Commission and a reporting requirement for the Centers for Medicare and Medicade Services.

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Client outcomes were achieved in respective settings and are not representative of benefits realized by all clients due to many variables, including solution scope, client capabilities and business and implementation models.