American Association of Critical Care Nurses (AACN) Largest
specialty nursing organization in the world Representing 500,000
nurses Dedicated to providing knowledge and resources necessary to
provide optimal care to critically ill patients
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AACN Clinical Scene Investigator (CSI) Program 16 month nursing
excellence and leadership program Team based with education,
coaching and mentoring Leverage the staff nurses expertise to
enhance patient care and create positive patient outcomes
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CSI Academy Objectives Demonstrate the components of innovative
project management. Develop, plan and implement an innovative
project that targets a patient/family or clinical outcome on the
unit. Create measureable improvements in patient/family, clinical
or organizational outcomes. Effective communication, collaboration
and innovation.
Purpose and Goals The Neurosurgical ICU experienced elevated
CAUTI rates. Goal: To decrease the incidence of CAUTIs in NSCU by
25%, as well as increase and sustain compliance in catheter care
and removal. Sept. 2012- Aug. 2013: Foley days: 3,653 CAUTIs:
19
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North Shore University Hospital New York State Designated
Regional "Level One" Trauma Center. It offers the highest level of
care to the most critically injured patients in the area.
Physicians and nurses of the ED care for more than 90,000 patients
per year. Employs more than 6,000 highly trained physicians, nurses
and other medical staff 806-bed teaching hospital on the 58-acre
Sandra Atlas Bass Campus Academically affiliated with the Hofstra
North Shore-LIJ School of Medicine
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Neuro-Surgical Care Unit Neurocritical Care Center at North
Shore-LIJ Health System's Cushing Neuroscience Institute features a
16-bed intensive care unit that was established in 2007 North
Shore-LIJ Health System Provides expert care via a team approach to
the management of patients with subarachnoid hemorrhage, traumatic
brain injury, intracerebral hemorrhage, complicated stroke and
other disorders Provides 24-7 intensivist coverage for critically
ill patients. U.S. News & World Report Ranks North Shore
University Hospital Among Top 50 in US for Neurology and
Neurosurgery 2014-2015
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Money Talks NSCU cost per day: $5,800 Floor cost per day:
$3,350 Increased LOS due to CAUTI: $1200 - $4700 Antibiotic cost (5
days): Cipro IV $34.50 Antibiotic cost (7 days): Cefepime IV $74.62
Average Increase in Direct Cost per case w/CAUTI - $22,400
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Money Talks Projected savings with a 25% CAUTI reduction:
$106,400 NSCU CAUTI Cost for 2013 (19 CAUTIs): $425,600 NSCU CAUTI
Cost for 2014 (14 CAUTIs): $313,600 Estimated savings from
2013-2014 : $112,000
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NSCU CAUTI September 2012- Present
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NSCU CAUTI
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NSCU Device Days (Foleys)
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Activities and Key Dates October 2013: Small test of change
Green clip monitor November 2013: (Anti) Foley Cart December 2013:
Chart reviews February 2014: CAUTI binder March 2014: Sunflower
Visual Aid
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Activities and Key Dates April 2014: Pre-survey, incentives May
2014: Why the Foley? Week June 2014: Hospital-wide CAUTI carnival
August 2014: Post-survey, incentives September 2014: NSLIJ 7th
Annual Nursing Education Conference Poster Presentation
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NSCU Straight Catheterization Protocol Female Patients: D/C
foley based on LIP order Bladder ultrasound for the first 24 hours
after each episode of incontinence, or each episode of voiding If
patient does not void Bladder ultrasound and straight
catheterization Q4 hours for volume > 300 mL. If volume is <
300, reassess in 2 hours Straight catheterize at any time the
bladder ultrasound shows volumes > 300 mL If patient has volume
> 500 mL X 3 straight catheterizations, notify provider and
reinsert foley.
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NSCU Straight Catheterization Protocol Male Patients: D/C foley
based on LIP order If the patient does not void within 4 hours and
volume is > 300 mL, perform straight catheterization If < 300
mL, reassess in 2 hours After 2 episodes of straight
catheterization, discuss next step as to whether the foley should
be reinserted.
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Why the Foley? Week!
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Hospital-Wide CAUTI Prevention Week! Modeled after NSCUs Why
the Foley? Week CAUTI Carnival Presentation of NSCU Methods Lunch
Skill Validation Vendors
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Project Outcomes The number of CAUTIs was reduced by 26%. This
outcome resulted in a savings of $112,000 since the AACN CSI
Academy program was launched.* Using the CMS estimated cost of
$6,913 per CAUTI, the savings would be $34,565 The number of device
days was reduced by 31%. * Based on the hospitals calculated cost
of $22,400 per CAUTI
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Unintended Positive Outcomes NSCU nurses have become CAUTI
knowledge experts. We have enhanced our skills in intermittent
catheterization. There is a notable surge in staff satisfaction
because of hospital wide recognition. There has been an increase in
collaborative efforts and camaraderie among the NSCU team.
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Expectations Resistance from the team (LIP, RN, and PCA)
Resistance from the patient and family members Increasing the need
to assess and provide patient care
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Momentum and Sustainability In-services via computer software
Annual CAUTI Prevention Week CAUTI binder Visual Aids T-shirts
CAUTI educational material Additional support
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Conclusion Special thanks to our amazing colleagues, the ICU
team, management, administration and AACN for their support. Due to
our outcomes we have the privilege sharing our success with others.
Institute for Health Improvement: Orlando, Florida: November 2014
Society for Critical Care Medicine Phoenix, Arizona: January 2015
AACN National Teaching Institute San Diego, California: May
2015
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References Castro E. CAUTI reduction and prevention at North
Shore University Hospital Department of Nursing Education, Patient
Care Services, Standards, Policy and Procedure Manual. 2014.
Research Triangle Institute for Center for Medicare & Medicaid
Services. Analysis report: Estimating the incremental costs of
hospital-acquired conditions (HACs). 2012. Retrieved from
http://www.cms.gov/Medicare/Medicare-Fee-for-Service-
Payment/HospitalAcqCond/index.html. Accessed April 1, 2014. (Click
Incremental Updated Cost Report). Umscheid C, Mitchell M, Doshi J,
Agarwal R, Williams K, Brennan P. Estimating the proportion of
healthcare-associated infections that are reasonably preventable
and the related mortality and costs. Inf Contr Hosp Epidem.
2011;32(2):101-114.
