Creating Home-grown Solutions
How to use your DATA to create solutions that will ACTUALLY work for your unit and not just Band-aid the problems...
Okay, I’m going to do it. I’m going to discuss CLABSIs and CAUTIs.
Let’s start with a quick description of what the hell I’m talking about…
CLABSI - Central Line-Associated Blood Stream Infection
CAUTI - Catheter-Associated Urinary Tract Infection
Basically, you stuck something into a patient and as a result, they now have an infection. The reason that we monitor this is pretty simple: we want to heal people. Giving them infections is usually frowned upon, as it compounds whatever other medical issue brought them to the hospital in the first place.
Nurses understand what CLABSIs and CAUTIs are. Nurses even understand their role in preventing such infections. But there is a whole lot of knowledge that is gained on the back-end, that never gets back to the floor nurse.
Part of that is because the collected data is provided to the directors and managers at the various meetings they are required to attend, and it is really hard for them to remember all the stuff they are supposed to do, and wouldn’t you know, it doesn’t always get discussed with the floor staff.
(Org Chart problems, amirite?)
The other part of the issue is that CAUTI and CLABSI rates are often tied to reimbursement, quality scores, you name it. The thing that everyone seems to agree on is that if the hospital gave the patient an infection, shame on them, we must dole out punishment. SO when the number of CAUTI & CLABSI rises, the big cheese FREAKS OUT and everyone else follows suit. They panic and throw a dozen solutions at the problem, without ever really knowing what, IF ANYTHING, worked. It is more important to find a quick solution than to take the time to really look at what the root cause is and spend time fixing it.
The best way to do that is to investigate EVERY INSTANCE OF CAUTI and CLABSI to see what (if anything) they have in common. To be fair, a lot of healthcare systems do this already. They have a process for investigating and reporting the results, the issue is that they believe the process in enough. But its not enough for just the administrators to know the data, it has to be communicated to front line staff - you know, the people who actually are going to be responsible for making a change.
Was the infection likely caused from insertion of the catheter or maintenance of the catheter? What was the type of bacteria? There are lots of tools out there that can be used to help facilitate successful investigations. At the end of the day though, all of the investigating is being done by other members of the healthcare team, not the frontline staff.
My point is this: posting a graph in the hallway or at the nurses station that shows that the unit has had three CAUTIs this year is not helpful to anyone. If you ask your staff to “speak to the data” they will say, “yep. We had three.”
It is more important to be as transparent and open with staff as possible about the data and work to fix the actual problems that were identified in the investigations.
Imagine the look on that Joint Commission surveyor’s face when they point to the graph and the staff say, “Ah, yes. We did have three CAUTIs this year. Interestingly, what we found was that all three events could have been attributed to other infection sources that we hadn’t considered or even known to culture (i.e. open wounds, oozing ostomies, etc.). SO - instead of implementing the newest, most expensive insertion kits that would have made no difference at all but were a quick solution, we spent the time working with providers and residents and the Epidemiology and Lab Departments to create a protocol for when to culture and when not to. Basically, we looked at our data and found a solution that was appropriate for our specific unit and not just a blanket fix-all that wouldn’t have really made an impact on our numbers but would have sounded good to talk about at board meetings. It’s great for me as the nurse, because I am no longer questioning why we are getting shamed at every staff meeting. I understand that it was a collective issue. None of us knew the specific CAUTI criteria and now that we have a better understanding of how a CAUTI is classified, we can work diligently to fix the issue.”
Mic drop. (Is that still a cool thing to say? If no, pretend I didn’t write that. If yes, laugh heartily for my topical humor is both refreshing and spot on.)
I will close out my post with this:
My example of CAUTI and CLABSI is super general. Any issue, whether it’s an important safety event, or just trying to figure out why all the 0500 lab draws are consistently collected late can be figured out with some data collection and a deeper dive.
It is much easier to jump to solutions than to take the time to do a thorough investigation because so many solutions exist out there. And some of them will work! You WILL get lucky some times if you just implement solution after solution hoping one of them sticks.
But that is how you get the “flavor of the month” mentality from staff. They see the constant change in protocol and get frustrated because they don’t understand the quick changes with little to no notice. Take the time to put in the hard work, get the RIGHT results, and include the staff in the conversations for creating a solution that is specific to your issue and will lead to better results. Continue to collect data and make changes based on what the DATA shows.
Norman out. (again, if this is not a hip thing to say, please disregard.)
