A collaboration between nurses specialising in infection prevention and control, continence, and staff on an elderly care ward have been shortlisted for a Nursing Times Award.
Newcastle’s Finalists in the Continence Promotion and Care category have been recognised for their pioneering efforts to raise the clinical profile of the need to assess for a urinary catheter and reduce unnecessary catheterisation, and as a consequence successfully reduce the risk of acquiring associated gram-negative blood stream infections (GNBSIs) for patients in our care.
Some gram-negative bacteria can live harmlessly in the body but when they move to other areas of the body infections can occur – these include urinary tract infections, hepatobiliary or gastrointestinal infection which can lead to serious bloodstream infections.
The National Ambition
The NHS Long Term Plan outlines an ambition to halve the incidence of both blood stream infections (BSIs) and E.coli bacteraemia by 2024/25 and Newcastle Hospitals has a robust strategy aligned to this national goal.
“Urethral catheter insertion is an invasive procedure and is known to be a high-risk factor for GNBSIs”, explains Jackie Rees, Nurse Consultant for Continence “and so we decided that our starting point should be to aim to clinically assess the patient for the need of a urethral catheter and minimise the use of inappropriate urinary catheters wherever possible.
“This is particularly important for our older patients where we continuously aim to promote good bladder health and do all we can to support these patients to be able to continue with normal day to day activities and maintain their independence.”
Newcastle’s approach
A project team made up of five experienced nurses harnessed their collective expertise in continence and infection prevention and control to implement a new initiative seeking to halt the practice of inappropriate catheterisation.
They developed a new quality improvement project with guidance from the Institute for Health Improvement, co-ordinated by the Newcastle Improvement team.
This involved dedicated education for staff of all disciplines on Ward 15 – one of our older people’s medicine wards at Newcastle’s Freeman Hospital which was chosen as the pilot ward – to promote good bladder health and in particular to avoid urinary catheterisation unless clinically indicated.
Jackie explains “As our elderly patients are amongst our most vulnerable and they tend to come from the community and other clinical areas before reaching the transfer ward with catheters in situ so it’s important to empower our nursing and medical staff to assess the need for the catheter and remove when clinically appropriate.”
The Innovation
However when developing their approach, the team found that other than the HOUDINI assessment tool there are currently no other nationally recognised prompts for catheter care.
Angela Cobb, Infection Prevention and Control Lead explains “Our ambition to improve our patients’ experience and clinical outcomes generated a great deal of discussion and we decided to do something innovative by introducing something simple but effective – a visual prompt of a C sign as a reminder for nursing staff to carry out daily reviews of the number of urinary catheters in use on the ward at any given time.
“This, when used in tandem with the HOUDINI tool, empowered them to consider clinical appropriateness and make informed decisions about timely catheter removal.”
The Results
The project was piloted on Ward 15 within older people’s medicine and within just one month we saw an immediate improvement with urinary catheter use decreasing from a baseline of 11 patients to 6 – a drop of nearly 50%.
There was also a 25% improvement in HOUDINI assessment for insertion and ongoing catheter care recorded following the project with 100% completion of document for patients with urinary catheterisation.
Plus knowledge in all aspects of urinary catheterisation and bladder health care greatly improve particularly around the benefit of following the HOUDINI assessment and not requiring dip-stick urinalysis in line with NICE guidance.
Cheryl Teasdale is Associate Director of Nursing overseeing clinical standards and delivery of high quality patient centred care. She said “The team’s collaborative effort has demonstrated how our nurse leaders are using their expert knowledge and skills to lead improvement and reduce patient harm, whilst encouraging innovation from our all nursing staff to influence decisions in an approachable, supportive culture.”
The QI Approach
“Engaging with staff and encouraging leadership has been key to the success of this QI project and members of the project teams were frequently available on the ward so that they could be approached at any time” says Angela Cobb, Infection Prevention and Control Lead.
“The clinical nurse educator for this directorate supported the delivery of education which reinforced the project focus and aims within the team. This ensures clear and concise two-way communication to prevent any misunderstandings and we held weekly project team meetings to maintain focus and momentum.”
Angela continues “Feedback from staff was encouraged at all times and the project adapted accordingly from comments received.
“Staff education also prompted empowerment through greater knowledge and confidence, and we were able to identify strong champions who promoted ownership of the project with their colleagues.”
Linda Morgan, Clinical Standards and Quality Improvement Lead for the Trust says “I’m extremely proud of what this team has achieved through true leadership and collaborative working.
“It is their dedication to their patients and commitment to quality improvement that has made their innovative approach so successful and the team are absolutely delighted with the success of this trial.” Linda adds “By using the PDSA (Plan, Do, Study, Act) cycle approach we have been able to adapt the project quickly and effectively to extend the initiative to other inpatient areas.”
The winners of the Nursing Times Awards 2022 will be announced on Wednesday 26 October. We wish all our finalists the very best of luck.
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