I'm really glad we've been able to implement the protocol
for our daily review of indwelling urinary catheters.
We know we've had some patients who have had their catheters
left in place longer than necessary within our unit,
so I'm really hopeful this will help us all improve.
Well, you know, it was great working with the physician team
that actually developed the protocol
and designed the process for the timely removal of catheters.
When I took that protocol back to the physician group,
they had no problem agreeing to it.
And that was really important Susan for everybody on the unit.
Since it's been adopted,
we've seen great compliance with the protocol.
Hi Ms. Kumari!
I am Audrey Moore, your nurse for today.
-I'm doing okay.
Do you think I can get up today?
Well, the team just finished making rounds,
so let me go and check to see what your plan is for today.
I see you have an IV and a urinary catheter.
Let me go and check your orders
and then I'll get back to you in just a few minutes.
Okay.
Hi Audrey!
What's up, you look concerned?
Of my five patients today,
three of them still have catheters in place.
Really?
Yeah, and when I did the daily review
of the Indwelling Urinary Catheter Checklist,
it looks like two of my patients actually meet the criteria.
One of my patients actually transferred from
the intensive care to general unit
and then the other patient actually requested
that the catheter be removed.
They really shouldn't have catheters in anymore.
I'm going to request that they be removed this morning.
Yeah, it looks like that to me too, it should be removed.
You know, I'll go ahead and take care of this during my shift
and then I'll follow up with Sheri
and find out why they weren't removed.
Good idea!
It will help you understand why she made the choices she made,
and it will help her better understand
the risk of not following the protocol.
Got it!
And then I'll talk to her one-on-one
during her next shift.
Thanks!
Sheri, good morning! How are you?
Doing well!
Look, we have about 20 minutes before our shift begins,
do you want to grab a cup of coffee?
I would love a cup.
Sheri, I know you've been involved
in some of the Learning from Defects Meetings.
And I know how important it is
that we work well together to keep our patients safe.
Very important!
Well, since we implemented the new protocol
for the removal of urinary catheters,
I know that some of the nurses
have actually had to make adjustments
to make sure that they remove those catheters
as soon as they can be.
That's what I want to talk to you about.
Yesterday during my shift I noticed that
two of my patients actually met the protocol,
but they still had their catheters in place.
Look, yesterday was a really busy day.
Are you trying to tell me that I'm not doing a good job?
No Sheri, we've worked together for a long time,
I know how committed you are to your patients.
You are totally dedicated to high quality patient care.
I try to do that too,
but sometimes, you know, when we get really busy
it's hard to follow the policy and procedures like we should,
and looking back I can remember
when I had been... even broken rules,
because I thought nothing bad
would happen to one of my patients.
Yeah, that's right, it is hard sometimes,
but my patients are very important to me.
See, that's why I wanted to talk to you,
because I know you want to provide
the safest care for our patients.
We both know that urinary tract is the most common site
for healthcare associated infections.
I'm just trying to understand,
is there something about this new protocol and using it that
keeps us from being able to do it when you get really busy?
Audrey, I do want to follow that protocol,
but like I said, yesterday was really busy.
I was afraid that if I took those catheters out,
the patients would end up putting on the call light
because they needed to go to the bathroom,
and I wouldn't be able to help them,
and you know what that can lead to.
Mr. Jones is elderly, and if he put on his call light
and I wasn't able to get there,
he would get up and try to go on his own.
I was worried he would have a bad fall.
You know, that's understandable
and I heard how busy it was yesterday.
There are going to be a lot of those days,
and I know having to go through
the checklist in the beginning of your shift is a burden,
and it takes even more time
when you have to help your patients go to the bathroom,
and your concern about falls is every bit as important
as lowering the risk of infection,
but I really need you to work on this,
because the data is real.
Patients are really getting bad infections
when they leave these catheters in for too long,
and infections aren't traceable to any one particular caregiver.
We may never know if one of our actions
is the reason why our patients are harmed.
-Uh-huh.
I think you took care of her a few times, right?
I did.
Well, she developed a horrible infection
because her catheter wasn't removed.
It went on to be urosepsis.
Look, looking back at the Learning from Defects Meetings,
I seem to remember a statistic about urinary tract infections
making up about a third of the healthcare-associated infections
that we have here in our hospital.
Audrey, you're so right.
I know UTIs are a really big problem.
I'm going to do a better job of using the checklist,
and just wish there was something
we could do about our busy days.
Yeah, we need to talk about that at our next meeting.
Yeah, I agree.
There are some units that use toileting rounds,
so the nurse checks in with the patient every hour
to see if they need to use the bathroom.
I've heard it actually helps patients
to use that call light less often.
That's an interesting idea.
You know, I'd like to learn more about that,
but for today
I am going to try hard to use the urinary catheter protocol.
That's great, Sheri!
Oh, look at the time, we need to get back to the floor.
Okay.