“Having the partnership with Medline was helpful because we have a person we can call,” said Lee. “Our clinical person is readily available to us if we have an issue or concern. The assessments provided us with the tools, and we have follow-up assistance.”
The overall CAUTI trend line continues to decline at FirstHealth, decreasing from 16 CAUTIs in 2018 to 5 in 2022. The CLABSI rate, which increased during the pandemic, is also coming down.
A refocus on ‘the little things’
Allegheny General’s first Medline clinical assessment was in May 2021.
“It was the little things that we missed,” said Baker of the assessment results, including that “tons of people were not using securement devices” or Foley kickstands. “We spent time with Medline. We did a lot of education around that.”
Later that year, only two Foleys were without a securement device at Allegheny General, down from a typical monthly rate of 100. There’s also a lot more discussion and consideration on whether or not a Foley is necessary, said Baker.
Allegheny General also created a hospital-wide “CAUTI Collaborative” that includes “engaged” physicians who are committed to the process and outcomes, and at the hospital level, a “CAUTI Championship Team” that has a designated time at the daily huddle.
“We look at every CAUTI that we had the last month,” said Baker. “We dig down into the nitty gritty. Sometimes, it’s a matter of – ‘Why did the physician order that?’ Often patients will complain of urinary urgency after the Foley is removed. This can be a normal occurrence after a Foley is removed. Without any other symptoms (leukocytosis, fever), waiting for 48 hours will often resolve the issue. That’s where we sometimes need our doctors to get involved. Don’t order a culture. This is a normal response. Often times you do have a slight infection and your body may improve on its own. We’re also looking at antibiotic use.”