David: Ladies and gentlemen, thank you for your patience in holding. We now have your presenters in conferences. Please be aware, each of your phone lines is in listen-only mode. You may submit questions at anytime throughout today's presentation by using the chat box located on the bottom right of your webinar. We are keeping attendance, so there is no need to identify yourself in the chat box. Please note that all links and email addresses on today's live show are live, and you're prompted to use them. It is now my pleasure to introduce today's first presenter Ms. Kattie Johnson.
Kattie: Hi everyone. Thanks David. We are going to start off today's webinar. Thank you for joining us for the AHRQ Safety Program for Long-Term Care HAIs/CAUTI. Today's webinar, titled "A Farewell to Harms: Turbocharged Walking Rounds", will be presented by Steve Schweon. This webinar will explain how performing walking rounds can help prevent infections, and it builds on infection prevention skills you learned during the training modules, especially webinar 2 on environment and equipment. It also incorporates infection prevention surveillance documentation, communication strategies discussed during onboarding 5.
Steve is an infection preventionist at an acute care hospital that has a 6-year history without an FTAPE 441 citation. He has has been an infection preventionist since 1995, and has been board certified since 1997. He has acute care, long-term care, and behavioral health consulting, and clinical experiences. Steve is also a content and faculty member, and coach for the AHRQ Safety Program for Long-Term Care HAIs/CAUTI. With that, I will turn it over to Steve who will be leading the rest of our presentation. Steve, go ahead.
Steve: Okay. Thank you Kattie. It's more of a technical glitch. Can you see me okay?
Kattie: Yeah. We can see you Steve.
Steve: Okay. Thank you very much. Let me go ahead and get started. I also want to add that I do, in my acute care facility, we also have a SNIP. I have the best and worst of both worlds, joint commission as well as CMS. On my first slide is my email address. We will have plenty of time at the end of today's presentation for questions and answers. However, if you would like to shoot me an email, feel free to do so. Please give me about 24 hours to turn the email around.
Let me move to technology here. I struggle with my microwave sometimes. I'm very lucky and honored to be part of the New Hampshire faculty. I have learned so much working with the New Hampshire colleagues. I was out there for learning session number one, but I went past the Old Man Historic Sites. Many of you now that the Old Man is actually a rock formation in New Hampshire. It also reminded that I'm getting older, but it's good motivation for me to help enhance my engagement in our great program.
The learning objectives: Describe the advantages of performing walking rounds to prevent infections, especially catheter associated urinary tract infections, also known as CAUTIs. Identify methods to communicate with the team about opportunities for improvement, and describe strategies to ensure effective walking rounds. Many of you recognize that this is a test for visual acuity, how good your vision is. You can clearly see how infection prevention just pops right up. I'm hoping that walking rounds will be a new look for you and hopefully augment your infection prevention program to make your infection prevention program pop. I have a very dry sense of humor, and I will do my best to keep it contained.
Now it's time put on your thinking cap. My approach is going to be a little bit atypical compared to previous webinars. In a few minutes, we're going to have some serious engagement from everybody in the audience. It's time for everybody to bring their A game and to claim your seat. We're going to have a lot of fun at the same time. Those are my goals. We have a polling question here. How many of you perform CAUTI prevention walking rounds within your facility?
It looks like about half of you do, maybe a third don't. Interesting. Those of you who are doing CAUTI walking rounds, hopefully the information you learn today can help augment and boost and turbo charge your program. For those of you who are not doing CAUTI walking rounds, perhaps this may be an initiative to launch CAUTI walking rounds. Okay. Thank you everybody.
We have a slight slowness with the technology. There's a lot of pictures within the presentation. Please excuse any glitches.
Those of you who are very familiar with the CAUTI inforgraphic, I was flattered enough to be part of the team that helped put this together. Today's walking rounds presentation will encompass all five components of the infographic and as an aside, if you've not done so already, feel free to download the poster and find a way to display it within your facility so your staff can see it as well as the residents as well as your visitors. It's very well done. I'm very proud of it. It was a great team effort.
I know medical history. I don't know how many of youse do. I say the word youse because I was born in Philadelphia, y-o-u-s-e, but I like medical history. I found out that the Foley catheter is named after Dr. Frederick Eugene Foley who was a Minnesota physician. He was one of several urologists attempting to develop a urinary catheter during the 1930s. The story takes an interesting twist, kink, obstruction. For those of you who are interested, at the end of today's presentation is the reference to find out how the story takes an interesting obstruction.
Work habits: I would suspect many of you work an occasional weekend, holiday, off-shift. Last time I worked a weekend was this past Sunday and I happened to go in early to see both night shift and day shift. I would like you to consider adding CAUTI walking rounds as part of your day especially when you come in during an atypical day like a weekend or a holiday or an off-shift. It gives you a very interesting perspective.
Why this topic? Here's a picture of my office. I'm sure my office resembles many of the offices of the viewers on today's presentation. Why did I pick this topic? We know that infection prevention in a culture of safety cannot be totally improved from behind my desk. I can't be a desk jockey. The regulators and your co-workers as well as my boss expects me to be more visible in the clinical care areas and for me to walk in people's shoes I have to get out of my chair and have a presence in the clinical areas. It makes it extremely challenging with all the demands that are being placed upon us today. All the reports that have to be done. All the surveillance that has to be done. It could be very challenging trying to find the time to get out there but it's so important and I will share with you, in a few minutes, why.
The goals of walking rounds is to minimize risk and protect the resident from infection. If you're protecting the resident you're also protecting your co-workers as well as yourself. It helps you to identify safety, educational and compliance improvement opportunities.
The joys of rounding: I was helping a visitor to the Short Procedure Unit, also known as the SPU, and I said to the visitor that I hope everything goes well today. She stopped and stared at me. You mean something can go wrong? I worry a lot. Then she caught herself and she kind of smiled and I kind of smiled also and I wished her well. It was a learning moment for me. I actually said though, one of the worst things I guess, when I said I hope everything goes well, which implies that something may not or we may not be having our A game that day. So, I just say best wishes to people. That takes any of the uncertainty, the unknown-ness out of the equation.
What are the advantages of doing walking rounds? There's the approachability. Staff will start to inform you about what's really going on. There's improved trust that over time more information will be shared with you. You have a greater awareness as far as what's really going on. Your accountability will increase providing that you do give consistent follow up to whomever is asking you a question or who is expressing a concern to you. Morale may improve when staff are listened to and they are heard. Productivity. I'm usually very creative when I'm on the move. If I'm sitting down I'm not as energized but if I'm on the move I can think clearer and ideas pop into my brain. This is also a way for you to meet the new residents as well as new staff people and to develop relationships with everybody. In addition, it gives you an opportunity to do business with some of your co-workers, some of your colleagues who you may not see on a daily basis.
The unintended advantages: Staff may share additional concerns unrelated to your primary mission and they may try to have you be their spokesperson. They may try to take advantage of your position within the facility to fight their battles. At the same time additional work may be created when you uncover things. On the flip side there's job security.
What exactly are you looking for when you do CAUTI rounds? Does the order match what's inserted inside the resident? Is it the correct balloon size? Is it the correct French size? 18 French? 16 French? 24 French? Not only does the order have to match what's in the resident but the regulators may also be looking at the same thing. What's the reason for the catheter? Is it for retention? Is it for wound healing? Is there a securement device in place to keep the catheter anchored securely? Is the tubing kinked? Is the urine collection bag off the floor? How is the leg bag? The urinary leg bag? How is that cared for? What does the resident's bathroom look like? Is the dignity cover being used on the collection bag? Is there a dedicated urine collection device with a resident identifier and a date?
Now, this also reminds about central lines. For those of you who have residents with central lines in your facility, allow me to go briefly on the word. In my career I've had two residents discharged from the hospitals with PICs, peripherally inserted central line catheters. They were discharged from the hospital with PICs with no indication, no reason that the PIC had to stay in. They went to long term care and the PICs continued to stay in for no reason. Both residents became bacteremic and developed central line associated blood stream infections because of PICs that did not need to be in them in the first place and they wound up coming back to the hospital bacteremic.
If your checking for Foley catheter necessity something to think about would be to consider if there's an indication for you to assess central lines in your facility. Now back to the CAUTIs.
You can develop a rounding tool and this could be done on any program that you can build a table, which ever program you feel very secure with. These are just some of the indicators that I've listed. I have the name, the medical record number, the location, what floor for example, and simple yes/no things. Is a securement device being used? Is the tubing not kinked? Collection bag off the floor? Dignity cover in place? You can put as many indicators as you like on the tool, print it out, put it on a clipboard so as you're rounding this gives you a quick and dirty way of checking off compliance. When you go back to your office you're all ready to go.
Rounding practice, do you see what I see? You must know and adhere to your facility's photography policy and procedure. We are familiar with people who have taken pictures within a long term care facility without the residents consent or semi-consent and the next thing you know these pictures show up on social media. You must clearly know your facility's policy and a procedure. You must adhere to it at the same time. I also need to share that some of the images have quality and resolution issues due to the camera being used, the lighting, etc. Bear with me here. Let's get started.
This is the first improvement opportunity. I would like you to text to me what is askew in this picture. I'm going to have a drink. Okay, clearly Jada, Laura and Carol and Amber, all you guys have your A game today. Thank you very much. The bag is on the floor. The resident is sitting in the chair. There is no dignity cover on the bag and of course, it's right next to the trash can. Very good.
Let's move on to the second improvement opportunity. Again, I need to apologize in advance if there's any tardiness or slowness with the transition because of the file size. Now the resolution isn't too great on this picture but I kind of highlighted what the improvement opportunity is. Can somebody text me and let me know what they think about this picture? Just keep going in your process of typing, I will tell you that none of the pictures ... This is real stuff. You walk into the bathroom and this is what you see here. Alberta says, express connection. Patty Canes, there's no cath. Amar, exposed tubing. Elizabeth says, not covered. Very good. Great infection control issue. No sterile cover over the tubing. Right next to the toilet.
I think most of you are very familiar with the aerosols that come from toilets. A lot of toilets within health care facilities don't have lids and when you flush it creates an aerosol mist. The mist comes up into the air and actually contaminates the area around the toilet. It creates more of an issue with fecal matter that's in a toilet when a toilet is flushed. Very good. Okay, let's move on here.
Are people liking this? Okay, here we go. This may be a little bit more challenging. The patient is in bed lying down and the bag is attached nearly to the top of the side rail. Anybody want to comment on this one? Carol picked up on this right away that the bag is above the bladder. It's positioned way to high. Wow. Okay, you guys are doing great. Great. Okay. Everybody is claiming their seats today. I'm glad to see such involvement, such engagement. Thank you guys.