The Tennessee Center for Patient Safety CAUTI Prevention Simulation Project is a pilot collaborative between two hospitals (TriStar Centennial Medical Center and Maury Regional Medical Center) and two schools of nursing (Belmont University and Aquinas College), to share evidence-based, standardized education and competency programs on preventing catheter-associated urinary tract infections (CAUTI). The pilot sites utilized the program for training and to reduce variation in practice.
The project partners are pleased to make available an electronic toolkit with CAUTI staff education and competency resources including a voice-over PowerPoint presentation, video, simulation scenarios, and other tools you may use or adapt for your organization. When using or adapting resources from this project, please note in writing, “Adapted from the TCPS CAUTI Prevention Simulation project: www.tnpatientsafety.com/simulation/cauti”. The materials are organized by pilot site with links to each site’s resources. The pilot is more fully described in this Overview Presentation.
Belmont University’s Gordon E. Inman College of Health Sciences and Nursing
Belmont University’s College of Nursing implemented the CAUTI program initially with a pilot group of senior nursing students. Each student took the pre-test and then was asked to view the voice-over PowerPoint and the pre-simulation video. Once completed, the students performed a catheter insertion that was video-taped for the students to review. Each student was debriefed individually by a faculty member. The students were able to ask questions, and the faculty discussed the areas of confusion and concern with the students. Students then completed the post-test. The statistical analysis was performed using a simple t-test and of the scores demonstrated a p of 0.00. Student comments such as, “The demo video that was viewed previously was very helpful…Students watching themselves perform procedures and finding their own mistakes…why hasn’t this been done before?” were meaningful to the faculty, as they examined their own teaching strategies. One of the most impactful changes was that the evidence-based content also was an impetus for updating the “how and what” the faculty taught in regard to Foley insertion.
Maury Regional Medical Center
Maury Regional Medical Center implemented the program using a blended learning format. The video and post-test were placed into computerized learning modules and put on the Learning Management System. Registered nurses (RN) were required to complete the modules and test prior to the hands-on demonstration of Foley catheter insertion. In the demonstration, each RN modeled catheterization according to standard work/protocol. After the demonstration, each nurse completed a simulated audit of three static mannequins/situations to ensure recognition of prevention measures. Nurse technicians were assigned a computerized-based learning module to complete “On the CUSP—CAUTI Prevention for Unlicensed Staff” and completed the prevention audits for competency. Transporters and respiratory therapy department staff also completed the prevention audits and discussed their roles in CAUTI prevention in staff meetings.
TriStar Centennial Medical Center
At TriStar Centennial Medical Center (TCMC), the collaborative program was implemented live in the classroom, using didactic, simulation, and competency validation components. The methods used to deliver the didactic component were pre-testing and video with scripted debriefing. The methods used to deliver the simulation were video with scripted debriefing and simulation of a urinary catheter bundle audit. The methods used to validate competency were simulations of female and male urinary catheter insertion using low fidelity models and post-testing. A total of 322 registered nurses and 40 other staff members who insert urinary catheters moved their mean scores from 49.5 to 79.3 (2 tailed p value, paired, <0.0001). The participant evaluations for professional and program objectives were primarily very good to excellent. The participants indicated they increased their knowledge and skill and would change their practice as a result. The number of hospital-acquired catheter associated urinary tract infections (HA-CAUTI) decreased during the fourth quarter of 2015 and continued to decrease during the first quarter of 2016. The collaborative program has been incorporated into Nursing Orientation and continues to run as a separate program.
Aquinas College School of Nursing
The CAUTI module was implemented in three different ways with three different groups of students at Aquinas College. The first implementation consisted of one small group of graduating Associate of Science in Nursing (ASN) students who volunteered for the project, so they could include the competency on their resumes. This first use of the module was successful. The students demonstrated internal motivation to complete the CAUTI work. They individually reported enjoying the module and learning a lot from it, as evident from the post-module quizzes. The second implementation involved beginning ASN students using only the audit portion of the module. This group was eager for the experience and intrigued by the “find-the-hidden-clues” style experience. Use of the audit alone was found to be very useful in allowing the students to ask questions and solidify the knowledge they had gained in theory and in laboratory evaluations. The third implementation involved a mixed-level student group in need of make-up clinical time. This group completed the entire module, demonstrated a positive attitude regarding the experience, and had a positive learning outcome.