New Jersey Hospital Uses AHRQ Toolkit To Reduce Urinary Tract Infections

Meadowlands Hospital Medical Center in Secaucus, New Jersey, used AHRQ’s "Toolkit for Reducing CAUTI in Hospitals" to increase staff knowledge about catheter-associated urinary tract infections (CAUTIs) by 20 percent. This resulted in a 264 percent improvement in Foley (indwelling) urinary catheter-free device days between 2015 and 2016.

Part of AHRQ's Comprehensive Unit-based Safety Program (CUSP), the CAUTI toolkit helps providers prevent urinary tract infection by promoting teamwork and focusing on patient safety. It promotes the judicious use of catheters, urine cultures, and antibiotics. It also encourages best practices for catheter use and removal.

The gains at Meadowlands resulted from a partnership between the hospital and iCareQuality, a Pennsylvania-based health care consulting company that supports efforts to improve patient safety. As part of an annual nursing improvement plan, the project was conducted over 10 weeks in early 2016.

Using online games and educational activities, the hospital’s quality improvement project focused on the following goals:

• Increasing nursing knowledge of AHRQ's best practices to prevent CAUTIs.
• Enhancing frontline provider engagement.
• Boosting and measuring mobile technology use at the point of care.

Although Meadowlands began using CUSP in 2013, ongoing improvement and sustainability efforts were challenging, due to patient complexity, limited clinical resources, and inconsistent provider engagement.

"We wanted to sustain quality improvement efforts at the bedside. CAUTI rates improved initially but were not sustained, with infection rates fluctuating up and down," explained Nancy Brobeck, B.S.N., R.N., CIC®, infection prevention and control practitioner at Meadowlands.

To address the problem, the Meadowlands project incorporated educational activities and mobile technology using online games and computer learning. The mobile technology platform included CAUTI modules from the AHRQ toolkit for shift-to-shift reporting, a best-practice CAUTI guidebook, case studies, videos, quizzes, a discussion board, and game reward points.

"AHRQ's CAUTI tools provided nurses at Meadowlands with the right information at the right time," said Rosemary Kennedy, Ph.D., R.N., M.B.A., faculty mentor for iCareQuality during the program implementation at Meadowlands.

Fifty nurses from Meadowland’s intensive care and medical/surgical units participated in a mandatory first phase; 26 staffers participated in a voluntary second phase. Pre- and post-testing showed the increase in staff knowledge of CAUTI and the reduction in catheter use.

Using the toolkit via mobile technology allowed nurses to earn reward points, acquire best-practice information to support a learning organization culture, and improve patient outcomes. Staff members who achieved point goals won gift cards.

Key findings from the project included:

• A "just-in-time" education platform that used mobile technology improved staff learning and sustained provider knowledge of CAUTI best practices.
• Mobile tools enhanced clinical workflow by making AHRQ tools available at the point of care.
• Incentives and games helped improve participation.

"The educational modules and hand-off tools have greatly improved our compliance with the CAUTI bundles," said Felicia Karsos, R.N., president and CEO at Meadowlands.