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April 11th 2014
Putting a S.T.O.P to traditional use of Invasive Devices: Use it or lose it!
Liz Smith
Conflict of interest
• No payment has been made to undertake the presentation
• No payment for advice given• No funding for research has taken place• 1000 Lives Improvement Service PHW have funded
attendance• No share holdings or pharmaceutical companies have
any interests in the programme • However, Health Foundation funding contribution was
made to enable the production of communication aids for the STOP campaign and Sepsis.
Wales
Population 3 million
• 9 Health Boards– Vary in population– 3 large– Limited tertiary– Rural – some shared
services with England– Some specialised
services
Scale of the problem• European Centre Disease Control
(ECDC) Point Prevalence Survey 2011 indicated high rates of– UC– PVC– SSI C-Section
Acute-9094 patients surveyed 3369 had either UC, PVC or bothNon acute-2506 surveyed343 had either PVC or UC
Concerns
• Acute sector surveyed 3369 had a device insitu– 60% identified as
Catheter related UTI (CAUTI)
– 26% of inpatient population had an indwelling PVC (some more than one)
• Non Acute survey 343 had a device insitu– 303 UC – 66 PVC
– 103 identified catheter related infection
Getting started
• One ward... one day• How many cannulas and catheters are insitu• How many of those are clinically indicated• In your professional opinion how many could be
removed
Model for improvement
S.T.O.P.
Stop - Is the device needed? Is there an alternative?
Think - What are the clinical indicators for use?Has the patient consented?
Options - Management of alternative therapies.Document the rationale for use
Prevent - Health Care Associated InfectionsDocument equipment used with traceability.Be vigilant with ‘Time in Time out’ prescription.Attention to detail.
STOP Order
• Before Insertion.– Clear clinical indication for insertion; to be
documented in clinical notes• Post insertion. Use it or lose it.
– Use should re assessed every shift andreasons documented in clinical/nursingnotes.
– If the device has not been used after 8 hours it should be removed
Creating characters - S.T.O.P.
CAUTI Bundle
Communications as a primary driver
Cwm Taf University Health Board
April May June July August0
10
20
30
40
50
60
70
80
90
Ward BWard A
Introduction of STOP order
• Orthopaedic Wards• % patients
Catheterised prior to theatre
Welsh Ambulance Service Trust (WAST)Cannula only
01-Dec
01-Jan
01-Feb
01-Mar
01-Apr
01-May
01-Jun01-Ju
l
01-Aug
01-Sep
01-Oct
01-Nov
01-Dec
01-Jan
01-Feb
01-Mar
01-Apr
01-May
01-Jun01-Ju
l
01-Aug
01-Sep
01-Oct
01-Nov
01-Dec
01-Jan
01-Feb
01-Mar
01-Apr
01-May
01-Jun
0
50
100
150
200
250
300
243
198
148.5
90108
94.5
Insertion Rate
Insertion Rate
Powys Teaching Health BoardCatheter only-CAUTI
Nov-11
Dec-11
Jan-12
Feb-12
Mar-12
Apr-12
May-12
Jun-12Jul-1
2
Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
Apr-13
May-13
Jun-13Jul-1
3
Aug-13
Sep-13
Oct-13
Nov-13
0
5
10
15
20
25
30
35
CAUTIInsertion rate
PPS 2011Programme Commenced
↑Community Nursing Teams
Hywel Dda Health Board
2011 2012 20130
200
400
600
800
1000
1200
PatientsCathetersPVC
2011 2012 20130
50
100
150
200
250
300
350
400
CathetersPVC
Final word
• Most organisations are reporting 50% reduction in device usage Catheters -Some HB reporting a reduction of 90%
• KIS-Keep it simple.• Work in progress
– community – those cared for at home.– Annual STOP day.
Thank you – Diolch! (Dee olcch)
www.1000livesplus.wales.nhs.uk/stop
@LizSimit
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