QUALITY IMPROVEMENT BY HILARY
DMACC Spring 2021
ADN 550
DESCRIPTION
Tip the Tank, Lose the Loop!
The quality improvement proposal I have identified is a campaign titled “Tip the Tank, Lose the Loop.” On the cardiac intensive care unit (CICU) at Iowa Lutheran Hospital during the night shift, every two hours nurses are required to record output. If the patient has an indwelling catheter, the nurses “tip the tank” to clear it and prepare to measure the next two hour period. The goal for this campaign is to ask nurses to tip the tank and then check for dependent loops in the indwelling catheter tubing at the same time.
TIP THE TANK, LOSE THE LOOP!
The Need for Quality Improvement
UNIT DATA
THE NEED FOR THIS QI INITIATIVE
EVIDENCE BASED PRACTICE ARTICLE
Quantitative Support
1 instance of a CAUTI within the last 6 months and 2 within the last year dating to May 2020
40% of the time, tubing I observed on the unit had a dependent loop (observations based on 4 shifts at 2200 and 0400)
A Happier, Healthier Floor
CAUTIs are the most common form of healthcare associated infections; 70-80% of UTIs in the hospital occur after or during an indwelling catheter insertion. They extend a patient's stay, opening them up to other complications, and one CAUTI can cost the hospital & patient more than $200,000.
Nurses can easily fix dependent loops by using the green hooks to run tubing along the bedframe, looping tubing on the patient's bed or placing the catheter bag towards the foot of the bed.
Prevalence of Dependent Loops in Urine Drainage Systems in Hospitalized Patients
This article, published by Danek et al. in 2015, had researchers from an academic health center in Florida measuring the physical presence of dependent loops of 141 patients with indwelling catheters.
The data showed 85% of catheters had dependent loops. The existence of dependent loops indicates that there is a lack of awareness or inadequate training on usage of indwelling catheter maintenance.
Dependent loops lead to CAUTI by allowing urine to sit below the level of the bag: it allows pathogens to grow and the pressure doesn't allow urine to drain.
IMPLEMENTATION
Rolling out the "Tip the Tank, Lose the Loop!" Campaign
UNIT BASED COUNCIL SUPPORT
A True Advantage
Step one was contacting the Unit Based Council in order to be added to the agenda. I attended this meeting on 13 April 2021, sharing my project idea.
I wanted to ensure I had adequate support from both day and night shift nursing leaders. I utilized notes and my ipad to introduce the campaign’s slogan “Tip the Tank, Lose the Loop.”
The next step would be getting approval for educational flyers and brochures to be placed on the unit and sent via listserv to nursing employees.
BARRIER ONE
Logistics
The first barrier to implementing the proposed quality improvement initiative is the logistics of implementing my campaign. UnityPoint has specific requirements for the placement of literature including flyers and brochures. It was my plan to utilize both of these methods in order to communicate with the day shift nurses I could not directly speak with during my shift. Getting permission is a barrier to completion, but it is a part of professionalism to be able to work within the framework of the hospital.
The realistic solution to this barrier was finding other nurses who could help me and utilizing teamwork. I was able to set up a system where I can get the literature signed off by the supervisor during the shift change who has agreed to get the required stamp of approval from human resources.
BARRIER TWO
Unpredictability of the ICU
My preceptor and I are often responding to medical emergency team (MET) calls, we have been floated to Iowa Methodist’s intensive care unit, and we have had to spend several hours with patients that are not assigned to us directly. I am not physically capable of talking to every nurse or continuing a consistent walk around the unit to check for dependent loops as I did at the beginning of this assignment in order to support the implementation of this campaign.
The realistic solution is to use communication, specifically informatics. Because nurses already have to chart output once every two hours, I did find a line in Epic that deals directly with dependent loops. By asking nurses to fill out the correct section in Epic, I can potentially have a report run to measure compliance and rely on digital communication rather than direct observation. This can be found under assessment, then urethral catheter. The sixth line down asks the nurse to choose yes or no to the question “tubing in correct placement-no dependent loops.” It is realistic because it already exists and it is in the same section nurses are already charting for indwelling catheters.
EVALUATION
Generate an Epic report showing the use of the section re: dependent loops under assessment (described above).
Complete random spot checks twice during shifts. Dependent loops can often be seen from simply walking past the patients' rooms.
CONTACT ME
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