1425: UNDERSTANDING PICU EARLY MOBILITY PRACTICES FOR DEVELOPMENT OF COMPREHENSIVE GOAL-DIRECTED PROGRAM

Abstract

Learning Objectives: Catheter associated urinary tract infections (CAUTI) are a substantial contributor of patient harm resulting in increased length of stay, increased institutional cost, and decreased patient satisfaction. In 2016, our PICU was 300% worse than the Solutions for Patient Safety benchmark. We hypothesized that through implementation De-Cath Protocol with guidelines for straight catheterization for urinary retention, we could decrease our rate of CAUTI and Foley utilization rate. Methods: The De-Cath Protocol included guidelines on which patients required Foley catheters and empowered bedside nurses to advocate for removal of Foley’s when patients no longer met criteria. It also provided guidance on management of urinary retention following Foley removal including bladder scanning and intermittent straight catheterization. This was implemented for all patients with Foley catheters admitted to the 12 bed Pediatric ICU after September 2017. Results: There have been no CAUTI’s in the PICU since implementation. From September 2017 to February 2018, 104 patients required Foley insertion (annualized to 208) as compared with 254 in 2016 (20% decrease). Foley days from September 2017 to February 2018 were in the 305.3 (annualized to 610.6) compared to 884 foley days in 2016 (21% reduction). Average Foley days decreased from 3.4 days per catheterized patient in 2016 to 2.9 days per catheterized patient following protocol implementation. There have been no known infections or trauma associated with intermittent straight catheterization from the De-Cath Protocol. By reducing CAUTI’s from 2016 to 2017, the estimated cost saving is $28,000. Conclusions: Implementation of the De-Cath Protocol was successful in reducing the number of patients requiring Foley’s, average Foley days per catheterized patients and rate of CAUTI’s in the Pediatric ICU.