Becker's Clinical Quality & Infection Control

30 INFECTION CONTROL & PATIENT SAFETY National Collaboration Shows Promise for CAUTI Reduction By Brian Zimmerman A concerted effort across 603 hospitals showed promise in reducing catheter-associated urinary tract infections among patients, according to a study published in The New England Journal of Medicine in June. The large collaborative effort was sponsored by the Agency for Healthcare Research and Quality and was primarily focused on providing training and educational resources to both physicians and nurses. Providers were given Comprehensive Unit-based Safety Program toolkits. The CUSP toolkit is customizable and includes a check- list of clinical best practices, slides, videos and facilitator notes to lead caregivers through modules. The results appearing in the NEJM were collected from four of the study's cohorts that completed the 18-month program between March 2011 and November 2013. Adherence to the program led to a CAUTI reduction of one-third among hospital patients in general wards. Cath- eter use also dropped, though patients in intensive care units didn't display a drop in either measure, suggesting further room for improvement. Sanjay Saint, MD, the paper's first author and a professor of internal medicine at the University of Michigan in Ann Arbor, said, "This program...shows we can make a differ- ence in catheter-associated UTI rates and the use of cath- eters by addressing both technical and cultural aspects of healthcare...there's more work to be done, but all involved in this effort should take pride in knowing they helped move the needle on this important issue." Some studies suggest that as many as 69 percent of CAU- TIs are preventable. n 20% of Hospitals Don't Have a Policy to Handle 'Never Events' By Shannon Barnet H ospitals that have a policy to follow if or when a "never event" occurs demonstrate both accountability to their patients and dedication to continuous improvement. Unfortunately, one in five hospitals has not adopted such a policy, ac- cording to a report released in June from e Leapfrog Group and Castlight Health. To meet Leapfrog's standard for an adequate never events policy, the policy must require the hospital to: • Apologize to the patient and/or family • Report the incident to an outside agency within 10 days • Perform a root-cause analysis • Waive costs related to the never event • Make a policy available to patients, family members and payers upon request Leapfrog added questions about organiza- tions' never event policies to its Hospital Survey in 2007. Highlighted below are five survey results pertinent to never event poli- cies, gathered from the 2015 survey. 1. Never event policy adoption increased from 53 percent in 2007, when Leapfrog added "Never Events Management" to its hospital survey, to 79 percent in 2012. Since 2012, however, progress has basically stalled. 2. In 2015, 80 percent of the hospitals met Leapfrog's standard for a never event policy. Although that represents a majority of the hospitals surveyed, that still means 20 per- cent have failed to adopt an adequate policy. 3. Never event policy adoption varies from state to state. For instance, 100 percent of the reporting hospitals in Maine, Massachusetts and Washington met Leapfrog's standard. 4. Eight states — California, Indiana, Min- nesota, New Jersey, Oregon, Rhode Island, Tennessee and Utah— had at least 90 percent of hospitals meeting the standard. 5. In seven states, fewer than 60 percent of hospitals met the standard, and in Arizona only 10 percent of reporting hospitals had an adequate policy. "Never events are egregious and they truly should never happen, but at the very least if they do happen, we expect hospitals to take the most humane and ethical approach," said Leah Binder, president and CEO of Leapfrog. "Unfortunately, many hospitals still won't commit to doing the right thing, including apologizing to the patient or family and not charging for the event. We should see 100 percent of hospitals with the Leapfrog policy." n "Never events are egregious and they truly should never happen, but at the very least if they do happen, we expect hospitals to take the most humane and ethical approach." — Leah Binder

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