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Feedback to Unit after Committee
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Items Identified as Contributing Factors to CAUTI
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Recommendations from QAPI Committee
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IPE
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Name | MRN
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Sex | Age
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Hospital Admit date
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Attributable Unit
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Unit Admit date
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Hand hygiene Complaince during month of CAUTI
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Service
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Medical History
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Surgical History
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Reason for admission
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Procedures (OR/other procedures)
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Other areas notified of CAUTI
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COVID-19 (Y/N)
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FOLEY INFORMATION
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Foley insertion date | removal date
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Temp Sensing (Y/N)
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Location of Insertion
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Level of inserter
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Was there an order for the Foley?
(was there an MD do not remove order?)
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Foley indication (flowsheet, orders)
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If indication "Accurate I/Os," was output measured hourly?
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Actively Diuresed?
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Duration of most recent Foley to Infection (if reinserted) (Committee)
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Duration Foley to Infection (total Foley days) (NHSN)
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Initial Foley Insertion (if current Foley was reinserted)
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Foley in Place at Time of Infection?
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[label Day of Event]
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Infection InformationAdditional
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UA
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Urine Culture
include time of culture
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Foley replacements/reinsertions (reason)
include time of replacement/removal
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Culture off >7 day Foley? (Y/N)
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BPA Fired?
Acknowleged?
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Reflex order used?
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Blood Culture
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Symptom to meet definition
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Reason/symptom for urine culture
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Documentation of Straight Cath (volume)
from Body system flowsheet
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Voiding characeterisitcs from Flowsheet
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Patient Transport
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Provider
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Did the patient need the Foley at the time of infection?
Could it have been removed sooner?
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Were alternatives considered? (select all that apply)
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If other, list:
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Were UAs and Urine cultures necessary?
Reason for culture
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Was the positive culture clinically significant, i.e did you treat?
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Any other contributing factors?
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Nursing
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Any known missed opportunities of Foley maintenance bundle
(bag above bladder,peri care missed)
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Was the urinary catheter drainage system opened at any point during duration of catheterization?
Is there any evidence that the closed system was not maintained?
Are you aware of any clinical issues that caused the catheter to be broken into?
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Were there any problems with the catheter equipment or supplies? Is there any evidence to support this?
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Any issues related to securing the indwelling urinary catheter?
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Was the urinary catherter drainage bag kept below the bladder at all times?
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Were alternatives considered? (select all that apply)
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If other, list:
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Was there trouble with any alternatives (equipment or other?)
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Potential contributing factors
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Was Foley assessed daily to ensure patient did not meet removal critera?
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Did patient need Foley?
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Workload impact to provision of care (Nursing HPPD data)
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Other areas that should be notified of CAUTI (i.e., transport, IR etc)
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Any other contributing factors?
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