EFD Bladder Management Program

Sept. 2020

CONFIDENTIAL – Contains proprietary information. CONFIDENTIAL – Contains proprietary information. Not intended f or external distributiondistribution.. 1 | Clinical Services Group Not intended for external distribution. Overview

CONFIDENTIAL – Contains proprietary information. 2 Not intended f or external distribution. Strategy

• Implement a systems-based project for appropriate indications for catheter placement and reduce overall indwelling catheter utilization. • Project goals: o Support appropriate indwelling catheter policies o Promote alternatives to indwelling catheters. • The algorithm was developed by a multidisciplinary team with input from frontline staff: o No changes can be implemented at the local facility level without group approval o Ongoing evaluation and edits

CONFIDENTIAL – Contains proprietary information. 3 Not intended f or external distribution. Bladder Management Program Options

CONFIDENTIAL – Contains proprietary information. 4 CSG Clinical Informatics | Health IT Policy & Strategy Not intended f or external distribution. BMP Options-Indwelling Urinary Catheter

Appropriate indicators for the insertion of an indwelling urinary catheter are: • acute urinary retention or bladder outlet obstruction • need for accurate urine output measurements in critically ill patients • perioperative use for patients undergoing urologic surgery or other procedures on structures of the genitourinary tract • prolonged surgery (with removal of catheters inserted for this purpose in the post- anesthesia care unit) • surgery requiring large-volume infusions or diuretic use • intraoperative urinary output monitoring • assistance with healing of open sacral or perineal wounds or skin grafts in selected patients with incontinence • prolonged immobilization (such as for a potentially unstable thoracic or lumbar spine or multiple traumatic injuries, including pelvic fractures) • improved comfort for end-of-life care, if needed

CONFIDENTIAL – Contains proprietary information. 5 Not intended f or external distribution. BMP Options- External Urinary Catheters

Indications: • Ask yourself if your patient can tolerate an external device? • If a patient is incontinent and has no perineal/gluteal wounds/skin breakdown, they may be a candidate for an external device!

CONFIDENTIAL – Contains proprietary information. 6 Not intended f or external distribution. BMP Options-Intermittent Catheterization or Void

Intermittent Catheterization Independent Void - bedside commode, urinal, bedpan, Indications absorbent incontinence pad:

• Used in patients with spinal cord Indication: injury, spinal tumors, diabetic • Patient has the ability to void neuropathy, multiple sclerosis, spina independently, can safely ambulate bifida, myelodysplasia, bladder outlet with or without assistance and can obstruction and continent urinary diversion. turn side to side to utilize the bedpan/urinal • Used to manage incontinence, urinary retention and to collect urine Always try to utilize the least specimens for culture and sensitivity. invasive, clinically appropriate bladder management program

CONFIDENTIAL – Contains proprietary information. 7 Not intended f or external distribution. Bladder Management Program Algorithm

Sept. 2020

CONFIDENTIAL – Contains proprietary information. CONFIDENTIAL – Contains proprietary information. Not intended f or external distribution. 8 | Clinical Services Group Not intended for external distribution. Bladder Management Program Algorithm

Decision Making Algorithm:

• The BMP algorithm is a decision making tool that will be utilized by nursing to ensure the bladder management method selected is the least invasive option and clinically appropriate for the patient.

• The algorithm provides guidance for clinical decision making for nursing staff, based on the indication for an ordered indwelling urinary catheter.

• The algorithm helps guide the nurse to the appropriate bladder management method.

• The algorithm is busy at first glance. Focus on the appropriate clinical indication and follow the flow of the diagram from that indication only.

CONFIDENTIAL – Contains proprietary information. 9 Not intended f or external distribution. Bladder Management Algorithm

CONFIDENTIAL – Contains proprietary information. 10 Not intended f or external distribution. Voiding and Urinary Retention Algorithm

CONFIDENTIAL – Contains proprietary information. 11 Not intended f or external distribution. Bladder Management Algorithm (BMA)

• The BMA will be utilized when the order is being placed by the provider to select the most appropriate device for the patient.

• The BMA will be utilized by nursing at least every 24 hours to guide the assessment of ongoing clinical necessity.

• The nurse will review the BMP algorithm and answer the decision- making questions under the clinical necessity of indwelling catheters per facility policy. .

CONFIDENTIAL – Contains proprietary information. 12 Not intended f or external distribution. Documentation

• When selecting the urinary catheter type, utilization of the Purewick is documented as an “external/condom” device.

CONFIDENTIAL – Contains proprietary information. 13 Not intended f or external distribution. Documentation

• Always document the clinical indication for indwelling urinary catheters. • If the clinical reason for an indwelling urinary catheter is not listed as an indication, question the necessity with the provider.

CONFIDENTIAL – Contains proprietary information. 14 Not intended f or external distribution. Documentation • Patients admitted with an indwelling catheter already in place should document appropriately.

• Refer to facility specific policy for management of indwelling catheters in place at time of admission.

CONFIDENTIAL – Contains proprietary information. 15 Not intended f or external distribution. Documentation

• Surgically placed urinary devices must be documented appropriately to ensure accurate device documentation and measurement of device utilization.

CONFIDENTIAL – Contains proprietary information. 16 Not intended f or external distribution. New Order: Bladder Management - Catheter

CONFIDENTIAL – Contains proprietary information. 17 EFD BMP Project Kickoff Not intended f or external distribution. Indwelling Catheter Order-Rules

Order Entry Rule Insert Indwelling Cath Order • A rule is in place not to allow stand alone order Entry • Removed the indication • Removal timeline remains 48 hours

CONFIDENTIAL – Contains proprietary information. 18 EFD BMP Project Kickoff Not intended f or external distribution. Continue Indwelling Order •Must be ordered if catheter is needed past 48 hours. •Indication adjusted based on the algorithm

CONFIDENTIAL – Contains proprietary information. 19 CSG Clinical Informatics | Health IT Policy & Strategy Not intended f or external distribution. Other Urinary Devices

• Straight Cath order • External Device

CONFIDENTIAL – Contains proprietary information. 20 EFD BMP Project Kickoff Not intended f or external distribution. Data Collection

Each patient presents with unique challenges and considerations that clinicians consider when selecting a bladder management program.

The purpose of the data collection form is to begin to generate data that reflects these considerations so that BMP decisions can be analyzed in a systematic way.

CONFIDENTIAL – Contains proprietary information. CONFIDENTIAL – Contains proprietary information. Not intended f or external distribution. 21 | Clinical Services Group Not intended for external distribution. BMP Denominator Form

• This form is a general tool that will allow the study of the inpatient unit’s BMP numbers.

• The form is completed by taking a daily tally of all patients on the unit.

• The tally will occur at the same time every day in order to ensure data consistency.

• Two versions of this form are available for units with and without vents

CONFIDENTIAL – Contains proprietary information. 22 Not intended f or external distribution. FAQs

• Why are we utilizing the BMP algorithm? Careful consideration for appropriate catheter indications will reduce indwelling catheter utilization and decrease infection risks.

• When do I use the BMP algorithm? Use of the tool begins when a provider initiates an order for an indwelling catheter. At this point, the clinical team utilizes the form to capture considerations made when selecting the patient’s BMP.

• Where do I find the nursing procedures? Facility specific policy and procedures and EBSCO nursing procedures

• Do I need an order to change bladder management? Consider your facility specific policy. For example, you may need an order, if re-inserting an indwelling catheter unless addressed through nursing policy in your facility.

• What else can I do to reduce indwelling catheter related infections? Utilize the BMP algorithm at least every 24 hours. Adhere to evidence based care bundles to prevent CAUTI.

• Once there is an order for an indwelling catheter and the BMA lands on a non-indwelling catheter, what are the steps to change the order? The care team will contact the provider to discontinue the order.

CONFIDENTIAL – Contains proprietary information. 23 Not intended f or external distribution.