Improving safety in urinary catheter care

SAVE ITEM
Nurse taking notes

19 / 2 / 2013 1.57pm

The organisation

What they did and why

How they did it

Results and next steps

Tips for other trusts

Further information and contacts 

                                                           

The organisation

Nottingham University Hospitals NHS Trust (NUH) provides services to over 2.5 million residents of Nottingham and its surrounding communities, as well as specialist services for a further 3-4 million from across the region.  There are around 1,700 beds in NUH.  The hospital trust employs around 13,500 people, with a wide variety of specialities.  It includes a large team specialising in infection control.

What they did and why

The Commissioning for Quality and Innovation (CQUIN) framework helps providers to set local quality improvement goals.  Trusts who perform excellently against their goals are recognised by commissioners.  One of CQUIN's aims is to increase the measurement of harm from pressure ulcers, falls, urinary tract infections in patients with catheters and venous thrombosis.

Following the release of the CQUIN targets for 2010/11, the NUH infection and control team carried out an audit of practice, and an anonymous staff questionnaire in relation to urinary catheters.  These both showed that there was room for improvement in practice.  Driven by an aim to reduce infection, reduce hospital stays, and improve patient experience, one of the nurses led the development and submission of a bid to the East Midlands Health Innovation Education Cluster for funding to develop an e-learning tool.

E-learning was thought to be a good solution, as the training could be undertaken at a time convenient to both the clinical area and the member of staff.  The resource was developed to be accessed online from devices outside the Trust, as well as within it.  Additionally, the different training modules could be completed individually, over a period of time as opposed to all in one go.

The proposal was developed by two managers from the infection control team, and one university partner (Nottingham University).  Its aim was to develop an accessible e-learning module with the aim of raising awareness about catheter associated urinary tract infections, and improving practice in the trust, to ultimately reduce infection rates.  The e-learning was intended to be accessed by student nurses, health care assistants, registered nurses and any other healthcare professional who may need to work with a urinary catheter.  The bid for funding was approved. 

How they did it

Project members were identified and invited to join a project group. Choosing the right contributors was key to being able to develop an up to date, relevant and useful resource.  The group was made up of NUH staff, their university partner (Nottingham), patient representatives, an industry representative (from TENA), and community infection prevention and control and continence staff.  The group worked together to develop eight training modules.

The learning modules are all:

  • based on local issues and experience
  • accessible, using terminology used by the widest variety of staff working with catheters possible
  • not too prescriptive, to allow learners to apply it to their local policy and practice
  • freely accessible online.

Results and next steps

Eight modules have now been completed. They guide learners through topics such as:

  • different modes of practice for their area of work,
  • risks involved in catheter insertion,
  • the importance of record keeping,
  • and alternative methods of treatment to consider prior to catheterisation. 

The e-learning tool is hosted by Nottingham University.  It can be accessed freely by all staff whose work it is relevant to, via the web.

The training includes a 'feedback' section at the end, intended to help its developers to gauge how useful learners perceived it to be, but also to understand to what extent the information was retained by each learner.  The feedback is collected on a separate website, hosted by the Centre for Excellence in Teaching and Learning (CETL), freely accessible to anyone.

Although the training was made live in September 2012, a decision was made to publicise it and promote it in January 2013.  Waiting until after a very busy period for NHS staff is intended to maximise take up figures, and its launch has been planned to align with other workforce programmes such as 'Pressure ulcer prevention', 'Preventing falls', and 'Nutrition'.

The training is being promoted through a trust wide campaign, via the trust intranet and on study/training days.  NUH has displayed a poster on the package at national conferences and the information has been distributed to a network of colleagues.  The trust has made plans for evaluating the training, and for monitoring take up figures.  These will be used to improve the training and promotion of it.

Tips for other trusts

It is essential to have the right people steering the project to ensure the content of any e-learning is correct from the start.  This can be costly to correct at a later stage.  Where possible, Involve someone from the team building the e-learning software from the start to help provide clarity on the size, scope and timescales for the work.  Having a mixture of acute and community staff representatives involved in the development of the training proved invaluable, as they were able to help ensure that the language and terminology used in the e-learning was accessible and relevant to a wide portion of staff.

In order to reach a greater number of learners, it is worth considering not making the training too prescriptive.  This training was developed with a view to learners being able to adapt it to their own employer's policies and practices.

Making e-learning assessed has its benefits, but it may also be worth considering different ways of assessing learning, so as not to deter learners from using the resource.

One of the key challenges faced in developing this package, was time constraints for those involved.  Being clear about necessary timescales, and setting realistic deadlines with everyone involved in the work helps to prevent delays.

Further information and contacts

Amy Cartwright
Team lead and Nurse specialist for continence
Email: amy.cartwright@nuh.nhs.uk

 

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