“When our nurses feel like they have a say in their practice, they’re more likely to be engaged,” says Margaret Collazo, DBA, MSN, Chief Nursing Officer for Temple Health-Chestnut Hill Hospital. That’s why her team has worked so hard to educate and empower the staff on campus, which has played a large role in their recent quality achievements.
The 3 Front Surgical unit hasn’t had a Catheter-Associated Urinary Tract Infection (CAUTI) since April of 2022. 3 South, a Med/Surg unit, hasn’t had a CAUTI or a Central Line-Associated Bloodstream Infection (CLABSI) since March 2022, while the ICU hasn’t had a CLABSI since June of 2023.
“This wouldn’t have been possible without the partnership between the Chestnut Hill leadership team, Infection Prevention, our education department, and the bedside staff,” Collazo says. “Jennifer White, BSN, RN, our Infection Prevention & Control Coordinator, has spearheaded the process: she’s always rounding, checking on lines and Foleys, and following up with the bedside nurses and team members when a catheter is no longer indicated.”
“Elizabeth Curran, RN has been phenomenal in educating our nurses about proper methods of insertion, why we should have a line, and when a line is or isn’t indicated,” Collazo continues. “She’s also a great resource on the floor for the staff nurses. That’s critical, because we have to have the buy-in of the bedside staff. If they don’t understand why it’s important to remove a line or a Foley, or why they shouldn’t put one in if it’s not necessary, then you won’t be able to make a real difference in patient safety.”
An Investment in Accountability
This emphasis on education has been accompanied by an investment in improved products, including the Care Dry female external catheter system and the Sure Fit male external catheter.
“These products—especially the Care Dry—are so much easier to use, and both our patients and staff like them,” White says. “We’re also using them across the entire Health System now, which is part of our push for greater standardization. We want to institute the practices from the best-performing departments across Temple on all of our units, with the hope that we’ll have zero CAUTIs and CLABSIs across all of TH-CHH.”
These changes have been particularly acute, and successful, in the ICU. “We now work really hard to make sure that patients don’t leave the ICU with a line or a Foley,” White says. “If a team member says the patient has to, I start questioning them about the line. I ask, ‘Why is it there? Why do they have it?’ and I ask them to write a note justifying their decision. This holds them accountable, and then I’m constantly checking with them to see if the lines are still in.”
A Culture of Respect
White and Collazo are always working to improve care at the hospital—and for them, that starts with listening to staff. “I genuinely believe that people don’t come to work to make mistakes,” says Collazo. “They come here to do a really good job. So when there’s a gap, we have to figure out what’s happening and what’s missing. Do we have to show them a different way to do things? Do we have to help them understand the ‘why’ behind the ‘what?’ Because nine times out of ten, once we explain things more in depth, the team member gets it, and that mistake is corrected.”
“It also goes the other way,” she continues. “Maybe they’re not engaging in a certain practice because it doesn’t work. We always say, ‘If we don’t know, we can’t fix it, so you have to tell us if that’s happening.’ We’re always open to listening to what’s going on, and to making adjustments based on feedback.”
This approach has created a culture of respect between nurses, educators, and leadership, and made bedside staff eager to institute changes that have improved patient safety. “Once they’ve realized why we’re making these changes, they’ve been really invested in ensuring they’re doing the right things,” White says. “We’ve been working together as a team to monitor all central lines and urinary catheters, and to make sure that all processes are in place to prevent infection.”
It's an attitude to be proud of, and that will be sure to lead to continued quality achievements at Chestnut Hill. “Everyone is really proud of their work and what we’ve accomplished,” says Collazo. “We’re definitely going to keep going in the right direction.”