title: Virtual Breakthrough Series, Part 1: Preventing Catheter-Associated Urinary Tract Infection and Hospital-Acquired Pressure Ulcers in the Veterans Health Administration.
abstract: In 2014 the Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) implemented a Virtual Breakthrough Series (VBTS) collaborative to help VHA facilities prevent hospital-acquired conditions: catheter-associated urinary tract infection (CAUTI) and hospital-acquired pressure ulcers (HAPUs).
  
  
  
  During the prework phase, participating facilities assembled a multidisciplinary team, assessed their current system for CAUTI or HAPU prevention, and examined baseline data to set improvement aims. The action phase consisted of educational conference calls, coaching, and monthly team reports. Learning was conducted via phone, web-based options, and e-mail. The CAUTI bundle focused on four key principles: (1) avoidance of indwelling urinary catheters, (2) proper insertion technique, (3) proper catheter maintenance, and (4) timely removal of the indwelling catheter. The HAPU bundle focused on assessment and inspection, pressure-relieving surfaces, turning and repositioning, incontinence management, and nutrition/hydration assessment and intervention.
  
  
  
  For the 18 participating units, the mean aggregated CAUTI rate decreased from 2.37 during the prework phase to 1.06 per 1,000 catheter-days during the action (implementation) phase (p < 0.001); the rate did not change for CAUTI nonparticipating sites. HAPU data were available only for 21 of the 31 participating units, whose mean aggregated HAPU rate decreased from 1.80 to 0.99 from prework to continuous improvement (p < 0.001). Staff education and documentation improvement were the most frequently implemented changes.
  
  
  
  This project helped improve CAUTI and HAPU rates in the VHA and presents a promising model for implementing a virtual model for improvement.
authors.affiliation: Health Science Specialist, White River Junction Department of Veterans Affairs (VA) Medical Center, White River Junction, Vermont; Assistant Professor of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Electronic address: Lisa.Zubkoff@va.gov.
authors.forename: Lisa
authors.initials: L
authors.lastname: Zubkoff
authors.affiliation: VA National Center for Patient Safety (NCPS), White River Junction.
authors.forename: Julia
authors.initials: J
authors.lastname: Neily
authors.affiliation: VA NCPS, Ann Arbor, Michigan.
authors.forename: Beth J
authors.initials: BJ
authors.lastname: King
authors.affiliation: Research Nurse Scientist, VA San Diego Healthcare System; Clinical Professor of Nursing, Hahn School of Nursing and Health Science, University of San Diego.
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: Dellefield
authors.affiliation: Research Career Scientist, Center for Clinical Management Research, VA Ann Arbor Healthcare System; Research Professor, Internal Medicine, with an adjunct appointment, School of Nursing at the University of Michigan, Ann Arbor.
authors.forename: Sarah
authors.initials: S
authors.lastname: Krein
authors.affiliation: White River Junction VA Medical Center.
authors.forename: Yinong
authors.initials: Y
authors.lastname: Young-Xu
authors.affiliation: White River Junction VA Medical Center.
authors.forename: Shoshana
authors.initials: S
authors.lastname: Boar
authors.affiliation: Director, VA NCPS, White River Junction; Adjunct Associate Professor of Psychiatry, Geisel School of Medicine at Dartmouth.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Mills
mesh_terms: D055499:Catheter-Related Infections / Q000517:prevention & control*; D003299:Cooperative Behavior; D003695:Delivery of Health Care / Q000458:organization & administration*; D019468:Disease Management; D006787:Hospitals, Veterans; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D007318:Inservice Training; D017146:Models, Organizational; D010348:Patient Care Team / Q000458:organization & administration*; D003668:Pressure Ulcer / Q000517:prevention & control*; D011785:Quality Assurance, Health Care / Q000379:methods*; D058996:Quality Improvement; D011795:Surveys and Questionnaires; D014481:United States; D014493:United States Department of Veterans Affairs; D014552:Urinary Tract Infections / Q000517:prevention & control*; D058014:Veterans Health