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Description

Introduction: Catheter associated urinary tract infections (CAUTI) can place significant financial burden on healthcare facilities, decrease quality of care and increase length of stay. Reducing indwelling urinary catheter days reduces the risk of a CAUTI. Current practice after catheter removal includes the reinsertion of the catheter if the patient demonstrates three episodes of urinary retention that requires intermittent urinary catheterization. Intermittent urinary catheterization, when implemented appropriately, has proven to be safe and decreases risk for urinary infection.

Background: Several initiatives have been introduced to decrease hospital CAUTI rates, including nursing education on appropriate urine culture collection, use of root cause analysis (RCA) tools to identify problem areas, and nurse driven removal protocols when catheters are no longer indicated. Despite some decreased catheter utilization rates, CAUTIs continued to occur. Data obtained through RCAs revealed a trend of catheter re-insertions due to urinary retention. A nurse driven pathway was developed using bladder scan and straight catheterization protocols with emphasis on not re-inserting catheters.

Study Aim: By utilizing an algorithm for monitoring patients after catheter References removal, which includes routine bladder scan assessment and intermittent urinary catheterization if applicable, this study aimed to reduce the incidence of reinsertion of an indwelling catheter. Decreased re-insertion rates contribute to decreased urinary catheter utilization days and decreased risk for CAUTIs.

Results: Metrics utilized to determine improvement included indwelling catheter utilization days and CAUTI count. Catheter days is defined as the number of days an indwelling catheter is in place. Each unit was compared to the previous year for the months of September, October, and November. The combined decrease of catheter days for all units was 17%, 23%, and 34% for September, October, and November, respectively.

Discussion:

Reducing the use of urinary catheters can reduce rates of catheter-associated urinary tract infections and their associated morbidities. Development of one standard protocol, in collaboration with urology provider input, and applying it across a variety of patient populations led to increased utilization of the protocol by the nursing staff. Improvement was also seen in nurses’ awareness and understanding of urinary retention post catheter removal and using bladder scanning and intermittent catheterization appropriately when needed. Due to the initial success of this project, the UCANP initiative is currently being implemented on additional units and will continue until all patient-care areas of the hospital are included.

Publication Date

9-23-2021

Comments

Presented at the Henry Ford Health System 15th Annual Nursing Research Conference: Nurses Leading the Way through Clinical Nursing Research and Evidence-Based Practice on Thursday, September 23, 2021.

UCANP: Urinary Catheter Alleviation Navigation Protocol Quality Improvement Project

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