Changing Behavior among Nurses to Track Indwelling Urinary Catheters in Hospitalized Patients

Abstract

Catheter-associated urinary tract infections (CAUTIs) are preventable complications of hospitalization. An interdisciplinary team developed a curriculum to increase awareness of the presence of indwelling urinary catheters (IUCs) in hospitalized patients, addressed practical, primarily nurse-controlled inpatient risk-reduction interventions, and promoted the use of the IUC labels (“tags”). Five thirty-minute educational sessions were cycled over three daily nursing shifts on two inpatient medical floors over a 1-year period; participants were surveyed (n = 152) to elicit feedback and provide real-time insight on the learning objectives. Nurse self-reported IUC tagging was early and sustained; after the IUC tag was introduced, there was a significant increase in tagging reported by the end of the block of educational sessions (from 46.2% to 84.6%, P = 0.001). Early engagement combined with a targeted educational initiative led to increased knowledge, changes in behavior, and renewed CAUTI awareness in hospitalized patients with IUCs. The processes employed in this small-scale project can be applied to broader, hospitalwide initiatives and to large-scale initiatives for healthcare interventions. As first-line providers with responsibility for the placement and daily maintenance of IUCs, nurses are ideally positioned to implement efforts addressing CAUTIs in the hospital setting.

Urinary Catheter Use and Appropriateness in U.S. Emergency Departments, 1995–2010

“…Nurses should be empowered to discuss the utility of catheters as physician-nurse engagement around CAUTI reduction has been successful on inpatient services. 31,32 Scott et al 33 implemented an ED-based multimodal intervention including an education program based on ED staff perceptions that resulted in a 25% decrease in the ED placement of catheters in admitted patients and a 9% decrease in the inappropriate use of catheters.…”

Do System-Based Interventions Affect Catheter-Associated Urinary Tract Infection?

“…Finally, multifaceted interventions often incorporated audits and feedback. 22 Meddings et al 20 Fuchs et al 23 Elpern et al 24 Fakih et al 7 Apisarnthanarak et al 25 Knoll et al 1 …”

“…22 Existing evidence for the interventions reviewed ranged from level A (daily reminder systems) to level C (education and product review/standardization; Table 2). Table 3 summarizes key impacts of these interventions.…”

“…11 Another option involves embedding approved indications into electronic order sets so that physicians must select the indication before inserting the catheter. 1 Yoon et al 22 trained staff to tag/date the catheter at the time of insertion. This visual reminder tells the health care team when the catheter was placed, obviating having to look up this information during daily review and bedside rounding.…”

Impact of Protocol of Care of Patients Undergoing Urinary Catheterization on Nurses, practice

“…The culture of evidence-based practice can be promoted within the organization, motivating nurses and other clinical staff to pursue evidence-based practice in their scope of work and compete with the rapid clinical advances and information explosion. Furthermore, the new protocol may also strengthen the concept of patient safety and hospital acquired infection (HAI) prevention (Pui, 2011).Nurses are responsible for placing and maintaining the urinary catheter system; including cleaning and other tasks in addition nurses play a vital role in the diagnosis of catheter associated urinary tract infection (Yoon et al, 2013).…”