De-implementation strategy to Reduce the Inappropriate use of urinary and intravenous CATheters: study protocol for the RICAT-study

Abstract

BackgroundUrinary and (peripheral and central) intravenous catheters are widely used in hospitalized patients. However, up to 56% of the catheters do not have an appropriate indication and some serious complications with the use of these catheters can occur. The main objective of our quality improvement project is to reduce the use of catheters without an appropriate indication by 25–50%, and to evaluate the affecting factors of our de-implementation strategy.MethodsIn a multicenter, prospective interrupted time series analysis, several interventions to avoid inappropriate use of catheters will be conducted in seven hospitals in the Netherlands. Firstly, we will define a list of appropriate indications for urinary and (peripheral and central) intravenous catheters, which will restrict the use of catheters and urge catheter removal when the indication is no longer appropriate. Secondly, after the baseline measurements, the intervention will take place, which consists of a kick-off meeting, including a competitive feedback report of the baseline measurements, and education of healthcare workers and patients. Additional strategies based on the baseline data and local conditions are optional. The primary endpoint is the percentage of catheters with an inappropriate indication on the day of data collection before and after the de-implementation strategy. Secondary endpoints are catheter-related infections or other complications, catheter re-insertion rate, length of hospital (and ICU) stay and mortality. In addition, the cost-effectiveness of the de-implementation strategy will be calculated.DiscussionThis study aims to reduce the use of urinary and intravenous catheters with an inappropriate indication, and as a result reduce the catheter-related complications. If (cost-) effective it provides a tool for a nationwide approach to reduce catheter-related infections and other complications.Trial registrationDutch trial registry: NTR6015. Registered 9 August 2016.

Prevention of Catheter-Associated Urinary Tract Infection: What Is the Gap in Clinical Practice?

“…Process indicators are a useful tool to do this, since they enable systematic evaluations of the interventions and consequently propositions of directed and structured educational strategies, since the inadequacy of a single indicator is sufficient for CAUTI to occur. 3,11,[24][25][26][27] Regarding limitations of the present study, it can be pointed out that the study only being carried out in one institution restricts extrapolation or comparison of the results, possibly interfering in its external validity.…”

“…22 Multiple, well-designed interventions such as those developed in the bundle are able to reduce the number of healthcareassociated infections. 24 Their implementation requires knowledge and adherence to preventive measures, technical ability and periodic training by all of the multidisciplinary team. Process indicators are a useful tool to do this, since they enable systematic evaluations of the interventions and consequently propositions of directed and structured educational strategies, since the inadequacy of a single indicator is sufficient for CAUTI to occur.…”

De-implementation: A concept analysis

“…These contextual factors include organizational leadership and setting at either the administrative level or localized using unit‐based “de‐implementation champions.” At either level, there needs to be a willingness to initiate change and to facilitate the process through stakeholder engagement. The ultimate goal is to work toward sustainability of the clinical practice change by adopting a systems change perspective from the beginning . Additional contextual factors include understanding the: history of the practice to be changed such as evolution of a provider's worldview regarding a practice; economic forces , including the possible financial structure of a practice that may influence the desire to de‐implement or maintain the practice; politics and specialty organizations that may rely on the practice to be maintained; social context , including consumer awareness that may be a source of motivation for providers to de‐implement a practice. …”

“…The ultimate goal is to work toward sustainability of the clinical practice change by adopting a systems change perspective from the beginning. 1,11,33,34 Additional contextual factors 35 include understanding the:…”

De‐implementation of tradition‐based practices in critical care: A qualitative study

“…Examples of de-implementation for practices associated with harm include early removal of central venous and urinary catheters, prevention of unnecessary peripheral intravenous catheter insertions, and stopping auscultation to assess feeding tube (FT) placement (Berenholtz et al, 2004;Bourgault, Heath, Hooper, Sole, & Nesmith, 2015;Laan et al, 2017;Pronovost et al, 2006). Despite connection to patient harm, someTBPs such as verification of FT placement using auscultation have been an ongoing challenge to de-implement (Bourgault et al, 2015;Metheny, McSweeney, Wehrle, & Wiersema, 1990).…”