Improving urinary catheterisation practices in a rural hospital in Ontario

Abstract

Introduction A urinary catheter constitutes a one-point patient restraint, can induce deconditioning and may lead to patient mortality. An audit performed at Winchester District Memorial Hospital revealed that 20% of patients had a urinary catheter, of whom 31% did not meet the criteria for catheterisation. The main objective of this study was to use the Influencer Change Model and the Choosing Wisely Canada toolkit to create a bundle of interventions that would reduce the unnecessary use of urinary catheters in hospitalised patients. Methods In a rural teaching hospital, a time-series quasiexperiment was employed to decrease inappropriate use of urinary catheters. Both the Choosing Wisely Canada toolkit for appropriate use of urinary catheters and the Influencer change management approach were used to create effective interventions. Results This study revealed that there was no improvement in appropriate urinary catheter use during Plan-Do-Study-Act (PDSA) cycle 1. There was gradual improvement during PDSA cycle 2, with the percentage of inappropriate urinary catheter use dropping from an initial 31% before any interventions to less than 5% by the end of this study. Discussion/conclusion This study aimed to reduce the inappropriate use of urinary catheters in a rural hospital with limited resources. The findings indicate that by using a change model, such as the Influencer Change Model, it is possible to promote better patient care through empowering healthcare staff to implement accepted protocols more stringently and thereby to decrease the inappropriate use of urinary catheters to 0%.

Where Do Models for Change Management, Improvement and Implementation Meet? A Systematic Review of the Applications of Change Management Models in Healthcare

“… 63 A multidisciplinary team reported the use of the Influencer Change Model, which seeks to address both motivation and ability across personal, social and structural levels, to enhance appropriate use of urinary catheters in a hospital in Canada. 59 This behaviourally focused approach was combined with PDSA cycles and led to a significant reduction in inappropriate catheter use. 59 A key factor identified by the authors in the success of the approach was the multi-modal change techniques to address more than just informational needs.…”

“… 59 This behaviourally focused approach was combined with PDSA cycles and led to a significant reduction in inappropriate catheter use. 59 A key factor identified by the authors in the success of the approach was the multi-modal change techniques to address more than just informational needs.…”

“… Dredge 37 2017 Mixed Methods Working party and survey Calvary Health Care Bethlehem community palliative care service, NSW, Australia Nurses in an outpatient palliative care service Kotter’s 8-step To change anticipatory medicine practices in palliative care Study identified carers found it difficult to attend training however, found the step by step instructions useful to administer medicines in a timely manner without a nurse. Gazarin 59 2020 Quasi-experimental Surveillance data Rural Teaching Hospital, Canada 224 patients with urinary catheters Influencer Change Model and the Choosing Wisely Canada toolkit To create a bundle of interventions that would reduce the unnecessary use of urinary catheters in hospitalised patients There was gradual improvement during PDSA cycle 2, with the percentage of inappropriate urinary catheter use dropping from an initial 31% before any interventions to less than 5% by the end of this study. Hennerby 65 2011 Quantitative Competency assessment tool Acute children’s hospital, Dublin, Ireland Registered general agency nurses Young’s nine stage framework Implementation of a competency assessment tool for registered general agency nurses 18% of agency nurses scored below expected standard and were not employed.…”

“…[29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] Eight studies referenced their application of the Lewin 3-Stage Model of Change into a healthcare setting, [48][49][50][51][52][53][54][55] with three further studies that integrated the Lewin model with a concern-based change management approach, McKinsey 7S Model of Change, and Roger's Diffusion of Innovation Theory, respectively. [56][57][58] A further eight articles reported the use of six further models for managing and leading change: Influencer Change Model (1 study); 59 Prosci ADKAR (1 study); 60 Accelerated Implementation Methodology (AIM) (2 studies); 61,62 Advent Health Clinical Transformation Model (1 study); 63 Riches 4 stage model (1 study); 64 Youngs Nine Stage Framework (1 study), 65 and the CAP model (1 study). 66…”

I-DECIDED® – A decision tool for assessment and management of invasive devices in the hospital setting

“…Daily assessment of invasive devices for continued need and early detection of complications enhances patient safety. Implementation studies of multimodal bundles, including daily prompts of device necessity, have achieved reduction in utilization of IUCs (Gazarin et al, 2020;Giles et al, 2020;Kuriyama et al, 2019;Niederhauser et al, 2019;Schweiger et al, 2020), CVADs (Kara et al, 2016;Kleinman Sween et al, 2021;Walz et al, 2015;Xiong & Chen, 2018), CVADs and IUCs (Chandramohan et al, 2018;Kaminski et al, 2021;Mena Lora et al, 2020), IUCs and PIVCs (Laan et al, 2020), andPIVCs (Egerton-Warburton et al, 2019;Mestre et al, 2013;Yagnik et al, 2017). Interventions that employ education, daily reminders, and automated stop-orders demonstrate greater clinician awareness of device use and prompt removal of unnecessary devices, with subsequent reductions in complications and infections (Kleinman Sween et al, 2021;Meddings et al, 2020;Mitchell et al, 2019;Yu et al, 2020), but continued vigilance is crucial (Chandramohan et al, 2018).…”