Stop Orders to Reduce Inappropriate Urinary Catheterization in Hospitalized Patients: A Randomized Controlled Trial

Abstract

BACKGROUND: Hospitalized patients frequently have urinary catheters inserted for inappropriate reasons. This can lead to urinary tract infections and other complications.OBJECTIVE: To assess whether stop orders for indwelling urinary catheters reduces the duration of inappropriate urinary catheterization and the incidence of urinary tract infections. DESIGN:A randomized controlled trial was conducted in three tertiary-care hospitals in Ontario, Canada. Patients with indwelling urinary catheters were randomized to prewritten orders for the removal of urinary catheters if specified criteria were not present or to usual care.PARTICIPANTS: Six hundred ninety-two hospitalized patients admitted to hospital with indwelling urinary catheters inserted for ≤48 h. MEASUREMENTS:The main outcomes included days of inappropriate indwelling catheter use, total days of catheter use, frequency of urinary tract infection, and catheter reinsertions. RESULTS:There were fewer days of inappropriate and total urinary catheter use in the stop-order group than in the usual care group (difference −1.69 [95% CI −1.23 to −2.15], P<0.001 and −1.34 days, [95% CI, −0.64 to −2.05 days], P<0.001, respectively). Urinary tract infections occurred in 19.0% of the stop-order group and 20.2% of the usual care group, relative risk 0.94 (95% CI, 0.66 to 1.33), P=0.71. Catheter reinsertion occurred in 8.6% of the stop-order group and 7.0% in the usual care group, relative risk 1.23 (95% CI, 0.72 to 2.11), P=0.45. CONCLUSIONS:Stop orders for urinary catheterization safely reduced duration of inappropriate urinary catheterization in hospitalized patients but did not reduce urinary tract infections.KEY WORDS: urinary tract infections; urinary catheters; randomized controlled trial; stop order.

Using A Criteria-Based Reminder To Reduce Use Of Indwelling Urinary Catheters And Decrease Urinary Tract Infections

“…1,5,6,8,15 Strategies to decrease the duration of catheterization have been recommended, such as reminding physicians to review whether a catheter is still appropriate and using automatic stop orders to facilitate the removal of catheters when the devices are no longer needed. 8,22 However, in 2 studies, 20,23 use of these approaches had no significant effect on the rate of UTIs. Using a before-and-after crossover design, Cornia et al 23 found that use of "computerbased order entry" did not significantly decrease the UTI rate.…”

The effect of a short educational intervention on the use of urinary catheters: a prospective cohort study

“…However, similar to other studies [23,30], we found its use in the context of this study of limited value, as it failed to reflect important practice changes. Comparable intervention studies show similar results with respect to catheter use and CAUTI rate [6,11]; despite fewer catheter days [31] or reduced duration of inappropriate urinary catheterization [10], the CAUTI rate is not always reduced. This may be explained by how the CAUTI rate is calculated [3], i.e.…”

“…Diverse interventions that focus on limiting catheter use and on their prompt removal may significantly reduce CAUTIs [3, [9][10][11]. Education of nursing staff, electronic reminders aimed at reducing the duration of invasive devices [6,12], such as automatic stop orders [13], and the use of nurses specially trained to lead implementation projects (change champions) [12] have proved to be effective in changing practice and reducing CAUTIs [14].…”

How to Write Up Your Quality Improvement Initiatives for Publication

“…A sensible solution therefore might bypass the physician altogether. For example, instituting automatic stop orders 7 and nursing advanced directives 8 to remove urinary catheters are 2 interventions that have previously been shown to be effective.…”