Wednesday, March 13, 2013

The Importance of Bedside Nurses for the Reduction of Urinary Catheter Use

This week I am giving the VCUHS Forum Grand Rounds on infection prevention and safety. A topic of discussion is the prevention of urinary catheter associated infections.  Unfortunately, urinary catheters are overused, frequently without appropriate indications thereby predisposing patients to urinary tract infections.

Here is a timely article in the American Journal of Infection Control on the importance of the bedside nurse for the evaluation of urinary catheter necessity. The study reports the effect of 3 interventions over 5 years: a nurse-driven multidisciplinary effort for early urinary catheter removal, an intervention in an emergency department to promote appropriate placement, and twice-weekly assessment of urinary catheter prevalence with periodic feedback on performance.

The investigators assessed the views of bedside nurses, case managers, and nurse managers with respect to appropriate catheter use, how often need is assessed, and who they consider responsible for the evaluation of urinary catheter need.

The outcome: a significant reduction in urinary catheter use from 17.3%-12.7% during the 5-year period (linear regression with time as independent variable, R2, 0.61; P < .0001) was documented. Of bedside nurses, 222 of 227 (97.8%) identified themselves as responsible or as sharing the responsibility for catheter necessity evaluation, 223 of 229 (97.4%) were confident in their knowledge, and 166 of 222 (74.8%) viewed physicians as receptive to their requests for catheter removal >70% of the time.

Nurses are critically important front line providers and their opinions matter. Sustained reductions in urinary catheter use is impossible without their enthusiasm and collaboration.

2 comments:

  1. When I had to get a urinary catheter I made sure I knew everything about it. When I go to the hospital I let the nurses do their job and thank heavens for good educated nurses. I probably would have a urinary tract infection if it wasn't for them.

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