A Quality Improvement Project To Reduce the Complications Associated with Indwelling Urinary Catheters

Headnote

The indwelling urinary (Foley®) catheter is a widely utilized device in the modern hospital environment in the United States. Under certain established medical conditions, these devices serve as a valuable tool in patient care. However, many indwelling urinary catheters are either placed inappropriately or are left in place longer than their intended use. This article describes a quality improvement project undertaken at the University of North Carolina Healthcare, Memorial Hospital, 8 Bed Tower Nursing Unit that developed and implemented a nurse-driven protocol to manage some of the risks associated with the use of these devices. The hospital team involved in this project was able to decrease the overall prevalence of indwelling urinary catheters from 24% to 17%.

© 2008 Society of Urologic Nurses and Associates Urologic Nursing, pp. 465-467, 473.

Key Words: Foley catheter, catheter-associated urinary tract infection (CAUTI), nursing protocol.

Introduction

The University of North Carolina Health Care System, Memorial Hospital, Medicine Service developed a nurse-driven protocol to remove unnecessary indwelling urinary catheters.

Purpose

To reduce the prevalence of unnecessary indwelling urinary catheters as well as the rate of catheterassociated urinary tract infections

Method

Quality improvement study design.

Findings

Prevalence of indwelling urinary catheters decreased from a baseline prevalence rate of 24% to a post-intervention rate of 17%. The rate of catheter-associated urinary tract infections was not reduced.

Conclusions

An independent, nurse-driven, protocol can reduce the prevalence of unnecessary indwelling urinary catheters.

Level of Evidence - VI

It has been estimated that between 16% and 25% of hospitalized patients in the United States receive an indwelling urinary (Foley®) catheter at some time during their hospital stay (Weinstein et al., 1999). One study found that 21% of those patients with an indwelling urinary catheter did not meet established criteria for its initial insertion and that almost 50% had the device left in place longer than necessary (Jain, Parada, David, & Smith, 1995).

There are many complications of indwelling urinary catheters. Bacteriuria can occur in about one half of the patients who have an indwelling urinary catheter for five days or more (Tambyah, Halvorson, & Maki, 1999). Although most cases of bacteriuria are asymptomatic and resolve spontaneously once the catheter is removed, Warren (1997) noted that as many as 30% of patients with catheterassociated bacteriuria...