This article is more than 5 years old. Information may no longer be current.

Empowering nurses to remove urinary catheters results in use decrease, less CAUTIs

An intervention in a general medicine ward found that a medical directive allowing nurses to remove urinary catheters was associated with positive outcomes, according to data published in JAMA Internal Medicine.

Jerome A. Leis, MD, MDc , and colleagues reported that implementation of the urinary catheter directive led to a significant decrease in use of UCs and catheter-associated urinary tract infections (CAUTIs).

"On a busy general medicine ward, delays in reassessment of [urinary catheters] can lead to [CAUTI]," Leis, an associate scientist at Sunnybrook Health Sciences Centre, and colleagues wrote. "Interventions aimed at physicians reduce unnecessary [urinary catheter] use, but empowering nurses to remove [urinary catheters] through the use of medical directives remains an underused strategy."

The researchers conducted a controlled before-and-after study of patients in a general medicine ward. Two general medicine wards implemented the medical directive as part of the intervention and two general medicine wards continued with usual practice. Nurses involved in the study participated in a 20-minute training session.

Results showed that the number of catheter-days per patient decreased after intervention to 410 of 4,816 days (8.5%; 95% CI, 7.8-9.3) compared with control wards that saw 794 catheter-days of 5,364 patient days (14.8%; 95% CI, 13.9-15.8); P < .001).

The researchers stated that, at baseline, CAUTIs per patient-days were 11 of 6,503 (1.7 per 1,000 patient days) and 10 of 7,011 (1.4 per 1,000 patient-days) in the intervention and control wards, respectively. After implementation of the medical directive, the intervention ward reported one per 4,816 (0.2 per 1,000 patient-days), which was less than the control ward, which reported eight of 5,364 (1.5 per 1,000 patient-days; P = .03).

"We observed a significant increase in [urinary catheter] use and CAUTIs following implementation of a medical directive allowing nurses to remove [urinary catheters], compared with wards that relied on usual practice," Leis and colleagues wrote. "Our experience adds to the literature supporting medical directives to reduce [urinary catheter] use and provides an example of a directive specifically designed for [general medicine] patients.

"The key to implementing this intervention was obtaining consensus among all [general medicine] physicians regarding criteria for [urinary catheter] removal and engaging nurse leaders," they concluded. – by Chelsea Frajerman Pardes

Disclosures: The authors report no relevant financial disclosures.