ISR 89 - Use of an Innovative Nurse-driven Strategy to Decrease Indwelling Catheter Utilization

Background: Poor outcomes related to Catheter Associated Urinary Tract Infections (CAUTIs) include increased morbidity, mortality, length of stay and cost of care. An estimated 70% of CAUTI are preventable using known strategies, the cornerstone being early indwelling catheter removal. Delayed discontinuation of indwelling catheters (ICD) is common despite availability of external collection devices (ECDs) designed to capture urinary output. Following a rise in CAUTI, one hospital implemented a nurse-driven intervention designed the ICD standardized utilization ratio (SUR). Targeted nursing education addressed inappropriate usage, barriers to discontinuation, protocol adoption and proper use of a new male ECD. Meanwhile, multidisciplinary engagement, including C level management, drove improved process and compliance.

Methods: The intervention was implemented across all levels of care at the level IV hospital. A retrospective pre-post study assessed the outcome variable, SUR, using a balanced eight month pre-post model. The predictor variable was the intervention and additional variables included in the model were unit and month. A general linear model (GLM) was used to evaluate interaction terms and determine which terms must remain in the model. Using the reduced model, analysis of variance (ANOVA) was used to assess significance at 5% while residual analysis of the reduced model was used to check assumptions of the GLM.

Results: ANOVA revealed a statistically significant reduction for indwelling catheter SUR following implementation of the intervention (p < 0.001) with average SUR ratios falling from 0.81 to 0.58 pre and post intervention, respectively. Additionally, the hospital has reported only one CAUTI in the seven months following implementation compared to four in just three months prior.

Conclusions: These data indicate success of the intervention for decreasing SUR, an important step towards reducing risk of CAUTI. Patient outcomes improve when nurses are empowered to implement practice changes that consider nursing workflow, provide adequate education and promote utilization of effective alternative devices.