Effect Of Nurse-Led Multidisciplinary Rounds On Reducing the Unnecessary Use Of Urinary Catheterization in Hospitalized Patients

Fakih, Mohamad G.; Dueweke, Cathleen; Meisner, Susan; Berriel-Cass, Dorine; Savoy‐Moore, Ruth T.; Brach, Nicole; Rey, Janice E.; DeSantis, Laura; Saravolatz, Louis D.

doi:10.1086/589584

Cited by 91 publications

(81 citation statements)

References 12 publications

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“…In comparison, the risk for CAUTI in the treatment contamination group (duration of catheterization >7 days, 34.9%) was 3.52 times (95% CI, 2.05-6.04; P < .001) higher than the risk of the per-protocol group (duration of In addition, we found a 22% decrease in the use of urinary catheters. Similarly, in a study by Fakih et al, 21 a nurse-led multidisciplinary approach for evaluating the need for urinary catheters reduced the rate of use by 20%.…”

Section: Characteristics Of the Patientsmentioning

confidence: 92%

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

Chen

Chi

Chen

et al. 2013

American Journal of Critical Care

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Background Duration of indwelling urinary catheterization is an important risk factor for urinary tract infection. Objectives To determine whether a reminder approach reduces the use of urinary catheters and the incidence of catheterassociated urinary tract infections. Methods A randomized control trial was performed in 2 respiratory intensive care units in a 2990-bed tertiary referral medical center. Patients who had urinary catheters in place for more than 2 days from April through November 2008 were randomly assigned to either the intervention group (use of a criteria-based reminder to remove the catheter) or the control group (no reminder). Results A total of 278 patients were recruited. Utilization rate of indwelling urinary catheters was decreased by 22% in the intervention group compared with the control group (relative risk, 0.78; 95% CI, 0.76-0.80; P < .001). The intervention significantly shortened the median duration of catheterization (7 days vs 11 days for the control group; P < .001). The success rate for removing the catheters in the intervention group by day 7 was 88%. The reminder intervention reduced the incidence of catheter-associated infections by 48% (relative risk, 0.52; 95% CI, 0.32-0.86; P = .009) in the intervention group compared with the control group. Conclusions Use of a criteria-based reminder to remove indwelling urinary catheters can diminish the use of urinary catheterization and reduce the likelihood of catheter-associated urinary infections. This reminder approach can prevent catheter-associated urinary infections, and its use should be strongly considered as a way to enhance the safety of patients.

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Section: Characteristics Of the Patientsmentioning

confidence: 92%

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

Chen

Chi

Chen

et al. 2013

American Journal of Critical Care

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“…1,4,12 Literature has focused on inpatient hospital efforts to reduce CAUTIs by preventing inappropriate catheter placement and removing IUCs as soon as no longer necessary. [13][14][15][16][17] Only recently have researchers targeted the emergency department (ED) as a potential site for intervention. …”

mentioning

confidence: 99%

A Novel Clinical Protocol for Placement and Management of Indwelling Urinary Catheters in Older Adults in the Emergency Department

Mulcare

Rosen

Clark

et al. 2015

Academic Emergency Medicine

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Objectives: Indwelling urinary catheters (IUCs) are placed frequently in older adults (age ≥ 65 years) in the emergency department (ED) and carry significant risks. The authors developed, implemented, and assessed a novel clinical protocol to assist ED providers with appropriate indications for placement, reassessment, and removal of IUCs in elders in the ED.Methods: A comprehensive, evidence-based clinical protocol was built from an extensive literature review and ED provider focus groups. It was implemented at a university-based medical center with a 20-minute scripted slide presentation. Written surveys were administered before, after, and at 6 months to assess providers' baseline practice and the protocol's effects. Surveys included asking providers for IUC management decisions in 25 unique clinical scenarios. Rates of IUC placement and catheterassociated urinary tract infections (CAUTIs) were compared in ED older adult patients admitted to the hospital in the 6 months before and after protocol implementation.Results: A total of 111 ED providers participated in the all three surveys. Immediately after protocol introduction, providers anticipated that this intervention would reduce rates of IUC use and increase patient safety. At 6-month follow-up, 81% felt the protocol had changed their practice, and 39% reported frequently referencing the protocol. In the clinical vignettes, ED providers correctly identified the appropriate approach for IUC placement in 63% of cases at baseline with an increase of 22% (95% confidence interval [CI] = 19% to 25%) postintervention and an increase of 8% (95% CI = 6% to 12%) between baseline and 6 months. An absolute reduction in the use of IUCs of 3.5% (p < 0.001) for older adults admitted to the hospital was observed after implementation of the protocol. There were three CAUTIs attributable to the ED in the 6 months prior to implementation and none in the 6 months after.Conclusions: This comprehensive, evidence-based clinical protocol was well received by participants and was associated with a sustained change in self-reported practice, as supported by a reduction in IUC placement in admitted older adults and a reduction in CAUTIs attributable to the ED for this vulnerable population over the 6-month study period.ACADEMIC EMERGENCY MEDICINE 2015;22:1056-1066 by the Society for Academic Emergency Medicine C atheter-associated urinary tract infections (CAUTIs) have been one of the most prevalent hospital-acquired infections, with significant associated morbidity, mortality, and cost.1,2 Recent research found it to be the fourth most active, accounting for 12.9% of all health care-associated infections. Older adult patients (aged ≥ 65 years) are disproportionately affected, as they more commonly receive indwelling urinary catheters (IUCs) 2,4 and are more susceptible to associated complications. 5 In addition to urinary tract infections, this population is more susceptible to the noninfectious side effects of IUCs, including falls from tethering, delirium, urethral trauma...

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“…Finally, multifaceted interventions often incorporated audits and feedback. 22 Meddings et al 20 Fuchs et al 23 Elpern et al 24 Fakih et al 7 Apisarnthanarak et al 25 Knoll et al 1 …”

Section: Resultsmentioning

confidence: 99%

“…4,5 But up to onethird of patients may not have an appropriate indication for a catheter to be used. 3,[6][7][8] Inappropriate catheter use occurs because of convenience, misunderstanding of necessity, and lack of clear orders for catheter removal 9 or the physician's lack of awareness of the catheter's presence. 8 More than 500 000 catheter-associated urinary tract infections (CAUTIs) occur each year in the United States alone.…”

mentioning

confidence: 99%

Do System-Based Interventions Affect Catheter-Associated Urinary Tract Infection?

Halm

OʼConnor

2014

American Journal of Critical Care

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Effect Of Nurse-Led Multidisciplinary Rounds On Reducing the Unnecessary Use Of Urinary Catheterization in Hospitalized Patients

Abstract: A nurse-led multidisciplinary approach to evaluate the need for UCs was associated with a reduction of unnecessary UC use. Efforts to sustain the intervention-induced reduction may be successful when trained advocates continue this effort with each team.

Cited by 91 publications

References 12 publications

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

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

A Novel Clinical Protocol for Placement and Management of Indwelling Urinary Catheters in Older Adults in the Emergency Department

Do System-Based Interventions Affect Catheter-Associated Urinary Tract Infection?

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