Implementation of a multifaceted nurse‐led intervention to reduce indwelling urinary catheter use in four Australian hospitals: A pre‐ and postintervention study

Abstract

Aims and objectives This study aimed to reduce indwelling urinary catheter (IDC) use and duration through implementation of a multifaceted “bundled” care intervention. Background Indwelling urinary catheters present a risk for patients through the potential development of catheter‐associated urinary tract infection (CAUTI), with duration of IDC a key risk factor. Catheter‐associated urinary tract infection is considered preventable yet accounts for over a third of all hospital‐acquired infections. The most effective CAUTI reduction strategy is to avoid IDC use where ever possible and to remove the IDC as early as appropriate. Design A cluster‐controlled pre‐ and poststudy at a facility level with a phased intervention implementation approach. Methods A multifaceted intervention involving a “No CAUTI” catheter care bundle was implemented, in 4 acute‐care hospitals, 2 in metropolitan and 2 in rural locations, in New South Wales, Australia. Indwelling urinary catheter point prevalence and duration data were collected at the bedside on 1,630 adult inpatients at preintervention and 1,677 and 1,551 at 4 and 9 months postintervention. This study is presented in line with the StaRI checklist (see Appendix S1). Results A nonsignificant trend towards reduction in IDC prevalence was identified, from 12% preintervention to 10% of all inpatients at 4 and 9 months. Variability in preintervention IDC prevalence existed across hospitals (8%–16%). Variability in reduction was evident across hospitals at 4 months (between −2% and 4%) and 9 months (between 0%–8%). Hospitals with higher preintervention prevalence showed larger decreases, up to 50% when preintervention prevalence was 16%. Indwelling urinary catheter duration increased as more of the short‐term IDC placements were avoided. Conclusions Implementation of a multifaceted intervention resulted in reduced IDC use in four acute‐care hospitals in Australia. This result was not statistically significant but did reflect a positive trend of reduction. There was a significant reduction in short‐term IDC use at 9 months postintervention. Relevance to clinical practice Clinical nurse leaders can effectively implement change strategies that influence patient outcomes. Implementation of the evidence‐based “No CAUTI” bundle increased awareness of appropriate indications and provided nurses with the tools to inform decision‐making related to insertion and removal of IDCs in acute inpatient settings. Working in partnership with inpatients and the multidisciplinary team is essential in minimising acute‐care IDC use.

<p>Effectiveness of a Multifaceted Educational Intervention to Enhance Therapeutic Regimen Adherence and Quality of Life Amongst Iranian Hemodialysis Patients: A Randomized Controlled Trial (MEITRA Study)</p>

“…50,51 This is while lack of abovementioned physical, psychological and social support, for instance, family members' support, 52 in the planned health care for the HDPs were suggested to be associated with difficulty with fluid restrictions and coming to dialysis therefore, failing to achieve proposed clinical outcomes. 53 As a priori facets of current knowledge which addresses efficacy of multifaceted health-care interventions and the synergy that they could create through combining advantages of the separate individual interventions, 54,55 successful implementation of a multimodal patient support mechanism in this study warrants further prospective exploration.…”

Barriers and facilitators to implementation of a multifaceted nurse‐led intervention in acute care hospitals aimed at reducing indwelling urinary catheter use: A qualitative study

“…The study involved all adult inpatient wards, emergency departments and operating theatres. The key component of the intervention is the evidence‐based “NO CAUTI” bundle (Giles et al., 2019). Focus groups were conducted to evaluate the impact of implementation of the intervention for clinicians.…”

“…Implementation of a bundle involves the alignment of a collection of tasks and usually requires the involvement and cooperation of a multidisciplinary team, which if achieved successfully adds to the spread and sustainability of the practice change (Greenhalgh, 2018). CAUTI reduction bundles have combined education, clinical skill development for placement and removal, catheter restriction and removal protocols and the use of specific equipment such as insertion packs and bladder scanners (Fakih et al, 2012;Giles et al, 2019;Giles et al, 2015;Krein, Kowalski, Harrod, Forman, & Saint, 2013;Meddings et al, 2014). Whilst evidence for the effectiveness of bundled interventions is shown through reported reductions in catheter use and CAUTI rates, the way in which implementation strategies are adopted and accepted across sites is not well reported.…”

Effect of Cluster Nursing Based on Risk Management Strategy on Urinary Tract Infection in Patients With Severe Craniocerebral Injury

“…It cannot only accurately observe and record the urine volume and the urine proportion of patients with severe craniocerebral injury, but also prevent surgical complications. At the same time, it can also treat dysuria and train the bladder function of patients (4,5). However, some studies have pointed out that the longer the urinary catheter is used, the higher the probability of catheter-associated urinary tract infection (CAUTI) in patients.…”