Practical Strategies for Addressing Foley-Associated Urinary Tract Infections

Purpose:
As a leading cause of mortality and morbidity in the US, it is necessary for hospitals to determine strategies to prevent high volume/high cost hospital acquired conditions. In addition to changes in reimbursement for these conditions, quality incentives have been introduced for use by hospitals.

Significance:
In 2007, it is estimated that there were 44,000 foley related deaths at a cost of $12,000 each=528 million dollars. Many such conditions are preventable. Preventive strategies not only save healthcare dollars but most importantly, provide evidenced based, high quality of care for our patients.

Strategy and Implementation:
We developed a well defined organizational policy regarding foley catheter care. This policy includes an algorithm to guide the appropriate use of foleys using specific indications for use and guidelines for timely removal. Emphasis was placed on education of physicians and nurses in utilizing critical thinking skills to determine the need for the use of a foley catheter (use should be more an exception than rule)--this was a significant culture change for the organization. We revised our documentation tool to include the electronic capture of POA foleys as well as insertion of a foley after admission. From this, we are able to generate a daily report on each unit to see which patients have a foley. A stamp is then used daily in the physician progress notes to alert the physician to write an order to discontinue the catheter if appropriate. The order for a foley catheter also generates an automatic order for a cath screen urinalysis prior to foley insertion.

Evaluation:
Decrease in foley utilization (23% med-surg units, 30% ICU); Decrease in total foley associated UTIs (81% med-surg, 84% ICU) with an estimated cost savings of $40-$102,000 NDNQI data shows decrease in UTIs(ICU) from 7.04 (2nd QTR 08) to 4.78 (3rd QTR 08) to 3.95 (4th QTR 08) to 0 in 1st QTR 2009

Implications for Practice:
Allows for more accurate and timely tracking of patients with foley and how long it has been in place; Stamp offers an increased awareness by nurses and physicians to decrease foley days, ultimately decreasing infections; Allows opportunity to identify the presence of UTI prior to foley insertion