Results of a Nurse-driven In-dwelling Urinary Catheter Algorithm

Purpose:
This project addressed a gap in both nurse and physician clinical practice related to the use of in-dwelling urinary catheters. Our institutional rate of CAUTI was significantly greater than the NHSN national rate.

Significance:
Prevention of health care-acquired infections is a critical patient safety issue. The introduction of foreign objects, even under sterile conditions, increases infection risk. Infection can be a complication of urinary catheterization, with reports that systems are often colonized within 48 hrs.

Strategy and Implementation:
In 2007, following an increased incidence in our CAUTI rate, a "Foley" task force was created. This group evaluated the products we used and and current practices that were in place. House-wide education was performed. RN and PCT education included catheter care, specimen collection, and assessment parameters. During the next 18 months, CAUTI rates were monitored, additional education was provided for direct-care staff and their leaders, with the continued supoport of the medical staff. In December 2008 the evidence-based algorithm was implemented. This change empowered staff nurses to remove in-dwelling urinary catheters, without MD orders, if specific criteria were met. The implementation of the protocol included education related to the criteria for removal as well as the contraindications for this. Our EHR was modified to reflect these changes. CAUTI continue to be reviewed on an on-going basis. Any clusters or patterns are identified for focused, unit-based interventions.

Evaluation:
CAUTI rate now=1.3(NHSN=4.9). CAUTI rate has fallen steadily since algorithm implementation. Documentation of catheter care has improved. Nurse and patients report increased satisfaction with the process since catheters are removed promptly. No current organism clusters have been identified.

Implications for Practice:
This nurse-driven protocol for care provides the foundation for our staff to plan and implement other EB plans. Success strengthens belief in the power to change practice and achieve better outcomes.