From ‘Uh-Oh' to ‘Oh-Yeah!': A Nurse Driven Urinary Catheter Removal Protocol

Purpose:
Nursing leadership on a 52-bed transitional care unit at an academic, community Magnet health network set a goal to decrease the use of urinary catheters by 50%. This unit provides nursing and rehabilitation care to mainly geriatric, post acute care patients prior to their return home.

Significance:
The utilization of indwelling urinary catheters in acute and transitional care settings is often inappropriate and associated with many negative outcomes, such as urinary tract infections, discomfort, impediment of mobility, restraint issues, increased health care costs, morbidity, and mortality.

Strategy and Implementation:
A nurse driven urinary catheter removal protocol was developed based on evidence and was supported by the medical director and administration. Nursing staff were educated on acceptable uses of urinary catheters, risks of prolonged use, alternative incontinence options, intermittent urinary catheterization, and bladder scan protocols. All staff was educated on infection control issues, inclusive of maintaining a closed catheter system. Physicians received education on the benefits of early catheter removal, documentation of medical necessity for urinary catheters, and alternatives for managing incontinence. Data collection, pre and post implementation consisted of tracking the number of urinary catheter days and rates of catheter associated urinary tract infections (CA-UTIs). Comparison data analysis demonstrated no significant decrease in the number of catheter days. An unexpected outcome was the significantly lower CA-UTI rate, which has been sustained on the unit.

Evaluation:
The number of catheter days has not decreased by 50%, but remains stable. A positive and unexpected result is the reduction of CA-UTIs. The pre-implementation CA-UTI rate was 17.88, six months after implementation the rate decreased to 3.74, and since February 2009 the rate has remained at zero.

Implications for Practice:
Nursing is poised to make a great impact on quality patient outcomes and, as such, hospital reimbursements. This offering details a nurse driven protocol to positively impact CA-UTI rates and can be used as a guide for other quality improvement initiatives.