Perceptions of a Nurse-Driven Urinary Catheter Removal Protocol in a Hospital Setting

Utilization of a novel humble inquiry interview approach in assessing implementation barriers to a nurse-driven Clostridioides difficile test order set

Hospital onset Clostridioides difficile infection (CDI) causes significant disease burden and is associated with increased patient mortality. A nurse-driven CDI test order set had been implemented to reduce hospital-onset CDI, yet the order set was not being used. We employed a humble inquiry interview method to identify barriers to using the CDI test order set. The humble inquiry approach uncovered unexpected barriers and may be a robust method to identify additional infection prevention evidence-to-practice gaps.

Rapid Response Systems at a Long-Term Acute Care Hospital

Rapid Response Systems (RRS) improve patient outcomes at large medical centers. Little is known about how RRS are used in other medical settings. The purpose of this exploratory study was to describe RRS events at a long-term acute care hospital (LTACH). We conducted a retrospective review of 71 RRS event records at an urban 50-bed Midwestern LTACH. Measures included demographic data, triggering mechanisms, contextual factors, mechanism factors, and clinical outcomes. Of patients who experienced a RRS event, median age was 71 (62, 80) years; 52.1% were female; most (n = 49, 69%) were "full code." Most (n = 41, 58%) events occurred during the daytime. The most common trigger was "mental status changes/unresponsiveness." Registered nurses were the most frequent activator (n = 19, 26.8%) and responders (n = 63, 60.6%). Median duration of RRS events was 14 (6, 25) minutes. Most patients stabilized and their condition improved (n = 54, 76.1%). RRS can be expanded and modified to the LTACH population.

Using statistical process control charts to measure changes from a nurse-driven protocol to remove urinary catheters

BACKGROUND

Implementing a nurse-driven protocol (NDP) to remove indwelling urinary catheters is a strategy to reduce catheter-associated urinary tract infections (CAUTI). The purpose of this project was to implement a comprehensive NDP to reduce indwelling urinary catheter utilization and CAUTI rates at a large academic health system.

METHODS

Statistical process control charts, a quality improvement method, was used to identify special cause variation. A formal protocol was developed to provide guidance for nurses to remove indwelling urinary catheters when no longer indicated. Changes were also made within the electronic health record.

RESULTS

Signals of improvement were not noted on the Statistical process control charts for urinary catheter utilization or CAUTI rates. The frequency with which the NDP was documented (process measure) was assessed, showing it is used approximately 600 times each month. Of those catheters removed by the NDP, an average of 6% were reinserted within 48 hours (balancing measure).

DISCUSSION

Our findings differed from other literature as we did not see a reduction in urinary catheter utilization after implementing a NDP. However, our project adds to the literature as we also evaluated process and balancing measures.

CONCLUSIONS

A NDP for urinary catheter removal provides nurses with the autonomy to remove catheters when no longer indicated; however, other interventions should be added to a comprehensive CAUTI-prevention program.