Impact of the lack of community urinary catheter care services on the Emergency Department

Long-term catheter management in the community: a population-based analysis of user characteristics, service utilisation and costs in England

BACKGROUND

Long-term urinary catheters are problematic and burdensome for patients, carers and health services. Nursing practice to improve the management of long-term urinary catheters has been held back by a lack of evidence to support policy and practice. Little is known about who uses a catheter long term and the resources and costs needed for their management. Understanding these costs will help to target innovations to improve care. There have been no substantial innovations to urinary catheters or their management recently and no publications to characterise users and costs.

AIM

To describe long-term catheter users and explore catheter-related service use and costs in England.

METHODS

Descriptive information on the characteristics of catheter users and their use of services was obtained from: General Practice records (n = 607), district nursing records (n = 303), questionnaires to patients (n = 333) and triangulated, 2009-2012. Annual service costs (British pounds 2011) were computed.

FINDINGS

Most catheter users (59.6%) were men, nearly three-quarters (71.2%) were over 70 years and 60.8% used a urethral catheter. Women tended to be younger than men and more likely to use a suprapubic catheter. The services used most frequently over 12 months were general practitioner (by 63.1%) and out of hours services (43.0%); 15.5% accessed Accident and Emergency services for urgent catheter-related care. Hospital use accounted for nearly half (48.9%) of total health service costs (mainly due to inpatient stays by 13.6% of participants); catheter supplies/medications were next most costly (25.7%). Half of all costs were accounted for by 14.2% of users. The median annual cost of services used was £6.38, IQR: £344-£1324; district nursing services added approximately a further £200 per annum.

CONCLUSIONS

Finding better ways to reduce catheter problems (e.g. blockage, infection) that cause unplanned visits, urgent or hospital care should be a priority to improve quality of life for long-term catheter users and reduce health service expenditure.

Development of a knowledge, attitude and practice questionnaire on urine leakage with an indwelling urethral catheter for nurses in China

AIM

A knowledge, attitude and practice questionnaire on urine leakage (UL) with an indwelling urethral catheter (IUC) was developed for nurses in China and validated.

DESIGN

Observational study.

METHODS

A systematic literature review, the Delphi method and focus group evaluation were used to develop the questionnaire, which was administered to 304 registered nurses at two hospitals in Guangdong, China. The validity and reliability of the questionnaire were assessed.

RESULTS

The 27-item questionnaire had four dimensions: knowledge I (aetiology), knowledge II (prevention and treatment), attitude and practice. The questionnaire showed excellent content validity and reliability. Four factors accounted for 70.526% of the variance. The data were well-fitted to the four-factor construct model. The questionnaire can be used to measure the knowledge of UL with an IUC among nurses in China, along with related attitudes and practices. This can improve nursing care of patients with IUCs. No patient or public contribution.

The role of the district nurse in managing blocked urinary catheters

This article will investigate the district nurse's role in managing urinary catheter blockages, looking at why people require long-term catheterisation and the causes of blockages and then reviewing treatment methods. Current practice will be critically analysed and compared to the most up to date research and literature to inform district nurses of best evidence-based practice in the hopes of improving service user outcomes and quality of life and reducing the impact this problem has upon district nursing services with regards to time and resources.

Long-term Suprapubic Catheter-Related Care Requirements When Living at Home: Development of a Best Practice Guide

PURPOSE

The purpose of this study was to develop a best practice guideline specific to the health care needs of adults living at home with a long-term suprapubic catheter (SPC).

DESIGN

Guided by the theory of social constructionism, a mixed-methods, 2-phased study design enabled an integration of experiences and consensus from 2 groups of experts.

SUBJECTS AND SETTING

The first group of experts involved 10 people living with a long-term SPC at home. The second group comprised 23 nurses who provided care to people living with a long-term SPC at home.

METHODS

During phase 1, semistructured in-depth interviews were completed to explore people's day-to-day self-care practices and support needs when living at home with a long-term SPC. These data were evaluated via thematic analysis. The themes identified in phase 1 provided the phase 2 question framework in the development of a 3-round Delphi survey involving the expert nurse group. The first round elicited the respondents' opinions on specific aspects of SPC-related care. Using qualitative content analysis, practice statements were generated and used in subsequent survey rounds. The respondents rated their level of agreement to each statement. The guideline comprises the statements that achieved consensus.

RESULTS

The 6 elements of the best practice guideline contracted using this mixed-methods study were psychological support needs, cystostomy site care, SPC replacement, drainage equipment practices, complication avoidance and management, and planning ahead.

CONCLUSIONS

This best practice document provides a valuable resource to guide health professionals, promoting standardized best practices when caring for persons living at home with an SPC.

Impact of COVID-19 Measures on Discharge Planning and Continuity of Integrated Care in the Community for Older Patients in Singapore

Introduction:

The COVID-19 pandemic affects the process of care transition for patients with underlying chronic conditions. This study aims to explore the impact of the pandemic measures on discharge planning and continuum of care for vulnerable older patients from multi-stakeholder perspectives.

Methods:

We conducted focus group discussions and individual interviews with healthcare workers, community partners, government officials and family caregivers in Singapore. All interviews were audio-recorded, transcribed verbatim and thematically analysed.

Results:

A total of 53 individuals participated in the study. Discharge planning and care continuity in the community were affected primarily by the limited step-down care options and remote assessment of discharge needs. Participants felt a need to revisit the decision of ‘essential’ community services through engagement of all stakeholders to enhance care community.

To improve better care transition, participants suggested the need for clearer communication of guidelines, improved intersectoral collaboration, shared responsibility of patient care through community engagement and employment of novel models of care.

Conclusion:

The pandemic measures generated challenges of safe discharge of patients and care continuity in the community. Findings shed light on the need to proactively assess care pathways and catalyse novel models to improve care transition beyond the pandemic.

Urinary catheter management: what neurologists need to know

Patients with neurological disorders often have lower urinary tract dysfunction, manifesting as urinary retention or urinary incontinence, and so commonly use catheters. Neurologists should therefore be aware of the different types of catheters and appliances and their risks, benefits and complications. Clean intermittent self-catheterisation is preferable to an indwelling catheter; however, if this is not possible, then a suprapubic indwelling catheter is preferable to a urethral catheter for long-term management. We review the decision-making process when selecting catheters for neurological patients, the evidence base regarding the different options and how neurologists can recognise and address complications. We also discuss alternatives to catheterisation, such as non-invasive containment products and surgical treatments, and the indications for urological referral.

Examining the challenges of hospital discharge for patients with a urinary catheter

BACKGROUND

Patient discharge between acute and secondary care will be viewed differently based on the stakeholder groups involved. Examining these different perceptions may help improve the discharge process and the patient journey from hospital to home.

AIMS

To determine the perceptions of community and hospital nursing staff regarding the challenges that exist with the general hospital discharge process for patients with a urinary catheter.

METHODS

A survey was created and sent to a wide range of acute and community nurses and the subscriber list of Journal of Community Nursing, Journal of General Practice Nursing and Wound Care Today.

FINDINGS

Compared with hospital staff, the opinions of community staff were more negative around the discharge process and post-discharge care and materials.

CONCLUSIONS

Results of this survey provide insight into the perceptions of nursing staff into general patient discharge for those with a urinary catheter and help identify the challenges that exist on the patient journey from hospital to home.

Preventing catheter-related problems in community settings

Linda Nazarko explains how catheters can be managed safely in the home

Supporting patients with long-term catheterisation to reduce risk of catheter-associated urinary tract infection

More than 90 000 of the UK adult population are estimated to have a urinary catheter, with 24% likely to develop symptoms of catheter-associated urinary tract infection (CAUTI). The consequences of having a CAUTI are reduced quality of life, risk of hospitalisation and increased mortality. The authors undertook a literature review of primary research studies to identify how nurses could support patients to maintain effective catheter care to reduce the risk of CAUTI. Four themes emerged: education, knowledge, empowerment and communication. The authors therefore conclude that consistent knowledge, clear communication and treating patients as partners in the decision-making process can help build trust and allow empower patients. This will enable patients to make safe and healthy decisions about their catheter, particularly with regard to personal hygiene and optimal fluid intake, to reducing the risk of CAUTI.

Innovating urinary catheter design: An introduction to the engineering challenge

Every day, people around the world rely on intermittent and indwelling urinary catheters to manage bladder dysfunction, but the potential or actual harm caused by these devices is well-recognised. Current catheter designs can cause urinary tract infection and septicaemia, bladder and urethral trauma and indwelling devices frequently become blocked. Furthermore, the devices can severely disrupt users' lives, limiting their daily activities and can be costly to manage for healthcare providers. Despite this, little significant design innovation has taken place in the last 80 years. In this article current catheter designs and their limitations are reviewed, common catheter-associated problems are outlined and areas of design ripe for improvement proposed. The potential to relieve the individual and economic burden of catheter use is high.