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To identify nursing practice for daily medical necessity of urinary catheters to facilitate their prompt removal to reduce risk for CaUTI.
Implementation:
Quarterly prevalence and incidence studies are the standard practice in acute care for monitoring and reporting pressure ulcer rates. Foley catheter management is apporpriate with specific indications, one of which the WOCN nurse is often managing the patient catheterized for wounds. The hospital's skin team was utelized to collect Foley catheter practices during the implementation of the audit. The data was collected during the quarterly pressure ulcer studies.
Data was collected on each medical-surgical unit and ICU. Observations included number of catheters, labeling of catheter and the reason for insertion. Best maintenance practice was assessed by observing securement, positioning off the floor and below the level of the bladder. Appropriateness of catheter placement was recorded as reason for presence of catheter on the survey date.Catheters from outside facility were identified.
Results:
Three quarters of data showed 71 catheters observed. Percentages of line items measured vary due to some outside facility placement.
Mainaince practices were 98.5% were secured; 100% below level of the bladder and 98.5% were off the floor. Labeling was considered complete if both the date and reason for insertion were recorded. Complete labeling rate was present 84.3%.
Reasons for catheter presence included: I&O-39.4%; Retention-9.8%;Wound-7%;Comfort-1.4%;Unknown-1.4%;AMS-1.4%;Immobilization/ventilator-25%; Surgery8.4%.
Maintaince of the catheters had good compliance with best practice. Areas for improvement include both reasons for insertion as well as assessment and documentation of the daily need for ingoing use of the catheter.
Implications for Practice:
Quarterly monitoring nursing practice for Foley catheter management is a useful tool to identify areas for improvement and benchmarking progress in staff education in the process to improve patient safety by reducing the CaUTI rates. It identifies areas for improvement and education to target best practices.