Doctor of Nursing Practice
Susan Penque, PhD, APRN, ANP-BC, NE-BC, NC-C
Ashley Putteti, MSN, BSN, RN
Second Practice Mentor
Edward Valente MSN, BSN, RN; Practice Expert
Significance and Background: Catheter-associated urinary tract infections (CAUTIs) are common but preventable hospital-associated infections. The inappropriate and prolonged use of indwelling urinary catheters can pose a significant risk for patients and healthcare organizations. The Centers for Disease Control and Prevention identified that the most important factor related to an increased risk of CAUTI is the length of time an indwelling catheter remains in place. This DNP (Doctor of Nursing Practice) project assessed the barriers to removing indwelling catheters in the intensive care unit (ICU) while providing encouragement of prompt removal.
Purpose: Three aims were developed for this quality improvement project: 1) Educate staff nurses in the ICU setting and encourage prompt removal of the indwelling urinary catheter; 2) Track compliance of utilizing catheter algorithm; and 3) Reduce the length of time an indwelling catheter remains in place.
Intervention/Setting: For this project, the Institute for Healthcare Improvement was the model chosen to improve the quality of care. Plan, Do, Study, Act (PDSA) drove the changes in practice. Two PDSA cycles were completed, including pre-intervention surveys to discuss barriers, beliefs, and current knowledge related to indwelling catheters, educational sessions, and an algorithm to determine the continued need for a catheter. Participants included any nurse working in the intensive care unit from June 1st to August 12th, 2022.
Evaluation: Pre-implementation survey revealed barriers associated with prompt removal by nurses, including convenience, inadequate staffing, patient immobility, and acuity of patients. Foley catheter use decreased by 20.3% with use of alternative measures and use of an algorithm, by the end of the 10-week implementation. The compliance rate of algorithm use increased by 55% by the end of the project.
Discussion: Implementing education sessions and an algorithm to determine the continued use of an indwelling catheter can be helpful in an ICU setting when used appropriately. Despite this being a small ICU and other variables leading to the results, bringing awareness to the need for the prompt removal of a catheter can help reduce the length of days, leading to a reduced risk of developing a CAUTI.
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Diurno, K. (2023). Reducing urinary catheter usage in the intensive care unit setting and education related to preventing CAUTIs: A QI project [Unpublished DNP project]. Sacred Heart University.