Get that Catheter Out: Decreasing Device Utilizing a Nurse-Driven Protocol

Catheter-associated urinary tract infections (CAUTIs) are avoidable adverse outcomes that contribute to hospital morbidity, mortality, and cost. The Centers for Disease Control report that 15-25% of patients will have a urinary catheter during hospitalization. A 32-bed medical-surgical unit had been without a CAUTI for 2 years from fiscal years (FY) 2015-2017. The urinary catheter utilization was within the expected number according to the Centers for Disease Control. The nurses hypothesized a nurse-driven urinary catheter removal protocol would decrease urinary device utilization below the expected percentage of urinary catheter utilization and continue to prevent CAUTIs

A retrospective cohort design study with pre- and post-intervention arms were conducted. Fiscal year 2017, patients with a urinary catheter were placed in the pre-intervention group. After the evidence-based approach of a nurse-driven urinary catheter removal was implemented in FY 2018, patients with a urinary catheter in FY 2018 and 2019 were placed in the post-intervention group. The nurse-driven protocol provides the bedside nurse an algorithm to remove a urinary catheter if the patient meets criteria without a physician’s order. The algorithm is embedded in the electronic health record and addresses indication for the urinary catheter, and if no indication is present the nurse is to remove the device. The primary outcome for this project was decreasing urinary catheter utilization on a medical-surgical unit.

The pre-intervention group contained data from 4,631 patient days, with 661 urinary catheter days in FY 2017. The post-intervention group included 5, 658 patient days with 647 urinary catheter days in FY 2018, and 6,425 patient days with 666 urinary catheter days in FY 2019. There was a reduction from 14% urinary device utilization in FY 2017 to 9 % urinary device utilization in FY 2019. This yielded a 35.7% reduction in urinary device utilization over 2 years.

Utilizing an evidence-based urinary catheter removal protocol is crucial in decreasing urinary catheters. This quality improvement project in urinary device management demonstrated the importance of empowering the bedside nurse to be proactive and remove unnecessary urinary catheters. A review of the data demonstrated a 35.7% reduction in urinary catheter utilization over 2 years. Additionally, the unit has not had a CAUTI in 5 years. Barriers to this project include retrospective chart review and initial compliance to the protocol in 2018.