Purpose: Indwelling urinary catheters are often placed pre-operatively and inappropriately left for an extended duration, predisposing the patient to a hospital-acquired infection (HAI). HAIs are a national health care issue that results in increased cost, length of stay, and morbidity. The adult surgical unit (ASU) is a 25-bed general surgical unit within a 350-bed Midwestern teaching hospital specializing in caring for patients who have had urologic, bariatric, and cosmetic procedures requiring indwelling urinary catheter use and/or specific urologic care. In 2020, ASU experienced an increase in catheter-associated urinary tract infections (CAUTI), increased indwelling urinary catheter days, and increased calls to urology specialist providers for assistance in performing urologic skills. Despite resources such as nurse-driven protocols for indwelling catheter removal, evidence-based indwelling urinary catheter care bundles, and mid-shift safety huddles, clinical staff still lacked the confidence in timely discontinuation of indwelling urinary catheters and performing urologic specific skills such as caring for suprapubic catheters, nephrostomy tubes, and continuous bladder irrigation (CBI) systems. A team comprised of a urology specialty provider, clinical operations manager, direct-care nurses, nursing professional development practitioner (NPDP), and a clinical nurse specialist (CNS) collaborated to identify gaps leading to nurses’ lack of competence and confidence in performing urologic specific nursing skills. An educational intervention, identified as the urology extravaganza, was created by this team to increase nurses’ clinical competence and confidence in urologic post-surgical care to improve the quality and safety of patient care.
Description: The urology extravaganza was a hands-on simulation training session set up open-house style on the unit. This location allowed staff to attend at a time convenient for them throughout the day. The hands-on training included five stations manned by the NPDP, clinical operations manager, direct care nurses, and CNS. The education was mandatory for all clinical staff, and nursing continuing professional development credits were offered. The skills included indwelling urinary catheter insertion and care, external catheter application, suprapubic insertion and care, bladder scanning, CBI, and nephrostomy tube care and irrigation. The content was delivered via verbal instruction and demonstration, videos accessible through links and QR codes, self-guided hands-on practice with a manikin, and skill checkoff with a verifier. This type of educational event provided the opportunity for real-time questions and immediate remediation.
Evaluation/outcomes: Following the implementation of the urology extravaganza, no CAUTIs were noted from October 2020 through December 2021. During this timeframe, safety huddles continued as did the use of the indwelling urinary catheter bundle. The indwelling urinary catheter utilization ratios decreased slightly among all patients on this unit from 0.102 in 2020 to 0.095 in 2021. These data support the improved competence level of nurses to care for indwelling urinary catheters and utilize the nurse-driven protocol for catheter removal. This educational activity proved effective in preparing competent, confident nurses and resulted in improved patient care and clinical outcomes. The unit plans to provide the urology extravaganza in the current year and yearly thereafter to maintain the competency level of current staff and reduce the educational gap among newly hired staff.
Evidence-based references
1. Gauron, G., & Bigand, T. (2021, June). Implementation of evidence-based strategies to reduce catheter-associated urinary tract infections among hospitalized, post-surgical adults. American Journal of Infection Control, 49(6), 843845. https://doi.org/10.1016/j.ajic.2020.11.016
2. Jamil, M. L., Wurst, H., Robinson, P., Rubinfeld, I., Suleyman, G., Pollak, E., & Dabaja, A. A. (2022, January). Urinary catheter alleviation navigator protocol (UCANP): Overview of protocol and review of initial experience. American Journal of Infection Control, 50(1), 81-85. https://doi.org/10.1016/j.ajic.2021.06.019
3. Lo, E., Nicolle, L. E., Coffin, S. E., Gould, C., Maragakis, L. L., Meddings, J., Pegues, D. A., Pettis, A. M., Saint, S., & Yokoe, D. S. (2014, May). Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35(5), 464-479. https://doi.org/10.1086/675718
4. Parker, V., Giles, M., Graham, L., Suthers, B., Watts, W., O’Brien, T., & Searles, A. (2017, December). Avoiding inappropriate urinary catheter use and catheter-associated urinary tract infection (CAUTI): A pre-post control intervention study. BMC Health Services Research, 17(1). https://doi.org/10.1186/s12913-017-2268-2
5. Pashnik, B., Creta, A., & Alberti, L. (2017, October). Effectiveness of a nurse-led initiative, peer-to-peer teaching, on organizational CAUTI rates and related costs. Journal of Nursing Care Quality, 32(4), 324-330. https://doi.org/10.1097/ncq.0000000000000249