Hostname: page-component-8448b6f56d-t5pn6 Total loading time: 0 Render date: 2024-04-23T14:01:25.046Z Has data issue: false hasContentIssue false
  • English
  • Français

Effect Of Nurse-Led Multidisciplinary Rounds On Reducing the Unnecessary Use Of Urinary Catheterization in Hospitalized Patients

Published online by Cambridge University Press:  02 January 2015

Mohamad G. Fakih ,
Cathleen Dueweke ,
Susan Meisner ,
Dorine Berriel-Cass ,
Ruth Savoy-Moore ,
Nicole Brach ,
Janice Rey ,
Laura Desantis  and
Louis D. Saravolatz
Mohamad G. Fakih*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Detroit, Michigan Infection Control Department, Detroit, Michigan St. John Hospital and Medical Center, and Wayne State University School of Medicine, Detroit, Michigan
Cathleen Dueweke
Affiliation:
Infection Control Department, Detroit, Michigan
Susan Meisner
Affiliation:
Infection Control Department, Detroit, Michigan
Dorine Berriel-Cass
Affiliation:
Quality Management Department, Detroit, Michigan
Ruth Savoy-Moore
Affiliation:
Medical Education Department, Detroit, Michigan
Nicole Brach
Affiliation:
Case Management Department, Detroit, Michigan
Janice Rey
Affiliation:
Infection Control Department, Detroit, Michigan
Laura Desantis
Affiliation:
Quality Management Department, Detroit, Michigan
Louis D. Saravolatz
Affiliation:
Division of Infectious Diseases, Department of Medicine, Detroit, Michigan St. John Hospital and Medical Center, and Wayne State University School of Medicine, Detroit, Michigan
*
Division of Infectious Diseases, Department of Medicine, St. John Hospital and Medical Center, 19251 Mack Ave, Suite 340, Grosse Pointe Woods, MI 48236 (mohamad.fakih@stjohn.org)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To determine the effect of nurse-led multidisciplinary rounds on reducing the unnecessary use of urinary catheters (UCs).

Design.

Quasi-experimental study with a control group, in 3 phases: preintervention, intervention, and postintervention.

Setting.

Twelve medical-surgical units within a 608-bed teaching hospital, from May 2006 through April 2007.

Intervention.

A nurse trained in the indications for UC utilization participated in daily multidisciplinary rounds on 10 medical-surgical units. If no appropriate indication for a patient's UC was found, the patient's nurse was asked to contact the physician to request discontinuation. Data were collected before the intervention (for 5 days), during the intervention (for 10 days), and 4 weeks after the intervention (for 5 days). Two units served as controls.

Results.

Of 4,963 patient-days observed, a UC was present in 885 (for a total of 885 “UC-days”). There was a significant reduction in the rate of UC utilization from 203 UC-days per 1,000 patient-days in the preintervention phase to 162 UC-days per 1,000 patient-days in the intervention phase (P = .002). The postintervention rate of 187 UC-days per 1,000 patient-days was higher than the rate during the intervention (P = .05) but not significantly different from the preintervention rate (P = .32). The rate of unnecessary use of UCs also decreased from 102 UC-days per 1,000 patient-days in the preintervention phase to 64 UC-days per 1,000 patient-days during the intervention phase (P < .001); and, significantly, the rate rose to 91 UC-days per 1,000 patient-days in the postintervention phase (P = .01). The rate of discontinuation of unnecessary UCs in the intervention phase was 73 (45%) of 162.

Conclusions.

A nurse-led multidisciplinary approach to evaluate the need for UCs was associated with a reduction of unnecessary UC use. Efforts to sustain the intervention-induced reduction may be successful when trained advocates continue this effort with each team.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 9 , September 2008 , pp. 815 - 819
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Saint, S. Clinical and economic consequences of nosocomial catheter-related bacteriuria. Am J Infect Control 2000;28:68–75.CrossRefGoogle ScholarPubMed
2.Tambyah, PA, Knazinski, V, Maki, DG. The direct costs of nosocomial catheter-associated urinary tract infection in the era of managed care. Infect Control Hosp Epidemiol 2002;23:27–31.CrossRefGoogle ScholarPubMed
3.Saint, S, Lipsky, BA, Goold, SD. Indwelling urinary catheters: a one-point restraint? Ann Intern Med 2002;137:125–127.CrossRefGoogle ScholarPubMed
4.Baumgarten, M, Margolis, DJ, Localio, AR, et al.Pressure ulcers among elderly patients early in the hospital stay. J Gerontol A Biol Sci Med Sci 2006;61:749–754.CrossRefGoogle ScholarPubMed
5.Fakih, MG, Nunu, O. A multidisciplinary effort to reduce the risk of urinary catheter associated infection: an intervention to get and keep the Foley out. In: Program and abstracts of the 16th Annual Meeting of the Society for Healthcare Epidemiology of America; Chicago, IL; March 2006. Abstract 9.Google Scholar
6.Wong, ES. Guideline for prevention of catheter-associated urinary tract infections. Am J Infect Control 1983;11:28–36.CrossRefGoogle ScholarPubMed
7.Huang, WC, Wann, SR, Lin, SL, et al.Catheter-associated urinary tract infections in intensive care units can be reduced by prompting physicians to remove unnecessary catheters. Infect Control Hosp Epidemiol 2004;25:974–978.CrossRefGoogle ScholarPubMed
8.Topal, J, Conklin, S, Camp, K, Morris, V, Balcezak, T, Herbert, P. Prevention of nosocomial catheter-associated urinary tract infections through computerized feedback to physicians and a nurse-directed protocol. Am J Med Qual 2005;20:121–126.CrossRefGoogle Scholar
9.Cornia, PB, Amory, JK, Fraser, S, Saint, S, Lipsky, BA. Computer-based order entry decreases duration of indwelling urinary catheterization in hospitalized patients. Am J Med 2003;114:404–407.Google Scholar
10.Munasinghe, RL, Yazdani, H, Siddique, M, Hafeez, W. Appropriateness of use of indwelling urinary catheters in patients admitted to the medical service. Infect Control Hosp Epidemiol 2001;22:647–649.CrossRefGoogle Scholar
11.Gokula, RRM, Hickner, JA, Smith, MA. Inappropriate use of urinary catheters in elderly patients at a Midwestern community teaching hospital. Am J Infect Control 2004;32:196–199.Google Scholar
12.Saint, S, Wiese, J, Amory, JK, et al.Are physicians aware of which of their patients have indwelling urinary catheters? Am J Med 2000;109:476–480.CrossRefGoogle ScholarPubMed
13.Saint, S, Kowalski, CP, Forman, J, et al.A multicenter qualitative study on preventing hospital-acquired urinary tract infection in US hospitals. Infect Control Hosp Epidemiol 2008;29:333–341.Google Scholar