Author: Cheema M.R.
Abstract: BACKGROUND/OBJECTIVES: Our study was conducted in the inpatient setting of Department of Elderly Medicine. A high percentage of indwelling catheters at discharge had been observed. Despite symptomatic benefit from placing a urinary catheter, they are often implicated in causing recurrent urinary tract infections, discomfort, and retention resulting from catheter blockage and are associated with an increased frequency of readmission. Our study aimed to ascertain whether these catheters were being placed for appropriate indications. METHODS: In the first cycle datawas collected over a period of two 2 weeks from notes of 61 elderly patients with urinary catheters. Medical notes were used to identify the indications for catheterization and to assess proper documentation pertaining to procedure of catheterization. This documentation comprised date, time, indication of catheterization, personnel name, catheter size, volume and colour of urine drained, use of aseptic technique and antibiotic prophylaxis given. To evaluate the knowledge among the staff regarding indications, complications and documentation of catheterization, questionnaire survey was carried out.After the initial cycle the ward managers and junior staff (junior doctors and nurses) were made aware about the findings of the audit through the presentation of the results in local grand round meeting. Lectures were given to the junior staff regarding the indications for catheterisation. Ward managers
and nurses in charge of elderly patients ward were informed about disseminating the knowledge regarding the indications and complications of catheterisation to the nursing staff. A repeat cycle of the audit was conducted 6 months after the intervention was carried out to assess the impact of the intervention. RESULTS: Our study revealed that 90% of total catheterizations in the first cycle were performed with complete/adequate documentation and for appropriate indications as per the IDSA guidelines. However, in
the second cycle after the intervention, 95.5% of total catheterisations were performed for the appropriate indications. In the first cycle,documentation of the date of procedure, the indication for catheterization use of aseptic technique: 100% agreed.Document if prophylactic antibiotics were given and if a sample was sent for analysis: 77% of agreed. Document the volume of urine drained: 97.4% agreed. 89.7% of them agreed they would document a description of the urine drained and 87% of them acknowledged they would document if it was a difficult procedure or not.After a period of 6 months post intervention, the results of the second cycle were encouraging. It showed positive attitudes and practices after the intervention. There were fewer number of inappropriate urinary catheterisations. Largely, the urinary catheterisation was performed for the
appropriate indications (95.5%) in accordance with the IDSA guidelines for catheterisation. Less number of unclear indications were seen (4.5%) in the second cycle as compared to the 1st cycle (10%). CONCLUSIONS: Responses to the questionnaire demonstrated good awareness of what needed to be documented among staff. However, the practice of documentation did not reflect the awareness demonstrated in the questionnaire in the first cycle. The awareness also improved in the second cycle after
intervention. The work also highlighted that there is a significant gap between the knowledge regarding urinary catheterisation and the practice performed by the junior staff. However, reinforcement with lectures has shown an improvement in this practice. This highlights the knowledge deficit which can be addressed with more effective educational interventions at both the undergraduate level (eg curriculum changes) and at
the postgraduate level (eg training and assessment as part of hospital induction). (Figure presented).
For more information about obtaining the full text of journal
articles, please visit our Document / Book Supply service.
