‘What are we going to do about the catheter?’ Our team’s way of starting the discussion.

Introduction:

The cornerstone of catheter-associated urinary tract infection (CAUTI) prevention is avoiding unnecessary indwelling urinary catheter (IUC) insertion [1]. As part of a long-term project to reduce the number of catheters, the most common inserted device used across MOE wards in our hospital, we recently undertook a project to improve planning (does it need to stay, can we remove it?) and the reliability of information reconciliation around their use.

Methods:

We designed a data collection tool, analysing key aspects of IUC care, measured our performance at least twice-yearly using data to educate and inform teams. After noting a drop off in documentation around planning, we designed an intervention for our electronic patient record: amending our multi-disciplinary team (MDT) prompt, encouraging teams each week to make a decision re the necessity for ongoing catheterisation. A further three cycles of audit were performed following the intervention.

Results:

Across the MOE footprint (up to 142 beds), the prevalence of IUC use averages around 25%. This has not changed significantly across the audit period. The most recent intervention showed marked and initially sustained improvement in planning which has not been sustained.

Whilst indication and date of insertion remained high, MDT rates of discussion dropped.

Conclusion:

Although we increased the MDT awareness of our use of IUCs and by doing so initially saw improvements in both planning and information reconciliation, these improvements have dropped off. Our next cycles will explore the MDT attitude to IUCs (are they seen as more convenient?) as well as linking to ongoing work around CAUTI reduction, which will hopefully reemphasise the importance of infection control.