Improving Patient Dignity and Mobility Through Appropriate Urinary Catheter Bag Selection: A Multi-Site QIP

Introduction 
Indwelling urinary catheters are commonly used in hospitalised adults. Measuring bags, while necessary for fluid monitoring in specific cases, are often used by default without clear indication. This can restrict mobility, affect dignity, and contribute to functional decline in patients with preserved mobility. This project aimed to evaluate the usage of urine collection systems and their impact on patient well-being and improve the usage of less restrictive leg bags where appropriate.

Methods 
QIP was conducted on medical wards at two hospital sites. Cycle 1 (Jan–Feb 2024) included a prospective audit of n=116 with short-term indwelling catheters. Patients requiring long-term catheters or strict fluid balance monitoring were excluded. Data were collected from clinical records and interviews with staff and patients, assessing catheter bag type, clinical justification, and its impact on dignity and mobility. Baseline mobility was assessed using the Bedside Mobility Assessment Tool (BMAT). A flowchart was then introduced to support appropriate bag selection based on clinical need, mobility, and patient preference. Cycle 2 (n=120) was completed in July 2025.

Results 
In Cycle 1, 84% of patients had measuring bags, but 59% were deemed to be suitable for leg bags. BMAT scores indicated 49% of patients were non-ambulatory. Of the mobile patients, 19% reported dignity concerns, and 13% felt mobility was affected. After the intervention, measuring bag use decreased to 58%, and leg bag use rose to 42%. Patient-reported dignity concerns reduced from 19% to 7%, and mobility restriction from 13% to 12%.

Conclusions 
This project identified a care gap where default use of measuring bags often overlooked clinical need, dignity and mobility. Implementation of a flowchart and education delivered to nursing and medical staff improved awareness and encouraged patient-centred urine collection bag selection. Embedding this in local training and inductions could support wider adoption across similar settings.