Improving Patient Safety: Assessment and Rationalisation of Urinary Catheterisation Practices in Hospitalised Adults

Introduction
Indwelling urinary catheterisation is common in hospitalised adults but is associated with catheter‑associated urinary tract infection, prolonged hospital stay, deconditioning and discomfort when not optimally indicated or reviewed. A two‑cycle quality improvement project in Morriston Hospital aimed to evaluate and improve the appropriateness, documentation and ongoing review of urinary catheter use to enhance patient safety.​

Method
Two retrospective audit cycles were undertaken on adult inpatients with indwelling urinary catheters, using clinical notes and catheter bundles as data sources. There were 50 patients in first cycle and the second cycle included 45 inpatients across multiple medical wards and reassessed indications, documentation, catheter bundles, care plans and trial without catheter (TWOC) after targeted interventions. Interventions comprised structured teaching for doctors and nursing staff in OPAU, AMU and ED on appropriate indications, daily review, documentation, timely TWOC and reinforcement of the existing catheter bundle.​

Results
Patients were older and moderately frail, with mean ages around 78–79 years. Between the first and second cycles, bladder scan use for suspected retention increased (50% to 62.2%), catheter bundle adherence improved, and documentation completion rose. The proportion of catheters without clear indications fell from 30% to 16%, patients without catheter bundles decreased from 24% to 18%, and those with no documentation reduced from 45% to 33%. However, the proportion of patients with unclear catheter management plans increased from 48% to 67%, highlighting persistent weaknesses in documenting duration and TWOC strategy.​

Conclusion
This two‑cycle project shows that focused education and reinforcement of an existing catheter bundle can improve documentation quality, bundle adherence, bladder scan usage and reduce catheters without clear indications. Ongoing challenges around catheter management planning highlight the need for regular teaching, repeated re‑audit, and embedding catheter status and plans into routine handovers and board rounds to sustain and extend these gains.