Tick-TWOC: Promoting Timely Urinary Catheter Removal and Reducing Associated Complications in a Geriatric Medicine Department

Introduction: 

Urinary catheterisation is a common intervention within the NHS. As with all medical interventions, there are associated risks, including infection, which may have a greater impact on older patients. Careful stewardship of catheter care is essential to prevent complications and maintain patient safety. However, there is a lack of clear national guidelines regarding catheterisation within the UK to support healthcare professionals.  

Aim: 

Improve documentation of urinary catheters and reduce the number of catheter-associated complications within two geriatric medicine wards of a district general hospital.  

Methods: 

The baseline data were collected on parameters regarding catheterisation, including documentation of indication, review and complications. The data were evaluated and an intervention for improvement involving the multidisciplinary team was formulated. A departmental teaching session, signage of urinary catheters at the bedside and an automated text template to facilitate documentation were implemented. Following this, a second cycle of data collection took place to evaluate changes in practice and outcomes.  

Results: 

Over two weeks, 104 patients were reviewed, of whom 36 (34.6%) were catheterised. Following intervention, 107 patients were reviewed, of whom 42 (39.3%) were catheterised. Documentation of catheter indication improved from 52.8% to 78.6%. Clinical justification for prolonged catheterisation increased from 38.5% to 56.7%. Mean catheter duration decreased from 14.4 to 13.4 days. Although catheter-associated complications increased (13.9% to 21.4%), the proportion requiring intervention fell (40.0% to 33.3%). 

Conclusion: 

Documentation of catheter indication and clinical reasoning for prolonged catheterisation improved following the intervention, supporting more informed decision-making regarding catheter stewardship. Although duration of catheterisation decreased only modestly and complication rates increased during the study period, the short follow-up between the intervention and second cycle, and a higher proportion of patients with long-term catheter indications may have influenced these findings. Ongoing quality improvement cycles will focus on strengthening catheter stewardship and reducing avoidable catheterisation.