A-voiding catastrophe: implementing a nurse-driven protocol

To evaluate the effectiveness of a nurse-driven indwelling urinary catheter removal protocol in an acute care setting.

The most common hospital-acquired infection is catheter-associated urinary tract infection (CAUTI). These infections account for 40% of all hospital-acquired infections. Although indwelling urinary catheters may be a needed intervention, studies have demonstrated over half of the patients who receive a urinary catheter do not have a valid indication for its use.

A retrospective chart review allowed measurement of prevalence of catheter usage, dwell time, and CAUTIs before and after implementation of the protocol. Indwelling catheter usage was tabulated monthly from nursing clinical documentation. The sum of catheter days was divided by the total patient days and multiplied by 100 to get a percentage of catheter usage for each month. Dwell time was calculated by tabulating the length of time in days each patient had an indwelling catheter and dividing it by the total number of catheterized patients to determine the mean duration in days. The number of CAUTIs was divided by the total number of patients with urinary catheters and multiplied by 100 to get the percentage of CAUTI.

Prior to implementing the nurse-driven removal protocol, indwelling urinary catheter usage was 37.6%, mean dwell time was 3.35 days, and the CAUTI rate was 0.77%. After implementation of the protocol, catheter usage was 27.7%, mean dwell time was 3.46 days, and the CAUTI rate 0.35%.

Findings support the use of a nurse-driven protocol to reduce the incidence and duration of urinary catheterization, to decrease incidence of CAUTI, and to improve the quality of care for hospitalized patients.