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Recommended Citation
Marshall K, Starnes A, Reed M. Enhancing Patient Safety: A Virtual Approach to Reducing Urinary Catheter Utilization in Critical Care. Nurse-driven Innovations in Care Redesign and Delivery podium presentation at Elevating Nursing Excellence: Purpose, Profession, Passion; Advocate Health Midwest Region Nursing Research & Professional Development Conference 2024; November 13, 2024; virtual.
Presentation Notes
Nurse-driven Innovations in Care Redesign and Delivery podium presentation at Elevating Nursing Excellence: Purpose, Profession, Passion; Advocate Health Midwest Region Nursing Research & Professional Development Conference 2024; November 13, 2024; virtual.
Abstract
Introduction and Context
From mid-2020, the Critical Care Unit at Atrium Health Lincoln consistently exceeded a urinary catheter utilization ratio of 1.0. This ratio was higher than other critical care units within the system and failed to meet established targets. Elevated urinary catheter utilization rates are associated with catheter-associated urinary tract infections. In the first quarter of 2023, the infection rate of the Critical Care Unit was 3.76 per 1,000 catheter days, posing a safety risk to patients.
Implementation Strategy
Before intervention, the process of discontinuing urinary catheters relied on nurses requesting removal from physicians. Despite having a nurse-driven protocol for removal, this process lacked consistency. To improve it, an interprofessional group utilized the Plan-Do-Study-Act cycle to leverage Virtual Critical Care’s expertise during daily rounds starting in June 2023. The virtual care team now provides daily recommendations for removal and ongoing patient progression monitoring. Key tools utilized include a mobile telehealth cart and software including Microsoft Forms®, Power BI®, and Epic electronic medical records.
Outcomes and Impact
Since implementation, Virtual Critical Care nurses assessed 586 patients for device necessity, resulting in recommendations to remove twenty-five urinary catheters with an acceptance rate of 88%. The urinary catheter utilization ratio has remained below 1.0, and the infection rate per 1,000 catheter days has been zero since the process change. These achievements improve patient outcomes and result in significant cost savings. According to the Agency for Healthcare Research and Quality, the cost of a catheter-associated infection is approximately $13,793.
Implications
This process change has fostered a culture of accountability and strengthened collaboration between the virtual and onsite care teams. Because of this success at Atrium Health Lincoln, the Virtual Critical Care unit has expanded this process to ten additional critical care units across the Southeast Region, leading to a combined decrease in standard utilization ratio from 0.812 to 0.794 (2022-2023).
References
Agency for Healthcare Research and Quality. (2017). https://www.ahrq.gov/hai/pfp/haccost2017-results.html
Baker, S., Shiner, D., Stupak, J., Cohen, V., & Stoner, A. (2022). Reduction of catheter-associated urinary tract infections. Critical Care Nursing Quarterly, 45(4), 290–299. https://doi.org/10.1097/cnq.0000000000000429
Garcia, D. M., Makic, M. B., & Casey, K. (2023). Rounding and quick access education to reduce catheter-associated urinary tract infections. Clinical Nurse Specialist, 37(3), 117–123. https://doi.org/10.1097/nur.0000000000000741
Konda, S. R., Johnson, J. R., Kelly, E. A., & Egol, K. A. (2020). Pull the foley: Improved quality for middle-aged and geriatric trauma patients without indwelling catheters. Journal for Healthcare Quality, 42(6), 341–351. https://doi.org/10.1097/jhq.0000000000000241
Mrziglod, L., Saydan, S., Schwab, F., Zohlnhöfer-Momm, D., Gastmeier, P., & Hansen, S. (2023). Reducing urinary catheter use in geriatric patients - results of a single-center champion-led intervention. BMC Infectious Diseases, 23(1). https://doi.org/10.1186/s12879-023-08064-8
Reynolds, S. S., Lozano, H., Fleurant, M., & Bhandari, K. (2022). Using statistical process control charts to measure changes from a nurse-driven protocol to remove urinary catheters. American Journal of Infection Control, 50(12), 1355–1359. https://doi.org/10.1016/j.ajic.2022.03.005
Van Decker, S. G., Bosch, N., & Murphy, J. (2021). Catheter-associated urinary tract infection reduction in Critical Care Units: A bundled care model. BMJ Open Quality, 10(4). https://doi.org/10.1136/bmjoq-2021-001534
Document Type
Oral/Podium Presentation
Publication Date
11-13-2024
Enhancing Patient Safety: A Virtual Approach to Reducing Urinary Catheter Utilization in Critical Care
Introduction and Context
From mid-2020, the Critical Care Unit at Atrium Health Lincoln consistently exceeded a urinary catheter utilization ratio of 1.0. This ratio was higher than other critical care units within the system and failed to meet established targets. Elevated urinary catheter utilization rates are associated with catheter-associated urinary tract infections. In the first quarter of 2023, the infection rate of the Critical Care Unit was 3.76 per 1,000 catheter days, posing a safety risk to patients.
Implementation Strategy
Before intervention, the process of discontinuing urinary catheters relied on nurses requesting removal from physicians. Despite having a nurse-driven protocol for removal, this process lacked consistency. To improve it, an interprofessional group utilized the Plan-Do-Study-Act cycle to leverage Virtual Critical Care’s expertise during daily rounds starting in June 2023. The virtual care team now provides daily recommendations for removal and ongoing patient progression monitoring. Key tools utilized include a mobile telehealth cart and software including Microsoft Forms®, Power BI®, and Epic electronic medical records.
Outcomes and Impact
Since implementation, Virtual Critical Care nurses assessed 586 patients for device necessity, resulting in recommendations to remove twenty-five urinary catheters with an acceptance rate of 88%. The urinary catheter utilization ratio has remained below 1.0, and the infection rate per 1,000 catheter days has been zero since the process change. These achievements improve patient outcomes and result in significant cost savings. According to the Agency for Healthcare Research and Quality, the cost of a catheter-associated infection is approximately $13,793.
Implications
This process change has fostered a culture of accountability and strengthened collaboration between the virtual and onsite care teams. Because of this success at Atrium Health Lincoln, the Virtual Critical Care unit has expanded this process to ten additional critical care units across the Southeast Region, leading to a combined decrease in standard utilization ratio from 0.812 to 0.794 (2022-2023).
References
Agency for Healthcare Research and Quality. (2017). https://www.ahrq.gov/hai/pfp/haccost2017-results.html
Baker, S., Shiner, D., Stupak, J., Cohen, V., & Stoner, A. (2022). Reduction of catheter-associated urinary tract infections. Critical Care Nursing Quarterly, 45(4), 290–299. https://doi.org/10.1097/cnq.0000000000000429
Garcia, D. M., Makic, M. B., & Casey, K. (2023). Rounding and quick access education to reduce catheter-associated urinary tract infections. Clinical Nurse Specialist, 37(3), 117–123. https://doi.org/10.1097/nur.0000000000000741
Konda, S. R., Johnson, J. R., Kelly, E. A., & Egol, K. A. (2020). Pull the foley: Improved quality for middle-aged and geriatric trauma patients without indwelling catheters. Journal for Healthcare Quality, 42(6), 341–351. https://doi.org/10.1097/jhq.0000000000000241
Mrziglod, L., Saydan, S., Schwab, F., Zohlnhöfer-Momm, D., Gastmeier, P., & Hansen, S. (2023). Reducing urinary catheter use in geriatric patients - results of a single-center champion-led intervention. BMC Infectious Diseases, 23(1). https://doi.org/10.1186/s12879-023-08064-8
Reynolds, S. S., Lozano, H., Fleurant, M., & Bhandari, K. (2022). Using statistical process control charts to measure changes from a nurse-driven protocol to remove urinary catheters. American Journal of Infection Control, 50(12), 1355–1359. https://doi.org/10.1016/j.ajic.2022.03.005
Van Decker, S. G., Bosch, N., & Murphy, J. (2021). Catheter-associated urinary tract infection reduction in Critical Care Units: A bundled care model. BMJ Open Quality, 10(4). https://doi.org/10.1136/bmjoq-2021-001534
Affiliations
Atrium Health Lincoln Critical Care Unit