Department of Hospice and Palliative Medicine

Aurora at Home Hospice

Zilber Family VNA Hospice

Presentation Notes

Poster presented at: Aurora Scientific Day; May 20, 2020; virtual webinar hosted in Milwaukee, WI.


Background: The Macy Catheter (MC) is a tool to aid rectal delivery of oral medications in microenemas. In 2019, Aurora Health at Home hospice chose the MC as a preferred route for delivery of medications when patients no longer tolerate the oral route. Despite training, adoption of the MC has been slow.

Purpose: To determine what barriers exist to faster adoption and utilization of the MC by hospice nursing staff. It is anticipated that once the barriers are identified they will be addressed through a campaign of quality improvement projects with subsequent monitoring of adoption.

Methods: An anonymous survey was given to 28 nurses at 2 meetings. The survey identified nurses that used the MC and their experiences. Nurses who had not used it were queried to see if they had no eligible patients or, if they had eligible patients, what their reasons were for not using it. Demographic data included age, experience as a registered nurse (RN) and hospice RN, usual shift worked, and work status. Basic descriptive statistics were used to describe the population.

Results: Of a total of 28 surveys completed, 7 reflected use of the MC, with most using it only once and 1 using it 3–5 times. The number of medication doses given ranged from 1 to 10–20. There was an overall agreement regarding the ease of the MC insertion and its effectiveness when compared to the oral route. There were no complications noted. Ten nurses reported to never have used the MC because of not having eligible patients, while 12 reported having eligible patients and not using the MC, though 9 considered it. Common reasons for not using it include patient/family objections, inexperience using the MC, or confidence in other methods. One nurse reported not using it due to a nursing facility policy. Of those who had eligible patients and who did not consider using it, reasons given included unfamiliarity and not thinking of it in the “heat of the moment.” There were no demographic differences among these groups that would account for their willingness to use or consider the MC.

Conclusion: The study identified leadership opportunities to increase the use of the Macy Catheter. Experienced nurses can help train and teach their peers how to “sell” this device to patients, families, and other clinicians. There is a need to develop educational collateral to help families understand the utility of the MC. We can work with facilities to make sure their policies align with the latest nursing approaches for excellent hospice care.

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