Nurse Driven Protocol to Decrease Catheter Associated Urinary Tract Infection

Abstract

Problem and Purpose: Even though many hospitals are dedicated to utilizing evidence-based practices to prevent nosocomial infections, there still exist practice gaps. Catheter Associated Urinary Tract Infection (CAUTI) is one of the most common preventable hospital acquired infections. CAUTIs can result in health complications such as patient distress, discomfort, pain, longer hospital stays, sepsis, and increased cost. The purpose of this quality improvement project was to implement a Nurse-Driven Protocol in adult patients with indwelling foley catheter (e.g., routine order, guideline, flowchart, algorithm) and discontinue foleys without a provider’s order. Method: A local hospital implemented a Nurse-Driven Protocol for management of urinary catheters. The protocol empowered nurses with the decision to discontinue catheters. All adult patients admitted to the Intermediate Care Unit (IMCU) and who received indwelling foley catheters during the twelve weeks of implementation were included. Champion leaders and registered nurses were selected and received in-service education about the Nurse-Driven Protocol. Algorithm, posters, and charts were developed and given to the nurses. In person and virtual meetings, in-services, phone calls and email reminders were used to engage champion leaders. Process measures were comprised of Device Utilization Ratio (DUR) and staff compliance. Outcome measures included pre-and-post CAUTI data and the number of CAUTIs per 1,000 catheter days. Chart audit tools were used, and data were collected bi-weekly. Pre-and post-implementation CAUTI rates were obtained. Run chart was used to display the data. Results: The staff training on the protocol was successful (92%). After the 12 weeks implementation period DUR decreased to 19.2% (Baseline was DUR 31%). Similarly, CAUTI rate was reduced to “zero” (Baseline CAUTI rate was 4). Nursing staff compliance was 92%. Conclusions: There were reductions of DUR and CAUTI in the IMCU unit during the implementation period. The Nurse-Driven Protocol was an effective intervention to reduce DUR and CAUTI rates. Future implication for practice includes incorporation of the protocol as part of the organization’s procedure manual to improve patient outcomes.