Quality improvement initiative improved catheter utilization

AUSTIN, TEX. – A quality improvement initiative reduced the number of days on a urinary catheter and improved catheter utilization among patients in a chronic ventilator-dependent unit.

During a preintervention period, 24 of 37 patients (65%) were catheterized for a total of 107 urinary catheter days (mean of 4.5 per patient); after the 2-month intervention that relied on a standardized electronic checklist and visual reminders, 18 of 35 patients (51%) were catheterized for a total of 58 urinary catheter days (mean of 3.2 per patient). Further, the device utilization ratio decreased from 0.299 before the intervention to 0.212 after, Dr. Perliveh Carrera reported at the annual meeting of the American College of Chest Physicians.

The catheter utilization rates on the unit were below the national average of 0.45, and the rates of catheter-associated urinary tract infections (CAUTI) were relatively low. The unit’s rates had increased in 2012 and 2013, however, prompting this effort to reduce infections by reducing utilization.

“CAUTI is the most common health care–associated infection, affecting up to 20% of patients,” said Dr. Carrera of the Mayo Clinic in Rochester, Minn.

About 80% of CAUTIs are precipitated by an indwelling catheter, and up to half of catheterized patients don’t have an indication for catheter placement, she said. Data suggest that 20%-50% of catheters are inappropriately placed, and catheter placement is an important modifiable risk factor for preventing UTI.

The quality initiative was implemented on a nine-bed chronic ventilator unit where adult patients had an average length of stay of about 2 weeks. The intervention involved the use of a Define, Measure, Analyze, Improve, and Control (DMAIC) framework and included a combination of multidisciplinary teamwork and tools for promoting adherence. These tools included educational presentations to staff, posters, reminder cards on patients’ doors, and promotion of an electronic checklist that required input of an appropriate indication for catheterization. A charge nurse was provided with a portable tablet to track use of the electronic checklist.

The approach was developed after an initial survey of nursing staff identified low utilization of a paper checklist and knowledge gaps about catheter utilization and infection control efforts, Dr. Carrera said.

The initiative was associated with a significant increase in electronic checklist compliance – from 33% to 79% – and with a trend toward a reduction in the number of urinary catheter days and catheter utilization, she said.

As a quality metric, catheter days and utilization are more stable than CAUTI, which has been recognized as labile and subject to wide variation, she added.

Dr. Carrera reported having no disclosures.

AUSTIN, TEX. – A quality improvement initiative reduced the number of days on a urinary catheter and improved catheter utilization among patients in a chronic ventilator-dependent unit.

During a preintervention period, 24 of 37 patients (65%) were catheterized for a total of 107 urinary catheter days (mean of 4.5 per patient); after the 2-month intervention that relied on a standardized electronic checklist and visual reminders, 18 of 35 patients (51%) were catheterized for a total of 58 urinary catheter days (mean of 3.2 per patient). Further, the device utilization ratio decreased from 0.299 before the intervention to 0.212 after, Dr. Perliveh Carrera reported at the annual meeting of the American College of Chest Physicians.

The catheter utilization rates on the unit were below the national average of 0.45, and the rates of catheter-associated urinary tract infections (CAUTI) were relatively low. The unit’s rates had increased in 2012 and 2013, however, prompting this effort to reduce infections by reducing utilization.

“CAUTI is the most common health care–associated infection, affecting up to 20% of patients,” said Dr. Carrera of the Mayo Clinic in Rochester, Minn.

About 80% of CAUTIs are precipitated by an indwelling catheter, and up to half of catheterized patients don’t have an indication for catheter placement, she said. Data suggest that 20%-50% of catheters are inappropriately placed, and catheter placement is an important modifiable risk factor for preventing UTI.

The quality initiative was implemented on a nine-bed chronic ventilator unit where adult patients had an average length of stay of about 2 weeks. The intervention involved the use of a Define, Measure, Analyze, Improve, and Control (DMAIC) framework and included a combination of multidisciplinary teamwork and tools for promoting adherence. These tools included educational presentations to staff, posters, reminder cards on patients’ doors, and promotion of an electronic checklist that required input of an appropriate indication for catheterization. A charge nurse was provided with a portable tablet to track use of the electronic checklist.

The approach was developed after an initial survey of nursing staff identified low utilization of a paper checklist and knowledge gaps about catheter utilization and infection control efforts, Dr. Carrera said.

The initiative was associated with a significant increase in electronic checklist compliance – from 33% to 79% – and with a trend toward a reduction in the number of urinary catheter days and catheter utilization, she said.

As a quality metric, catheter days and utilization are more stable than CAUTI, which has been recognized as labile and subject to wide variation, she added.

Dr. Carrera reported having no disclosures.

AUSTIN, TEX. – A quality improvement initiative reduced the number of days on a urinary catheter and improved catheter utilization among patients in a chronic ventilator-dependent unit.

During a preintervention period, 24 of 37 patients (65%) were catheterized for a total of 107 urinary catheter days (mean of 4.5 per patient); after the 2-month intervention that relied on a standardized electronic checklist and visual reminders, 18 of 35 patients (51%) were catheterized for a total of 58 urinary catheter days (mean of 3.2 per patient). Further, the device utilization ratio decreased from 0.299 before the intervention to 0.212 after, Dr. Perliveh Carrera reported at the annual meeting of the American College of Chest Physicians.

The catheter utilization rates on the unit were below the national average of 0.45, and the rates of catheter-associated urinary tract infections (CAUTI) were relatively low. The unit’s rates had increased in 2012 and 2013, however, prompting this effort to reduce infections by reducing utilization.

“CAUTI is the most common health care–associated infection, affecting up to 20% of patients,” said Dr. Carrera of the Mayo Clinic in Rochester, Minn.

About 80% of CAUTIs are precipitated by an indwelling catheter, and up to half of catheterized patients don’t have an indication for catheter placement, she said. Data suggest that 20%-50% of catheters are inappropriately placed, and catheter placement is an important modifiable risk factor for preventing UTI.

The quality initiative was implemented on a nine-bed chronic ventilator unit where adult patients had an average length of stay of about 2 weeks. The intervention involved the use of a Define, Measure, Analyze, Improve, and Control (DMAIC) framework and included a combination of multidisciplinary teamwork and tools for promoting adherence. These tools included educational presentations to staff, posters, reminder cards on patients’ doors, and promotion of an electronic checklist that required input of an appropriate indication for catheterization. A charge nurse was provided with a portable tablet to track use of the electronic checklist.

The approach was developed after an initial survey of nursing staff identified low utilization of a paper checklist and knowledge gaps about catheter utilization and infection control efforts, Dr. Carrera said.

The initiative was associated with a significant increase in electronic checklist compliance – from 33% to 79% – and with a trend toward a reduction in the number of urinary catheter days and catheter utilization, she said.

As a quality metric, catheter days and utilization are more stable than CAUTI, which has been recognized as labile and subject to wide variation, she added.

Dr. Carrera reported having no disclosures.