Indwelling catheterisation in adults – Urethral and suprapubic (2024)

13. QUALITY IMPROVEMENT

The term quality improvement is a collective term with different objectives. Thus, effectiveness of measures, avoidance of complications, as well as preventive aspects (e.g., avoidance of UTIs or incontinence) are understood under this term. Implementation, good clinical practice and evidence-based practice are also included in this topic, as well as quality improvement programmes or studies and projects.

The identified studies and articles about quality improvement took place in different settings and studied different interventions. In the table in Appendix T, an overview of the relevant articles is found to give some recommendations.

The focus of the articles includes:

• How to manage stop orders
• How to reduce inappropriate indwelling catheter use
• How to reduce catheter time and remove catheters that are no longer needed
• How to reduce CAUTIs
• How to follow evidence-based practice
• Education
• Quality improvement

Examples of programmes that have been demonstrated to be effective include:

1. A system of alerts or reminders to identify all patients with urinary catheters and assess the need for continued catheterisation
2. Guidelines and protocols for nurse-directed removal of unnecessary urinary catheters
3. Education and performance feedback regarding appropriate use, hand hygiene, and catheter care [227, 228]
4. Guidelines and algorithms for appropriate perioperative catheter management, such as:
   a. Procedure-specific guidelines for catheter placement and postoperative catheter removal
   b. Protocols for management of postoperative urinary retention, such as nurse-directed use of intermittent catheterisation and use of bladder ultrasound scanner [24]

Stop order or reminder

In an integrative review which is also a meta-analysis [229] (LE: 1b), different aspects to prevent CAUTIs are described. Stop order interventions include prompting/requiring removal of the catheter based on time or clinical criteria. Reminder interventions that a urinary catheter is still present could be directed at either physicians or nurses. There are also interventions to avoid unnecessary catheter placement (e.g., restricted indications of use, and bladder scanning protocols). Catheter placement restrictions and urinary retention protocols result in decreased use of urinary catheters as well as reduction in appropriate indications.

The result of this meta-analysis shows that stop orders can result in prevention of many CAUTIs. Using reminders shows some effect in comparison with the control group but this is not significant. [229]