BERKELEY, CA (UroToday.com) - This is a very good review of the steps that Kaiser Permanente, Southern California region, successfully used to reduce the inappropriate use of indwelling urinary catheters (IUCs).
Specific interventions are detailed after a review of the use of IUCs with resulting adverse events. The authors note that patients with dementia and CHF are 2 groups that have a disproportionately high frequency of inappropriate IUC insertions. They also note that insertion of an IUC has been shown to precipitate inappropriate IUC use. The first intervention implemented in these hospitals was implementing a physician requirement to specify the reason for insertion of an IUC through the electronic medical record, with continued use renewed daily. Nurses were expected to inquire about the patient’s toileting needs every 1 to 2 hours, and provide patient assistance as needed. This was part of a nursing plan to encourage patient ambulation while minimizing IUC use. A pilot project using bladder ultrasonography was conducted to monitor for abnormally large, postvoid residuals. This project was successful in reducing IUC insertions in the emergency department by 80%. Due to this success, the hospitals decided to purchase bladder scanners for all departments. Surgeons were educated about IUC use and expected to remove them as soon as possible, preferably on the first or second day postoperatively. All interventions mentioned in this article could be adopted by all US hospitals.