Early Removal of Unnecessary Urinary Catheters: Lose The Tube!
Project Lead: Dr. Jerome Leis
In April 2014, a point prevalence audit confirmed that 18% of hospitalized patients were catheterized even though 69% lacked an appropriate guideline-based reason. Urinary catheter removal was frequently haphazard and many urinary catheters were re-inserted at the first sign of urinary retention. A medical directive was developed to standardize removal of urinary catheters on transfer to the medicine ward. Staff were then trained to follow the medical directive to remove urinary catheters lacking pre- specified reasons and to follow a post-catheter care algorithm to detect and manage any urinary retention in a standard way. Dr. Jerome Leis, who led the project, credits its success to, “obtaining consensus among all physicians and surgeons regarding appropriate reasons for urinary catheter use, and successfully engaging nurse leaders”. This medical directive has resulted in 50% fewer urinary catheters on the medical wards sustained beyond 1-year, and the team has not encountered any inappropriate urinary catheter removals. Although the project has had great success thus far, Dr. Leis is cognizant of the fact that these results will be challenging to sustain. As such, the medical directive has become hospital policy and included in the training of new employees.
A toolkit on appropriate removal of urinary catheters in hospitals has been developed by Dr. Leis and Dr. Christine Soong. You can find the toolkit and its modules here.