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Effect Of Nurse-Led Multidisciplinary Rounds On Reducing the Unnecessary Use Of Urinary Catheterization in Hospitalized Patients

  • Mohamad G. Fakih (a1) (a2) (a3), Cathleen Dueweke (a2), Susan Meisner (a2), Dorine Berriel-Cass (a4), Ruth Savoy-Moore (a5), Nicole Brach (a6), Janice Rey (a2), Laura Desantis (a4) and Louis D. Saravolatz (a1) (a3)...

Abstract

Objective.

To determine the effect of nurse-led multidisciplinary rounds on reducing the unnecessary use of urinary catheters (UCs).

Design.

Quasi-experimental study with a control group, in 3 phases: preintervention, intervention, and postintervention.

Setting.

Twelve medical-surgical units within a 608-bed teaching hospital, from May 2006 through April 2007.

Intervention.

A nurse trained in the indications for UC utilization participated in daily multidisciplinary rounds on 10 medical-surgical units. If no appropriate indication for a patient's UC was found, the patient's nurse was asked to contact the physician to request discontinuation. Data were collected before the intervention (for 5 days), during the intervention (for 10 days), and 4 weeks after the intervention (for 5 days). Two units served as controls.

Results.

Of 4,963 patient-days observed, a UC was present in 885 (for a total of 885 “UC-days”). There was a significant reduction in the rate of UC utilization from 203 UC-days per 1,000 patient-days in the preintervention phase to 162 UC-days per 1,000 patient-days in the intervention phase (P = .002). The postintervention rate of 187 UC-days per 1,000 patient-days was higher than the rate during the intervention (P = .05) but not significantly different from the preintervention rate (P = .32). The rate of unnecessary use of UCs also decreased from 102 UC-days per 1,000 patient-days in the preintervention phase to 64 UC-days per 1,000 patient-days during the intervention phase (P < .001); and, significantly, the rate rose to 91 UC-days per 1,000 patient-days in the postintervention phase (P = .01). The rate of discontinuation of unnecessary UCs in the intervention phase was 73 (45%) of 162.

Conclusions.

A nurse-led multidisciplinary approach to evaluate the need for UCs was associated with a reduction of unnecessary UC use. Efforts to sustain the intervention-induced reduction may be successful when trained advocates continue this effort with each team.

Copyright

Corresponding author

Division of Infectious Diseases, Department of Medicine, St. John Hospital and Medical Center, 19251 Mack Ave, Suite 340, Grosse Pointe Woods, MI 48236 (mohamad.fakih@stjohn.org)

References

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