Urinary catheters and (peripheral and central) intravenous catheters are often used in clinical practice. These catheters can cause serious complications.
Every doctor and nurse knows that leaving a catheter in for too long is not good, yet 21-56% of patients have a urinary catheter and 25-56% of patients an intravenous catheter without appropriate indication. Not inserting and timely removing urinary and intravenous catheters is therefore the most important strategy to prevent catheter-associated infections. This project aims to reduce the number of urinary and intravasal catheters in adult patients.
Using several interventions, the number of urinary and intravenous catheters without appropriate indication was reduced. The study design was a multicenter, prospective interrupted time series study at the Internal Medicine departments and adjacent specialties in seven hospitals.
The de-implementation strategy consisted of a bundle of interventions:
Active surveillance during data collection
5691 patients were included. A first analysis without correcting for confounding showed that the percentage of patients with an unnecessary urinary catheter is reduced from 32% to 24% and the percentage of unnecessary intravasal catheters from 22% to 14%. The total number of catheters did not change.
Most catheters are unnecessary because they are left in for too long. The indications for a catheter that expire most often are ‘monitoring the production of urine in a severely ill patient’ for urinary catheters and ‘delivering medication or fluids intraveniously’ for intravenous catheters.
At the moment, this project is being completed. In the following years, this de-implementation strategy will be scaled up to other hospitals in the Netherlands.
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