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Description

Purpose- Improve outcomes and safety for PICU patients through an Evidence Based Practice (EBP) approach to reduce catheter associated urinary tract infections (CAUTI)

PICO For pediatric patients in the ICU does a nurse driven urinary catheter (UC) program with discussion in rounds decrease urinary catheter utilization as compared to current practice?

Background There was an increased rate of CAUTI in the PICU between 2018 and 2019. UC necessity was not often discussed in rounds. The cost of a CAUTI is estimated to be between $1000- $13,793 per episode. Also associated with CAUTI are increased LOS (approximated at 2.3 days), excess mortality rate (estimated at 3.6%) and for each day a UC remains in place about an 8.1% increase in risk of CAUTI for the first 7 days.

Methodology/Intervention A group of bedside nurses, CNS, two team leaders, and manager conducted a literature review to identify strategies to reduce CAUTI in an ICU. Evidence was found that a nurse led urinary catheter (UC) removal program could reduce catheter utilization and CAUTI. This group in conjunction with the ICU medical director, ICU providers, and urology revised criteria for UC necessity and developed a removal algorithm. Education was provided to staff through a video and meetings. The program was implemented in September 2020 and nursing staff began to have robust discussions at team rounds for UC necessity. If patients didn’t meet criteria, nurses asked to remove the UC. In addition, new products were trialed and adopted to provide alternatives to UC use.

Results

In 2020 there was an 80% decrease in the number of PICU CAUTIs compared to 2019 (5 events in 2019 to 1 in 2020). As of September of 2020, there have been 0 CAUTI events. Since the development and implementation of the nurse driven urinary catheter (UC) program, the PICU unit with the most catheter days has seen a 21% reduction in catheter utilization (0.24 in 2020 to 0.19 in 2021).

Publication Date

2021

Disciplines

Pediatric Nursing

Decreasing the Risk: Early Discontinuation of UrinaryCatheters Through Nurse Led Removal Program

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