Authors (including presenting author) :
Ho HY(1), Sin KH(1), Choy YM(1), Lee SY(1), Kwok WH(2), Tam KF(2), Kwan SCW(1), Lee MM(1), To HC(3)
Affiliation :
(1)Nursing Department, Hong Kong Buddhist Hospital, (2)Medicine Department, Hong Kong Buddhist Hospital, (3)Surgical Department, Queen Elizabeth Hospital
Introduction :
Catheter-associated urinary tract infection (CAUTI) is the most common healthcare-associated problem over the world. Although CAUTI was usually not life-threatening, its complications would increase the burden of the healthcare sector, and increase morbidity and mortality. Evidence showed that the use and the duration of urinary catheters were important factors to cause CAUTI.
Objectives :
To reduce the inappropriate use of urethral urinary catheters, an “Auto-stop system” was implemented in the Hong Kong Buddhist Hospital in 2021. In this program, nurses were empowered to initiate weaning off urinary catheters.
Methodology :
The pre-printed “Auto-stop System of Weaning Off Urinary Catheter Preventing CAUTI” form was designed for nurses to follow. Nine exclusion criteria were listed in the form, for example, urinary catheter to relieve obstructive uropathy, urinary catheter to improve comfort for terminally ill patients, urinary catheter to monitor urine output in critically ill patients. A nursing assessment would be done on the scheduled date of changing urethral urinary catheter. If the patient does not meet any of the nine exclusion criteria listed, urethral urinary catheter would be trialed for weaning off. After weaning off the urinary catheter, bladder scanning would be done on days 0,1 and 2, regardless of whether the patient had micturition or not. Once if the patient had more than 400ml of residue urine, urethral urinary catheter would be reinserted. If there were 3 consecutive micturition with volume of post-void residual (PVR) urine < half of the voided volume or PVR < 300ml, the patient would be considered weaning off the catheter successfully. The program was piloted in 2 medical wards in January 2021, and it had been fully rolled out in all other medical wards from May 2021 onward. A preference survey for doctors, nurses, and patients was also done in December 2021.
Result & Outcome :
Until the end of November 2021, 265 patients’ urethral urinary catheters were weaned off with the auto-stop system. Among those patients, 159(60%) were successful cases. For the rest of the 40% cases, they developed urinary retention within 3 days after weaning off urinary catheter and urinary catheter were reinserted. The Preference Survey was conducted with 12 doctors, 15 patients, and 115 nurses, and the average score was 4.4/5, 4.2/5, and 3.65/5 respectively. Most doctors and patients were satisfied with the program and they agreed that the workflow was beneficial to patients. A relatively low score was found among nurses as they thought that it had increased their workload in filling the pre-printed form. They reflected that the pre-printed form could be further simplified so as to reduce their workload, nevertheless, around 70% of nurses agreed that the workflow was beneficial to patients especially for the long-stay cases. In conclusion, reduction of urinary catheter use is essential in preventing CAUTI. The “Auto-stop system” not only increased nurses’ autonomy but also contributed to patients’ health. Revision of the pre-printed form and support for nurses would be followed up to make the program sustainable.
