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AN EVIDENCED-BASED PROTOCOL TO REDUCE URINARYCATHETER USE IN SKILLED NURSING FACILITIES

AN EVIDENCED-BASED PROTOCOL TO REDUCE URINARYCATHETER USE IN SKILLED NURSING FACILITIES. Murthy Gokula, M.D.,CMD Phyllis M. Gaspar, Ph.D., RN Thotakura, Sreekiran, M.D., MPH Rubeen, Shafia, M.D.,MPH University of Toledo, Department of Family Medicine Toledo,Ohio.

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AN EVIDENCED-BASED PROTOCOL TO REDUCE URINARYCATHETER USE IN SKILLED NURSING FACILITIES

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  1. AN EVIDENCED-BASED PROTOCOL TOREDUCE URINARYCATHETER USE INSKILLED NURSING FACILITIES Murthy Gokula, M.D.,CMD Phyllis M. Gaspar, Ph.D., RN Thotakura, Sreekiran, M.D., MPH Rubeen, Shafia, M.D.,MPH University of Toledo, Department of Family Medicine Toledo,Ohio

  2. Acknowledgement of funding from the AMDA Foundation/ Pfizer QI Award

  3. Background • Use of indwelling urinary catheters (IUC) in skilled nursing facilities (SNF) persists even though CMS requires a valid medical justification for use. • Gap in knowledge EXISTS regarding long term indwelling catheters continued need, proper maintenance, managing complications of urinary catheters in SNFs and its effect on reducing catheter associated UTIs (CAUTIs) • Important: • CAUTIs are a major cause of UTIs, leading to acute hospitalization of elders from SNFs • UTIs contribute to the problems of urinary incontinence, falls and delirium • IUCs are an added concern as they are one point restraints

  4. Purposes • Purposes of this study were to: 1) describe the current use, care, and CAUTIs related to IUC in SNFs; and 2) determine the effects of the implementation of the FIRM (Foley Insertion Removal and Maintenance) protocol on these same aspects of IUC use.

  5. FIRM Protocol • 2 Components • FIRMS (Foley Insertion Removal and Maintenance Sheet) • Order Sheet that documents rationale for order and maintenance care • Education Component • to provide evidence based content to nursing staff and providers

  6. FIRM Protocol: Education Component • Education Program • Content included: • Introduction to the FIRMS • Significance of problems associated with IUCs • Criteria for appropriate use of IUCs • Appropriate approaches for insertion, maintenance and of IUCs • Presented to staff nurses and providers at the 3 settings.

  7. Settings • 3 SNFs served as settings for this study. • Following the initial data collection one setting (#3) was dropped from the follow up analysis as the policy for admission included the need to remove an unnecessary IUC prior to admission.

  8. Characteristics of 3 Facilities

  9. Methods • Retrospective review (10 months prior to implementation of protocol) and monthly review (6 months following implementation) of charts of residents identified as having an IUC was conducted to determine: • Length of time in place, • Documentation of reason for use and care, and • Occurrence of CAUTI.

  10. Results • A comparison of the data prior to implementation with data following implementation of the protocol related to: • Number of IUCs • Length of time IUCs were in place • Documentation of reason for placement • Relevant outcomes

  11. Comparison of Use of IUC Use Prior to and Following Implementation of Protocol

  12. Documentation of IUC Reason

  13. Documented Reasons Prior to and Following Protocol Implementation

  14. Outcome: Attachment of IUC • Number of IUCs attached for security increased dramatically after implementation with 100% documented as attached following implementation compared to only 20% prior to implementation.

  15. CAUTI Rates Prior to and Following Protocol Implementation

  16. Limitations • Limitations of the study contributed to findings of the study: • Initial chart review was retrospective and retrieval of data difficult. • Identification of residents with IUC difficult prior to implementation. • Lack of protocol champion at one facility.

  17. Conclusions • FIRM Protocol is advocated even though the number of documented IUC increased and the length of time IUCs were in place increased following implementation. • Documentation of order for IUC placement, indication for placement, and secured attachment of catheter to thigh improved dramatically following implementation of the protocol.

  18. Recommendations • FIRM Protocol is advocated even though the number of documented IUC increased and the length of time IUCs were in place increased following implementation. • The implementation of a policy that incorporates the FIRM protocol is advised. The policy needs to include the following: • Criteria for appropriate use of catheters • Removal within 1-3 days following placement unless absolutely indicated • Continuous education and surveillance • Facility champion

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