Perceptions of a Nurse-Driven Urinary Catheter Removal Protocol in a Hospital Setting.

PURPOSE/AIMS: The purpose of this study was to examine the feasibility and acceptability of a nurse-driven catheter removal protocol among nurses in a hospital setting. DESIGN: A mixed-methods design was used. A modified version of the Abbreviated Acceptability Rating Profile was used in this study, along with 3 open-ended questions. METHODS: Staff nurses assigned to care for nonpregnant, cognitively intact adults with a short-term Foley catheter were asked to apply a nurse-driven catheter removal protocol on the enrolled patient every 12 hours. They were asked to complete a modified version of the Abbreviated Acceptability Rating Profile and open-ended questionnaire each time they used the protocol. RESULTS: A total of 13 questionnaires were completed (52% completion rate). Nurses reported that the nurse-driven catheter removal protocol was highly acceptable in intensive care units and intermediate care units, but not in medical-surgical units. Nurses felt that the protocol should be effective in preventing catheter-associated urinary tract infection, that they would be willing to use the protocol with their loved ones, and that overall, the protocol was helpful for their patient. However, they did not feel that their patient's risk for catheter-associated urinary tract infection was high enough to warrant using the protocol. Barriers to using the protocol as planned included encrustation, inconvenient times of day, unawareness, and a desire to follow orders and current institutional policies. CONCLUSION: Findings from this study generally support the acceptability of the nurse-driven catheter removal protocol, particularly in higher-acuity units. Recommendations are provided to help clinical nurse specialists support adherence to these protocols.

A Tool to Assess the Signs and Symptoms of Catheter-Associated Urinary Tract Infection: Development and Reliability.

The purpose of this pilot study was to determine the inter-rater reliability of four clinical manifestations of catheter-associated urinary tract infections (CAUTI) among hospitalized adults with short-term indwelling urinary catheters using a tool developed for this purpose: the CAUTI Assessment Profile (CAP). Study participants included 30 non-pregnant English-speaking adults, recruited from two community hospitals. Three nurses assessed each participant for fever, suprapubic tenderness, flank tenderness, and delirium using standardized techniques. Based on the generalized Kappa statistic and 95% confidence intervals, there was evidence of strong inter-rater reliability for fever (K = 1.00, 0.793-1.207), suprapubic tenderness (K = 0.39, 0.185-0.598), and delirium (K = 0.58, 0.379-0.792), but not for flank tenderness (K = 0.29, -0.036 to 0.617). This study provides preliminary evidence that the CAP can be used to consistently identify these clinical signs and symptoms of CAUTI in hospitalized adults.

Volume Measures Using a Digital Image Analysis System are Reliable in Diabetic Foot Ulcers.

UNLABELLED: Reliable measures of wound size are critical to wound healing research and clinical management. Measurement of full-thickness wounds is increasingly being done using digital images and photogrammetric software, such as VeVMD (Vista Medical, Winnipeg, Manitoba, Canada), to estimate wound volume. The reliability of VeVMD in determining wound volume is unknown. The present study sought to examine the reliability of wound volume measurements obtained using VeVMD. METHODS: A cross-sectional study of adults with full-thickness, neuropathic, diabetic foot ulcers (DFU) at 2 sites in the US Midwest was undertaken. Ulcer images were obtained, stored, and used to obtain measures of wound volume using VeVMD. Four raters independently completed wound measures, and then repeated these measures 2 weeks after the first measurement. Raters were blinded to the comparison measurements. Inter- and intra-rater correlations were computed. RESULTS: Thirty-three enrolled subjects with 33 DFU were included in the analyses. Inter-rater reliability was 0.745 and intra-rater reliability was 0.868. Four ulcers showed noticeably less agreement between raters; these ulcers had small, but deeply recessed areas, resulting in differences in defining the wound margin. When these 4 ulcers were removed, inter- and intra-rater reliabilities were excellent (0.970 and 0.981, respectively). CONCLUSION: Reliabilities of volume measurements obtained with VeVMD were acceptable in DFU, even when raters had different definitions of the ulcer margin or changed their definition from time to time. However, conclusions cannot be drawn regarding the performance of VeVMD in other wound types.

Reminder systems to reduce the duration of indwelling urinary catheters: a narrative review.

Catheter-associated urinary tract infection (CAUTI) is a common and costly problem for hospitalized patients. Policymakers have taken notice of the importance of these infections, and changes to the prospective payment rules of Medicare, Medicaid, and many additional third-party payers have been implemented to hold hospitals accountable for the delivery of poor quality health care services. As key members of the health care team, nurses must be prepared to utilize evidence-based practices to prevent CAUTI in hospitalized patients. This article describes several variable-technology interventions to remind clinicians to remove unnecessary urinary catheters and proposes potential roles for nursing informatics in the prevention of CAUTI in hospitalized adults.