Improving urinary catheterisation practices in a rural hospital in Ontario.

INTRODUCTION: A urinary catheter constitutes a one-point patient restraint, can induce deconditioning and may lead to patient mortality. An audit performed at Winchester District Memorial Hospital revealed that 20% of patients had a urinary catheter, of whom 31% did not meet the criteria for catheterisation. The main objective of this study was to use the Influencer Change Model and the Choosing Wisely Canada toolkit to create a bundle of interventions that would reduce the unnecessary use of urinary catheters in hospitalised patients. METHODS: In a rural teaching hospital, a time-series quasi-experiment was employed to decrease inappropriate use of urinary catheters. Both the Choosing Wisely Canada toolkit for appropriate use of urinary catheters and the Influencer change management approach were used to create effective interventions. RESULTS: This study revealed that there was no improvement in appropriate urinary catheter use during Plan-Do-Study-Act (PDSA) cycle 1. There was gradual improvement during PDSA cycle 2, with the percentage of inappropriate urinary catheter use dropping from an initial 31% before any interventions to less than 5% by the end of this study. DISCUSSION/CONCLUSION: This study aimed to reduce the inappropriate use of urinary catheters in a rural hospital with limited resources. The findings indicate that by using a change model, such as the Influencer Change Model, it is possible to promote better patient care through empowering healthcare staff to implement accepted protocols more stringently and thereby to decrease the inappropriate use of urinary catheters to 0%.

Distinct expression of neuronal apoptosis inhibitory protein (NAIP) during murine development.

The childhood spinal muscular atrophies (SMAs) are autosomal recessive neurodegenerative conditions characterized by progressive degeneration of lower motor neurons. The gene encoding NAIP (neuronal apoptosis inhibitory protein) has been proposed to be a modulator of the severity of SMA and is frequently deleted in type I SMA. In this study we have assessed NAIP (murine homologue of NAIP) transcript levels during mouse embryogenesis. NAIP mRNA is present in the developing brain and spinal cord of E9.5-E14.5 mouse embryos as detected by various in situ hybridization techniques. It is also found in the embryonic branchial arches, the nasal epithelium and in the future digits. At E16.5, NAIP mRNA transcripts were found in the marginal zone of the lateral ventricle, the follicles of the vibrissae, in the retina and in the intestinal villi. These results are the first report of NAIP gene transcript levels in embryogenesis. If motor neuron attrition occurs in the second and third trimester of gestation in SMA, the observation of NAIP transcription in the mouse spinal cord between E9.5 and E14.5 is consistent with a role for NAIP in modifying this disorder.