Early removal of unnecessary indwelling urinary catheters

Urinary catheters are often placed unnecessarily, remain in place without physician awareness, and are not removed promptly when no longer needed. Prolonged catheterization is the strongest risk factor for catheter-associated urinary tract infection (CAUTI).  Promptly removing unnecessary catheters is an important step in reducing a patient’s risk of CAUTI.

In most hospitals, 4 steps are required before a urinary catheter is removed:

1. Physician recognizes that a urinary catheter is present,

2. Physician recognizes that the urinary catheter is unnecessary,

3. Physician writes the order for urinary catheter removal,

4. Nurse removes the catheter in response to the physician’s order.

Thus, many hours and days can pass before a urinary catheter that is no longer necessary is recognized and removed; by default, urinary catheters usually remain in place until these steps occur. In contrast, using strategies to remind and prompt removal of unnecessary urinary catheters has the potential to bypass several of these steps, and reduce the occurrence of hospital-acquired catheter-associated urinary tract infections.

Two types of reminder systems have been studied:

1. “Reminders” function simply to remind the clinicians (physician and/or nurse) that a urinary catheter is still being used, and may provide an educational list of reasons to continue or discontinue the urinary catheter. “Reminders” help bypass steps 1-2.

2. “Stop orders” prompt the clinician to remove the catheter by default after a certain time period or a set of clinical conditions has occurred (such as 24 or 48 hours post-operative) unless the catheter remains clinically appropriate. Stop orders “expire” in the same fashion as restraint or antibiotic orders, unless action is taken by physicians.

Challenges and pearls to keep in mind  when implementing catheter removal  strategies: 

 

Early removal of unnecessary indwelling urinary catheters (PDF)

Computerized Urinary Catheter Removal Example (PDF)

Written Reminder Example (PDF) (Source)