specific unit-based nursing practice actions on a pulmonary
medical and a general surgical inpatient unit. Management and
ongoing care of an IUC is within the purview of nursing practice.
Re-education of nurses regarding placement, management, and
early removal of IUCs as well as focused, unit-specific interventions
were found to decrease catheter-days and had a less consistent
effect on CAUTI rates. Improved care processes and patient
outcomes were achieved by examining best evidence to guide
practice and developing system supports that provided education
and improved product accessibility to achieve optimal care.
Whereas electronic media for education of health care providers
can be challenging,20 creating an online educational program for
RNs and CNAs as well as updating hospital policy offered consistent,
succinct, and factual content providing an effective medium to
improve practice. Re-education about a common nursing intervention
(catheter insertion) to ensure that best practice occurred
elevated this perceived “simple” skill to a higher level of importance.
Expanding the education to ancillary services (eg, rehabilitation
professionals and transport staff) helped raise collective
awareness of drainage bag location to reduce reflux and CAUTI
risks. Product changes that streamlined IUC devices, collection
bags, and catheter type (eg, removal of silver alloy catheters)
provided an important opportunity for practice improvement and
cost savings.
Focused unit interventions, specifically providing detailed
education on postoperative retention, use of a bladder scanner to
evaluate urinary retention and intermittent catheterization, and
encouraging early removal of the IUC resulted in reduced
indwelling catheter-days.
A dedicated bladder scanner provided an objective means for
the nurse to evaluate the patient’s urinary retention and guide
interventions. Use of the bladder scanner averted reinsertion of an
IUC after initial removal. The nurses perceived the bladder scanner
to be an important aspect of the intervention and the Quality
Intervention Team believed it was used appropriately to prevent
IUC reinsertion.