scholarly journals Reducing urinary catheter use using an electronic reminder system in hospitalized patients: A randomized stepped-wedge trial

2019 ◽  
Vol 40 (4) ◽  
pp. 427-431 ◽  
Author(s):  
Brett G. Mitchell ◽  
Maria Northcote ◽  
Allen C. Cheng ◽  
Oyebola Fasugba ◽  
Philip L. Russo ◽  
...  
Keyword(s):  
Focus Group ◽  
Urinary Catheter ◽  
Hospital Setting ◽  
Hospitalized Patients ◽  
Ease Of Use ◽  
Cox Proportional Hazards Model ◽  
Urinary Catheters ◽  
Electronic Reminder ◽  
Reminder System ◽  
The Mean

AbstractObjective:To determine the effectiveness and ease of use of an electronic reminder device in reducing urinary catheterization duration.Design:A randomized controlled trial with a cross-sectional anonymous online survey and focus group.Setting:Ten wards in an Australian hospital.Participants:All hospitalized patients with a urinary catheter.Intervention:An electronic reminder system, the CATH TAG, applied to urinary catheter bags to prompt removal of urinary catheters.Outcomes:Catheterization duration and perceptions of nurses about the ease of use.Methods:A Cox proportional hazards model was used to assess the rate of removal of catheters. A phenomenological approach underpinned data collection and analysis methods associated with the focus group.Results:In total, 1,167 patients with a urinary catheter were included. The mean durations in control and intervention phases were 5.51 days (95% confidence interval [CI], 4.9–6.2) and 5.08 days (95% CI, 4.6–5.6), respectively. For patients who had a CATH TAG applied, the hazard ratio (HR) was 1.02 (95% CI, 0.91–1.14; P = .75). A subgroup analysis excluded patients in an intensive care unit (ICU), and the use of the CATH TAG was associated with a 23% decrease in the mean, from 5.00 days (95% CI, 4.44–5.56) to 3.84 days (95% CI, 3.47–4.21). Overall, 82 nurses completed a survey and 5 nurses participated in a focus group. Responses regarding the device were largely positive, and benefits for patient care were identified.Conclusion:The CATH TAG did not reduce the duration of catheterization, but potential benefits in patients outside the ICU were identified. Electronic reminders may be useful to aid prompt removal of urinary catheters in the non-ICU hospital setting.

scholarly journals Changing Behavior among Nurses to Track Indwelling Urinary Catheters in Hospitalized Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Bona Yoon ◽  
Samantha D. McIntosh ◽  
Leslie Rodriguez ◽  
Alma Holley ◽  
Charles J. Faselis ◽  
...  
Keyword(s):  
Large Scale ◽  
Hospital Setting ◽  
Interdisciplinary Team ◽  
Hospitalized Patients ◽  
Learning Objectives ◽  
Small Scale ◽  
Urinary Catheters ◽  
First Line ◽  
Healthcare Interventions ◽  
Tract Infections

Catheter-associated urinary tract infections (CAUTIs) are preventable complications of hospitalization. An interdisciplinary team developed a curriculum to increase awareness of the presence of indwelling urinary catheters (IUCs) in hospitalized patients, addressed practical, primarily nurse-controlled inpatient risk-reduction interventions, and promoted the use of the IUC labels (“tags”). Five thirty-minute educational sessions were cycled over three daily nursing shifts on two inpatient medical floors over a 1-year period; participants were surveyed(n=152)to elicit feedback and provide real-time insight on the learning objectives. Nurse self-reported IUC tagging was early and sustained; after the IUC tag was introduced, there was a significant increase in tagging reported by the end of the block of educational sessions (from 46.2% to 84.6%,P=0.001). Early engagement combined with a targeted educational initiative led to increased knowledge, changes in behavior, and renewed CAUTI awareness in hospitalized patients with IUCs. The processes employed in this small-scale project can be applied to broader, hospitalwide initiatives and to large-scale initiatives for healthcare interventions. As first-line providers with responsibility for the placement and daily maintenance of IUCs, nurses are ideally positioned to implement efforts addressing CAUTIs in the hospital setting.

scholarly journals Reducing urinary catheter use: a protocol for a mixed methods evaluation of an electronic reminder system in hospitalised patients in Australia

BMJ Open ◽  
2018 ◽  
Vol 8 (5) ◽  
pp. e020469 ◽  
Author(s):  
Oyebola Fasugba ◽  
Allen C Cheng ◽  
Philip L Russo ◽  
Maria Northcote ◽  
Hannah Rosebrock ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Urinary Catheter ◽  
Electronic Reminder ◽  
Reminder System ◽  
Mixed Methods Evaluation ◽  
Hospitalised Patients

scholarly journals I-DECIDED® – A decision tool for assessment and management of invasive devices in the hospital setting

2021 ◽  
Vol 15 (3) ◽  
pp. 7-14
Author(s):  
Gillian Ray-Barruel
Keyword(s):  
Patient Safety ◽  
Vascular Access ◽  
Medical Devices ◽  
Hospital Setting ◽  
Hospitalized Patients ◽  
Evidence Based ◽  
Urinary Catheters ◽  
Decision Tool ◽  
Safety Priority

Indwelling medical devices, including vascular access and urinary catheters, pose a risk for infection, and therefore daily assessment and consideration of their continued need is a patient safety priority. The I-DECIDED® device assessment and decision tool is an evidence-based checklist, designed to improve the assessment, care, and timely removal of invasive devices in acute hospitalized patients. This paper explains each step of the tool, with rationale for inclusion.

scholarly journals Prevalence and Appropriateness of Indwelling Urinary Catheters in Japanese Hospital Wards: A Multicenter Point Prevalence Study

2021 ◽  
Author(s):  
Kohta Katayama ◽  
Jennifer Meddings ◽  
Sanjay Saint ◽  
Karen Fowler ◽  
David Ratz ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urinary Catheter ◽  
Urinary Catheters ◽  
Appropriate Use ◽  
Catheter Complications ◽  
The Mean ◽  
Study Teams ◽  
Hospital Wards

Abstract Background: Indwelling urinary catheters are commonly used in hospitalized patients, which can lead to the development of urinary catheter complications, including catheter-associated urinary tract infection (CAUTI). Limited reports on the appropriateness of urinary catheter use exist in Japan. This study investigated the prevalence and appropriateness of indwelling urinary catheters, and the incidence of CAUTI in non-intensive care unit (non-ICU) wards in Japanese hospitals. Methods: This prospective observational study was conducted in 7 non-ICU wards from 6 hospitals in Japan from October 2017 to June 2018. At each hospital the study teams evaluated urinary catheter prevalence through in-person bedside evaluation for at least 5 days of each week for 3 months. Catheter associated urinary tract infection (CAUTI) incidence and appropriateness of catheter use was collected via chart review.Results: We assessed 710 catheter-days over 5528 patient-days. The mean prevalence of indwelling urinary catheter use in participating wards was 13% (range: 5% to 19%), while the mean incidence of CAUTI was 9.86 per 1000 catheter-days (range: 0 to 33.90). Approximately 66% of the urinary catheter days assessed had an appropriate indication for use (range: 17% to 81%). A physician's order for catheter placement was present in only 10% of catheterized patients.Conclusion: This national prospective study provides epidemiological information about the appropriate use of urinary catheters in Japanese non-ICU wards. A multimodal intervention may help improve the appropriate use of urinary catheters.

The Ten Point Clock Test: A Quick Screen and Grading Method for Cognitive Impairment in Medical and Surgical Patients

1994 ◽  
Vol 24 (3) ◽  
pp. 229-244 ◽  
Author(s):  
Peter J. Manos ◽  
Rae Wu
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Deficits ◽  
Neuropsychological Tests ◽  
Medical Center ◽  
Neuropsychological Test ◽  
Hospitalized Patients ◽  
Surgical Patients ◽  
Tertiary Referral Center ◽  
The Mean ◽  
State Examination

Objective: The objective of this study was to evaluate the clinical utility of the ten point clock test in screening for and grading cognitive deficits in medical and surgical patients. Method: The setting was the hospital and clinics of Virginia Mason Medical Center, a tertiary referral center. Consecutive samples of hospitalized patients, and clinic outpatients—with and without a dementia—were administered the ten point clock test as well as a number of other neuropsychological tests and measures of cognitive impairment. Results: Clock scores correlated with neuropsychological test scores and with the mini-mental state examination. They were stable from rater to rater, and from day to day in stable patients. The mean clock score of elderly outpatient controls was 8.5, significantly different from the mean of 5.5 scored by patients with a dementia. A cut off score of seven identified 76 percent of outpatients with dementia and 78 percent of elderly controls. Clock scores correlated well with nurses' ratings of their inpatients' cognitive deficits (Spearman's rs = −0.61). The test was easy to administer, even to hospitalized patients. Conclusions: The ten point clock test is reliable, valid, and useful as a quick screen and grading method for cognitive deficits in medical and surgical patients.

scholarly journals Implementation of a Female External Urinary Catheter Reduces Indwelling Urinary Catheter Use and Catheter-Associated Urinary Tract Infections

2020 ◽  
Vol 41 (S1) ◽  
pp. s482-s483
Author(s):  
Paul Gentile ◽  
Jesse Jacob ◽  
Shanza Ashraf
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Urinary Catheter ◽  
Improve Patient Safety ◽  
Academic Medical Center ◽  
Secondary Outcome ◽  
Successful Implementation ◽  
Urinary Catheters ◽  
Tract Infections ◽  
The Impact

Background: Using alternatives to indwelling urinary catheters plays a vital role in reducing catheter-associated urinary tract infections (CAUTIs). We assessed the impact of introducing female external catheters on urinary catheter utilization and CAUTIs. Methods: In a 500-bed academic medical center, female external catheters were implemented on October 1, 2017, with use encouraged for eligible females with urinary incontinence but not meeting other standard indications for urinary catheters. Nurses were educated and trained on female external catheter application and maintenance, and infection prevention staff performed surveillance case reviews with nursing and medical staff. We determined the number of catheter days for both devices based on nursing documentation of device insertion or application, maintenance, and removal. We used the CAUTI and DUR (device utilization ratio) definitions from the CDC NHSN. Our primary outcomes were changes in DUR for both devices 21 months before and 24 months after the intervention in both intensive care units (ICUs) and non-ICU wards. We used a generalized least-squares model to account for temporal autocorrelation and compare the trends before and after the intervention. Our secondary outcome was a reduction in CAUTIs, comparing females to males. Results: In total, there were 346,213 patient days in 35 months. The mean rate of patient days per month increased from 7,436.4 to 7,601.9 after the implementation of female external catheters, with higher catheter days for both urinary catheters (18,040 vs 19,625) and female external catheters (22 vs 12,675). After the intervention, the DUR for female external catheters increased (0 vs 0.07; P < .001) and for urinary catheters the DUR decreased (0.12 vs 0.10; P < .001) (Fig. 1). A reduction in urinary catheter DUR was observed in ICUs (0.29 vs 0.27; P < .001) but not wards (0.08 vs 0.08; P = NS) (Fig. 2). Of the 39 CAUTIs, there was no significant overall change in the rate per 1,000 catheter days (1.22 vs 0.87; P = .27). In females (n = 20 CAUTI), there was a 61% reduction in the CAUTI rate per 1,000 catheter days (0.78 vs 0.31; P = .02), but no significant change in the rate in males (0.44 vs 0.56; P = .64). The CAUTI rate per 1,000 catheter days among females decreased in the ICUs (1.14 vs 0.31; P = .04) but not in wards (0.6 vs 0.33; P = .96). Conclusions: In a setting with a baseline low UC DUR, successful implementation of female external catheters further modestly reduced UC DUR and was associated with a 61% decrease in CAUTI among females in the ICU but not in wards. Further interventions to better identify appropriate patients for female external catheters may improve patient safety and prevent patient harm.Funding: NoneDisclosures: None

scholarly journals IndoorPlant: A Model for Intelligent Services in Indoor Agriculture Based on Context Histories

Sensors ◽  
2021 ◽  
Vol 21 (5) ◽  
pp. 1631
Author(s):  
Bruno Guilherme Martini ◽  
Gilson Augusto Helfer ◽  
Jorge Luis Victória Barbosa ◽  
Regina Célia Espinosa Modolo ◽  
Marcio Rosa da Silva ◽  
...  
Keyword(s):  
Technology Acceptance ◽  
Mean Square Error ◽  
Ease Of Use ◽  
Coefficient Of Determination ◽  
Square Root ◽  
Mean Square ◽  
Use Context ◽  
The Mean ◽  
Acceptance Model ◽  
The Internet Of Things

The application of ubiquitous computing has increased in recent years, especially due to the development of technologies such as mobile computing, more accurate sensors, and specific protocols for the Internet of Things (IoT). One of the trends in this area of research is the use of context awareness. In agriculture, the context involves the environment, for example, the conditions found inside a greenhouse. Recently, a series of studies have proposed the use of sensors to monitor production and/or the use of cameras to obtain information about cultivation, providing data, reminders, and alerts to farmers. This article proposes a computational model for indoor agriculture called IndoorPlant. The model uses the analysis of context histories to provide intelligent generic services, such as predicting productivity, indicating problems that cultivation may suffer, and giving suggestions for improvements in greenhouse parameters. IndoorPlant was tested in three scenarios of the daily life of farmers with hydroponic production data that were obtained during seven months of cultivation of radicchio, lettuce, and arugula. Finally, the article presents the results obtained through intelligent services that use context histories. The scenarios used services to recommend improvements in cultivation, profiles and, finally, prediction of the cultivation time of radicchio, lettuce, and arugula using the partial least squares (PLS) regression technique. The prediction results were relevant since the following values were obtained: 0.96 (R2, coefficient of determination), 1.06 (RMSEC, square root of the mean square error of calibration), and 1.94 (RMSECV, square root of the mean square error of cross validation) for radicchio; 0.95 (R2), 1.37 (RMSEC), and 3.31 (RMSECV) for lettuce; 0.93 (R2), 1.10 (RMSEC), and 1.89 (RMSECV) for arugula. Eight farmers with different functions on the farm filled out a survey based on the technology acceptance model (TAM). The results showed 92% acceptance regarding utility and 98% acceptance for ease of use.

scholarly journals 1157. GET IT OUT! Nurses and Clinical Quality Improvement Specialists Drive Initiative to Reduce Standardized Utilization Ratios for Indwelling Urinary Catheters in Hospitalized Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S413-S414
Author(s):  
Aldo Martinez ◽  
Deborah Parilla ◽  
Melissa Green ◽  
Anne Murphy ◽  
Sylvia Suarez-Ponce ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Urinary Tract ◽  
Night Shift ◽  
Healthcare Research ◽  
Hospitalized Patients ◽  
Urinary Catheters ◽  
Clinical Quality ◽  
Tract Infections ◽  
Clinical Quality Improvement ◽  
Critical Reviews

Abstract Background Urinary tract infections (UTIs) account for 34% of all healthcare-associated infections (HAI). Urinary catheters (UC) are placed in 15–25% of hospitalized patients and >75% of HAI UTIs are UC-related. Bacteria introduced via UC can colonize the bladder within 3 days. So, the greatest risk factor for acquiring a catheter-associated urinary tract infection (CAUTI) is prolonged use of indwelling UC. Nursing (RN) staff noted inconsistency with appropriate use of UC and commonly UC remained in place well after their original indication had expired. Methods As part of a multi-faceted approach for quality improvement and patient safety, we rolled out an Agency for Healthcare Research and Quality (AHRQ)-based initiative to reduce UC days/Standardized Utilization Ratio (SUR). Daily critical reviews of the indication for UC were conducted by two groups. First, frontline night shift RN staff identified patients who no longer had a valid justification for continued UC. They handed-off the information to day-shift RNs, who recommend removal of UC during daily rounds with the physician teams. A second review was performed by Clinical Quality Improvement Specialists (CQIS) based on defined criteria from our nursing decatheterization protocol. Their discontinue UC recommendations were also sent to the care teams. The critical reviews of UC for CAUTI reduction started with 4 ICUs in August 2018, with additional ICUs added in December, January and March. Monthly UC SURs were tracked Results Figure 1 shows the number of UCs recommended for removal by RNs vs. CQIS (bars), as well as the percent discordance between RNs and CQIS (line). CQIS identified many more removable UCs than the RNs (888 vs. 256). 211 UC were removed after RN recommendations, and an additional 386 UCs were removed as a result of the CQIS audits. Figure 2 shows the marked corresponding decline in our SUR over this intervention. Conclusion As more units participated in the initiative, we saw increasing numbers of “discontinue UC” recommendations. Over time there was also a moderate decrease in the discordance between RN and CQIS recommendations for UC removal. CQIS routinely identified many more UCs to be removed compared with RNs, and more than doubled the number of discontinued UC. Notably, the UC SUR markedly improved, decreasing from 0.98 to 0.78. Disclosures All authors: No reported disclosures.

scholarly journals 875Prospective Monitoring of Indwelling Urinary Catheters in Hospitalized Patients

2014 ◽  
Vol 1 (suppl_1) ◽  
pp. S251-S251
Author(s):  
Bona Yoon ◽  
Lena Furmark ◽  
Samantha Mcintosh ◽  
Angelike P. Liappis
Keyword(s):  
Hospitalized Patients ◽  
Urinary Catheters
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