Study Provides Recommendations for Detecting and Removing Unnecessary Catheters

An AHRQ-funded study identified potential actions medical facilities can take to ensure the timely removal of urinary and vascular catheters, including providing clinicians with ready access to accurate catheter data, clearly defining staff responsibilities, utilizing effective tools to facilitate discussions and establishing standardized removal protocols. Observations and in-person interviews with physicians and nurses at a large, academically affiliated tertiary-care hospital provided a deeper understanding of the current challenges to timely catheter removal, allowing for recommendations to address barriers. Access the abstract of the article, published in the Joint Commission Journal on Quality and Patient Safety.

2019 Dec 23. pii: S1553-7250(19)30421-0. doi: 10.1016/j.jcjq.2019.10.004. [Epub ahead of print]

Persistent Barriers to Timely Catheter Removal Identified from Clinical Observations and Interviews.

Quinn M, Ameling JM, Forman J, Krein SL, Manojlovich M, Fowler KE, King EA, Meddings J.

Abstract

BACKGROUND:

Indwelling urinary and vascular catheters are valuable devices in patient care, but prolonged or unnecessary use increases the risk of infectious and noninfectious catheter harms.

METHODS:

To understand persistent barriers to detecting and removing unnecessary catheters, researchers conducted a multimethod qualitative study that included observations and in-person interviews with clinicians working on a progressive care unit of a large hospital. Observations consisted of shadowing nurses during shift change and while admitting patients, and observing physicians during morning rounds. Observational data were gathered using unstructured field notes. Interviews were conducted using a semistructured guide, audio-recorded, and transcribed. Qualitative content analysis was conducted to identify main themes.

RESULTS:

Barriers to timely removal identified during 19 interviews with clinicians and 133 hours of field observations included physicians not routinely reviewing catheter necessity during rounds, catheters going unnoticed or hidden under clothing, common use of "Do Not Remove" orders, and little or no discussion of catheters among clinicians. Five overall themes emerged: (1) Catheter data are hard to find, not accurate, or not available; (2) Catheter removal is not a priority; (3) Confusion exists about who has authority to remove catheters; (4) There is a lack of agreement on, and awareness of, standard protocols and indications for removal; and (5) Communication barriers among clinicians create challenges.

CONCLUSION:

To address barriers and facilitate detection and timely removal, clinicians need ready access to accurate catheter data, more clearly delineated clinician roles for prompting removal, effective tools to facilitate discussions about catheter use, and standardized catheter removal protocols.