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Use of Indwelling Urinary Catheters in Nursing Homes: Implications for Quality Improvement Efforts
Author(s) -
Gurwitz Jerry H.,
DuBeau Catherine,
Mazor Kathleen,
Sreedhara Meera,
Lemay Celeste,
Spenard Ann,
Pandolfi Michelle,
Johnson Florence,
Field Terry
Publication year - 2016
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.14464
Subject(s) - medicine , catheter , observational study , urinary catheterization , urinary retention , urinary system , urinary catheter , emergency medicine , nursing homes , intensive care medicine , surgery , nursing
Objectives To describe the epidemiology of indwelling urinary catheter use in nursing homes ( NH s). Design Observational cohort study. Setting A purposeful sampling strategy was used to identify a diverse sample of 28 Connecticut NH s, defined in terms of ownership, quality ratings, and bed size. Participants Long‐stay (>100 days) residents of study NH s with an indwelling urinary catheter present at any time over a 1‐year period. Measurements Duration of catheter use was determined, and indications for catheter placement were documented. Indications considered appropriate included urinary retention or outlet obstruction, pressure ulcer (Stage 3 or 4 with risk of contamination by urine), hospice care, and need for accurate measurement of input and output. During quarterly follow‐up assessments, whether the catheter was still in place or had been removed for any reason other than routine maintenance was determined. Results The overall rate of any urinary catheter use per 100 resident‐beds over a 1‐year period was 4.8 (range 1.0–9.9, median 5.1). Of the 228 residents meeting eligibility criteria, a documented indication for the catheter was present in the NH record for 195 (86%). Of those with a documented indication, 99% (n = 193) had one or more indications deemed appropriate, including urinary retention (83%), pressure ulcer (21%), hospice care (10%), and need for accurate measurement of input and output (6%). The urinary catheter was removed at some point during the period of observation in 49% (n = 111) of participants; those with a shorter duration of catheter use before study enrollment were more likely to have the catheter removed during the follow‐up period. Of the 111 residents who had the catheter removed, 58 (52.3%) had it reinserted at some point during follow‐up. Conclusion These findings suggest that indwelling urinary catheter use in long‐stay NH residents is uncommon and generally appropriate and that efforts to improve catheter care and outcomes should extend beyond a singular focus on reducing use.