Indwelling Urinary Catheter Removal HOUDINI Protocol

Practice Problem: Catheter-associated urinary tract infections (CAUTIs) in spinal cord injury (SCI) patients have many negative health consequences, including increased cost, increased length of hospital stays, delay in bladder training, increased associated infections, and mortality. PICOT: The PICOT question that guided this project was: In adult SCI patients (P), does the implementation of a nurse-driven indwelling urinary catheter removal protocol (I), compared to without a nurse-driven protocol (C), decrease the indwelling urinary catheter days and the occurrence of CAUTIs (O) within six weeks (T)? Evidence: Nurse-driven discontinuation protocols are an effective method of decreasing indwelling urinary catheter (IUC) days and CAUTI rates. Each day a catheter remains in place, the risk of CAUTI increases. Intervention: The registered nurses used the Indwelling Urinary Catheter Removal (IUCR) HOUDINI nurse-driven protocol to assess whether patients met the criteria to have their indwelling urinary catheter (IUC) removed and bladder training initiated. Outcome: Pre-and post-implementation data for IUC days and CAUTI rates were evaluated using descriptive statistics. Catheter days did not decrease in the post-intervention; however, there was earlier catheter removal and zero occurrences of CAUTIs in the post-intervention group. Conclusion: Implementation of the evidence-based nurse-driven protocol IUCR-HOUDINI in the SCI unit promoted earlier catheter removal, improved patient outcomes related to CAUTIs, and empowered nurses to manage a patient’s IUC more effectively.