Kristin Schmid, MD
Washington University in Saint Louis School of Medicine
Saint Louis
Disclosure information not submitted.
Maura Walsh, MD
Critical Care Fellow
Washington University in Saint Louis School of Medicine, United States
Disclosure information not submitted.
Laurie Robertson, MSN, MHA
BSN, MSN, MHA
Barnes Jewish Hospital, United States
Disclosure information not submitted.
.jpg "Marilyn Schallom, CCNS, PhD, FCCM photo")
Marilyn Schallom, CCNS, PhD, FCCM
Research Scientist
Barnes-Jewish Hospital
Saint Louis, MO
Disclosure information not submitted.
Donna Prentice, PhD, RN, CNS, FCCM
Research Scientist
Barnes-Jewish Hospital
Saint Louis, Missouri, United States
Disclosure information not submitted.
Carrie Sona, BSN, CCNS, CCRN, MSN
Clinical Nurse Specialist
Barnes Jewish Hospital
Saint Louis, MO
Disclosure information not submitted.
Brian Wessman, MD, FCCM
Division Chief Critical Care Medicine, Associate Professor of Emergency Medicine and Anesthesiology
Washington University in Saint Louis School of Medicine
Saint Louis, Missouri, United States
Disclosure information not submitted.
Enyo Ablordeppey, MD, MPH, FACEP
Washington University School of Medicine
Saint Louis, MO, United States
Disclosure information not submitted.
Title: Acceptability of an Ultrasound and Bladder Scanner Protocol to Reduce Urinary Catheter Utilization
Introduction: Annually, there are millions of hospitalized patients with indwelling urinary catheters although there are less invasive options to monitor bladder volumes such as bladder scanner or direct ultrasound measurement. Indwelling urinary catheter utilization and catheter-associated urinary tract infection (CAUTI) rates remain high among intensive care unit (ICU) patients despite targeted, best practice implementation efforts. We initiated a stakeholder driven ICU protocol to replace urinary catheters with less invasive methods in patients with kidney injury. To facilitate clinical adoption, we evaluated the attitudes and perceptions of stakeholders of this protocol to guide deimplementation strategies for urinary catheters in the ICU.
Methods: We conducted an electronic survey at an urban, academic medical center among surgical ICU nurses (RN's) and physicians. We assessed self-reported practice, acceptance, and perceived barriers toward widespread adoption of a newly developed protocol called DUCKI (Decreasing Urinary Catheters in Kidney Injury). We assessed these attitudes pre intervention and 3 months post intervention.
Results: Total response rate of 131 surveyed was 67% pre and 56% post. Eighty-nine percent of participants were RN’s. In pre and post surveys respectively, 87% and 92% of RNs thought a protocol would be beneficial while 93% and 95% reported that it could decrease catheter days. RN's (93%) and physicians (87%) thought they had the ability to decrease CAUTI pre-survey, which increased to 95% and 100% respectively post-intervention. Seventy-six percent of nurses and 88% of physicians reported daily participation in the protocol since implementation. A minority (26%) of respondents felt that the protocol increased the burden to their workflow. The most cited barriers to implementing the catheter removal protocol were concern for skin breakdown in female patients (72%), concern for inaccurate urine output measurement (57%), and surgical (49%) or ICU team (39%) resisting catheter removal.
Conclusions: Deimplementation of urinary catheters is well accepted before and after intervention in the SICU. There are notable barriers to catheter removal that need further exploration to guide sustainable strategy development that will decrease urinary catheter utilization rates in the ICU.