Monday June 30, 2008
Do all patients need Foley Catheter in ICU?

See this interesting work: "The Effects of Criteria-Based Foley Catheter Guidelines in an ICU", from Morristown Memorial Hospital, NJ, USA.

Background: The prolonged use of indwelling urinary catheters in the hospital-setting can lead to many complications. In an effort to decrease Foley catheter related urinary tract infections (UTI's), our critical care unit (22-bed mixed medical/surgical/trauma adult ICU) focused on reducing the number of foley catheter device days in the critical care setting.

Measurement : The measurement metric utilized was Foley catheter device days (DD). A device day began when a patient was admitted to the intensive care unit (ICU) with an indwelling Foley catheter intact or one was placed in the ICU. A DD ended when the patient was discharged from the ICU with the Foley catheter intact or the Foley catheter was discontinued in the ICU.

Strategy: Nurse-driven surveillance of Criteria-Based Foley Catheter Guidelines (CFCG) was imlemented and an intense educational program was instituted over a 2-week period. A daily checklist for every patient with an indwelling Foley catheter was completed by the nurses. The checklist functioned as a trigger to determine the necessity of the catheter. If the patient did not fall into one of the criteria categories, the nurse contacted the physician to request an order for discontinuation of the catheter.

Results:

• The pre-intervention UTI infection rate for units was 6.4 (UTI's per 1000 device days). Post-intervention the UTI rates decreased by almost 70% to 1.9 (UTI's per 1000 device days.
• Pre-intervention only 6% of the Foley catheters were removed before the patient was transferred out of the ICU and post-intervention 20% of the Foley catheters were removed prior to ICU transfer.
• When a patient leaves the ICU without the Foley catheter, chances are the Foley catheter will not be reinserted on the general hospital floor and the potential to decrease hospital-wide Foley catheter related UTI's is very probable as well.

Conclusion: Although a large percentage of patients did meet the criteria for continued Foley catheter use, there was a subcategory that, prior to intervention, had a continued use of Foley catheters when they weren't warranted.


Previous related pearl: Urinary Catheter related UTIs in ICU


Reference: click to get abstract

1. The Effects of Criteria-Based Foley Catheter Guidelines in an ICU - presented at Sigma Theta Tau International, 38th Biennial Convention - Clinical Sessions, November 12-13, 2005Indianapolis, IN