Use of Indwelling Urinary Catheters in Nursing Homes: Implications for Quality Improvement Efforts
Meyers Primary Care Institute; Department of Medicine, Division of Geriatric Medicine
Geriatrics | Health Services Administration | Health Services Research
OBJECTIVES: To describe the epidemiology of indwelling urinary catheter use in nursing homes (NHs). DESIGN: Observational cohort study. SETTING: A purposeful sampling strategy was used to identify a diverse sample of 28 Connecticut NHs, defined in terms of ownership, quality ratings, and bed size.
PARTICIPANTS: Long-stay (>100 days) residents of study NHs 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.
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Citation: J Am Geriatr Soc. 2016 Nov;64(11):2204-2209. Sep 19. Link to article on publisher's site
CAUTI, healthcare-associated infections, nursing home, urinary catheter
Gurwitz, Jerry H.; DuBeau, Catherine E.; Mazor, Kathleen M.; Sreedhara, Meera; Lemay, Celeste A.; Spenard, Ann; Pandolfi, Michelle; Johnson, Florence; and Field, Terry S., "Use of Indwelling Urinary Catheters in Nursing Homes: Implications for Quality Improvement Efforts" (2016). University of Massachusetts Medical School Faculty Publications. 1241.