Implementation of an EBP Protocol to Reduce Use of Indwelling Urinary Catheters in the Long-Term Care Environment

Tuesday, 23 July 2013: 1:30 PM

Phyllis M. Gaspar, PhD, RN
College of Medicine and College of Nursing, University of Toledo, Toledo, OH
Murthy Gokula, MD, CMD
College of Medicine, Department of Family Medicine, University of Toledo, Maumee, OH

Learning Objective 1: describe the process of implementation of an evidence based practice protocol regarding the appropriate use of indwelling urinary catheters in a long-term care environment.

Learning Objective 2: identify the key components of an evidence based practice protocol for appropriate use of an indwelling urinary catheter in a long term care environment.

Purpose:  Use of indwelling urinary catheters (IUC) has been documented between 5-15% in long-term care (LTC) even though the Centers for Medicare and Medicaid Services (CMS), requires a valid medical justification for use.  A major complication of IUCs is infection, which is a primary cause of hospitalization of patients from LTC facilities.  UTIs also contribute to the problems of incontinence, falls and delirium. Purpose of this project was to implement the evidence based FIRM (Foley Insertion, Removal, and Maintenance) Protocol aimed to increase appropriate use of IUCs in LTC thus reducing related infections and other complications.  The protocol was a revision of an acute care protocol developed, implemented and evaluated by the authors.  Larrabee’s model of evidence-based practice change guided the implementation of the study along with Model of Technology, Nursing and Patient Safety. 

Methods: The FIRM Protocol incorporated an electronic order sheet that was complimented with a web-based education program for health care providers regarding use and care of IUC, and prevention of CAUTIs.  The protocol was implemented at 14 LTC settings with 17 comparison sites.

Results: Knowledge scores of the staff of the intervention sites increased significantly following the education program from a mean of 65.5% to 77.6% compared to no change for the comparison site staff (mean =65.5%).  Review of EHRs over 3 months following implementation revealed 81 documented IUCs (13 at intervention sites; 68 at comparison sites).  100% of the IUCs at intervention sites had an order for use compared to only 70.6% at comparison sites.  Other outcomes including rate of use and occurrence of CAUTIs will be reported.

Conclusion: Implementation of the FIRM Protocol was effective in decreasing inappropriate use of IUC in LTC environments.  Recommendations for revisions in the protocol to promote utility and efficacy at the current sites as well as other LTC settings will be presented.