Risk Factors and Outcomes Associated with Initial Use of Inappropriate Indwelling Urinary Catheters Among Hospitalized Elderly Patients

Sunday, 27 July 2014

Shih-Ting Piao, RN
Department of Nursing, Chi Mei Medical Center, Tainan, Taiwan

Purpose: The aim of this study was to explore the risk factors and clinical outcomes for initiation of inappropriate urinary catheterization among hospitalized elderly in Southern Taiwan.

Methods: The subjects were selected with a purposive sampling method at a medical center in Southern Taiwan from October 29, 2012 to May 19, 2013. A prospective study was conducted to collect data from hospitalized elders who used IUCs within 48 hours after admission. One hundred and fifteen patients were recruited. Data was collected including: demographic variables, Charlson Comorbidity Index, Katz Index of Independence in Activities of Daily Living, Geriatric Depression Scale Short–Form, Short Portable Mental Status Questionnaire, and information of IUCs placement. The outcomes associated medical care was collected at discharge. SPSS software for windows version 19.0 was applied to analyze the data through descriptive statistic, chi-square, t-test, and binary logistic regression analyses.

Results: The results indicated that the incidence rate of inappropriate use of IUCs was 37.4%. The most frequent indication for catheterization was surgical intervention (43.1%), the second most frequent indication was accurate assessment of urinary output (37.5%). The most common reasons that inappropriate IUCs use was for convenience (62.8%), and used for manage acute urinary retention without assessment (18.6%). The findings of logistic regression analysis suggested that the diagnosis of urinary tract infection (OR=7.75, 95%CI=1.84-32.73, p=.005), lower scores of SPMSQ (cognitive function) (OR=0.77, 95%CI=0.62-0.96, p=.02), and higher Katz scores (activities of daily living) (OR=1.17, 95%CI=1.04-1.33, p=.012) were risk factors associated with inappropriate IUCs use among hospitalized elderly. Inappropriate catheterized patients also had a poor recovery in activities of daily living at discharge, but were not associated with such outcomes as catheter- associated urinary tract infection, length of hospital stay, nursing home admission, mortality, and catheters reinsertion.

Conclusion: Urinary catheters were inappropriately used more commonly among the diagnosis of urinary tract infection, poor cognitive function, and better activities of daily living status in older patients. Careful attention to this aspect of medical care may increase the degree of recovery in activities of daily living at discharge. Given the significance of these results can help identify groups at increased risk for inappropriate urinary catheters placement. Multiple approaches are needed to reduce inappropriate utilization, including avoiding the placement of unnecessary urinary catheters and education about appropriate indications for indwelling urinary catheters.