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Urinary Catheter Process Measures Improve in MI

Cheryl Clark, for HealthLeaders Media, February 13, 2012

"Possible differences between high and low performing hospitals might include varying levels of commitment from each institution to make this effort a high priority, or differential involvement of champions to support the effort," they wrote. "External forces influencing the decision to fully adopt safe processes may also play an important role, whether related to public reporting or financial incentives."

The authors acknowledged that their study had some design elements that may have biased the results.  First, there was no control group and it may have been that more appropriate catheter use would have happened anyway, perhaps in response to the 2008 CMS policy to deny reimbursement for additional care required by hospital acquired infections.

Also, the authors wrote, the hospitals participating may have been more willing to initiate change in their urinary catheter practices than hospitals that chose not to participate.

 

Lastly, they cautioned they did not measure changes in rates of catheter-associated infections at these hospitals, only the process measures that logically would have led to a reduction.

In an invited commentary accompanying the article, Michelle Mourad, MD and Andrew Auerbach, MD, of the University of California San Francisco said many hospitals have found it difficult to overcome barriers. Those include lack of knowledge of appropriate urinary catheter use criteria, failure to notice that a catheter is in place especially when it was inserted elsewhere and failure to remove it when appropriate.

Despite the success of bedside placards, computer reminders and stop orders, "clinical implementation of these practices remains low," they wrote, adding that such incentives are used "in fewer than 1 in 10 U.S. hospitals."

They called for a greater emphasis on infection control interventions and better incentives for compliance, and especially in the appointment of a "champion" who is "focused on overcoming barriers to implementation."


Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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2 comments on "Urinary Catheter Process Measures Improve in MI"


rachel (3/4/2012 at 7:10 AM)
I care for a spinal cord injured male patient, and almost any contact with his penis causes a spontaneous erection, even routine perineal washing or adjusting the sheets. This causes difficulty [INVALID]ing a catheter, which causes discomfort for him, and concerns me. It took some time for me to be comfortable dealing with a a male with reflexive erections in general, but now I am concerned because I feel a lot more resistance [INVALID]ing a catheter into him than with most male patients, particularly during the last few inches – I'm assuming that this involves his prostate and/or urogenital diaphragm. Do you have any suggestions or tips? As he doesn't have normal sensation below his shoulders (C4-5 injury), I have considered many things, including manually inducing an orgasm to allow his penis to become flaccid, but I'm not sure that would be appropriate, or even helpful. I've tried waiting up to 15-20 minutes after [INVALID]ing the lidocaine gel, but the erections are quite persistent – Any ideas, suggestions, or tips would be greatly appreciated! Thank you, rachel from <a href="http://www.brightmedical.com/adult-diapers">ADULT DIAPERS</a>

ADULT DIAPERS (2/19/2012 at 8:48 AM)
Urinary catheters were said to be appropriate for urinary tract obstruction, neurogenic bladder, urologic study or surgery on contiguous structures, sacral pressure ulcer (stage III or IV) with incontinence, and end of life care.