Improving urinary catheterisation practices in a rural hospital in Ontario

• Main Authors: Mohamed Gazarin, Jennifer Ingram-Crooks, Fatima Hafizi, Lynn Hall, Kirsti Weekes, Cindy Casselman, Sean Burnett, Mikyla Lennard, Amanda Pinches, Darren Tse
• Format: Article
• Language: English
• Published: BMJ Publishing Group 2020-03-01
• Series: BMJ Open Quality
• Online Access: https://bmjopenquality.bmj.com/content/9/1/e000703.full

IntroductionA urinary catheter constitutes a one-point patient restraint, can induce deconditioning and may lead to patient mortality. An audit performed at Winchester District Memorial Hospital revealed that 20% of patients had a urinary catheter, of whom 31% did not meet the criteria for catheterisation. The main objective of this study was to use the Influencer Change Model and the Choosing Wisely Canada toolkit to create a bundle of interventions that would reduce the unnecessary use of urinary catheters in hospitalised patients.MethodsIn a rural teaching hospital, a time-series quasi-experiment was employed to decrease inappropriate use of urinary catheters. Both the Choosing Wisely Canada toolkit for appropriate use of urinary catheters and the Influencer change management approach were used to create effective interventions.ResultsThis study revealed that there was no improvement in appropriate urinary catheter use during Plan-Do-Study-Act (PDSA) cycle 1. There was gradual improvement during PDSA cycle 2, with the percentage of inappropriate urinary catheter use dropping from an initial 31% before any interventions to less than 5% by the end of this study.Discussion/conclusionThis study aimed to reduce the inappropriate use of urinary catheters in a rural hospital with limited resources. The findings indicate that by using a change model, such as the Influencer Change Model, it is possible to promote better patient care through empowering healthcare staff to implement accepted protocols more stringently and thereby to decrease the inappropriate use of urinary catheters to 0%.