Back to Basics Education for Urinary Catheter Care in a Home Care Setting

Abstract

ISSUE: Noting an increase in catheter associated urinary tract infections by internal and external benchmarking, an examination of policies and practices demonstrated inconsistency, brought about by individual physician preferences, long standing cultural habits, and efforts to meet reimbursement criteria. Reference material specific to home care was limited, published guidelines generally commented on catheter care and not the unique care in challenging and complicated chronically ill home bound patients. Networking through a regional home care alliance revealed other home care agencies in the area had similiar issues. PROJECT: Develop a back to basics campaign on urinary catheter management, both for staff and home caregivers. The practice was to change the catheter every 30 days, symptomatic or not. Another practice was to begin with a large gauge catheter, and if leaking, increase diameter until controlled. Education on change intervals, techniques to elimate breaking sterile system and to prevent leakage was provided. Basic care regarding hydration, diet, positioning and hygiene were reinforced. Disparity was found in reveiwing the supplies. Products were upgraded to include anti-microbial features. Reimbursement tied to visit frequency was addressed by education in the appropriate manner to access and document care of chronically catherized patients to comply with regulations and maintain quality care. RESULTS: Several discoveries were made, including a patient with blue urine syndrome, which was quite startling. After a three year initiative, the catheter associated urinary tract infection rate fell from 6.9 to 1.6. The external benchmarks frequently reported home care agencies with zero infections for a 3 month period. This raised concerns with our regional home care networking group. An absence of urinary infections in this population for several months stirred questions of accuracy in reporting and definition adherence. Our regional group voted to develop a database for purposes of external benchmarking to better discover the norms for our community. This is in process. LESSONS LEARNED: Benchmarking with external databases remained problematic. Hospice was included in the first months, until clarified with the external database by definition. Our own data was perplexing. Personnel issues were reveiwed for a four year period and it was suggestive that data collection tools and practices may have been influenced by mutiple personnel changes in the year preceding the initiative. Possibly this demonstrated a more drastic deviation from our internal mean than originally thought. The tool was revised and definition reveiwed at the start of this project to assure consistency. As staff evolves, continuing education is parmount to maintain and further reduce catheter associated urinary tract infections.