Effect of Physician Documentation on Catheter Associate Urinary Tract Infection Rates at a Community Hospital

Abstract

<h3>Background</h3> Urinary tract infections (UTIs) account for more than 30% of healthcare-associated infections. Urinary catheters are often placed and continued for inappropriate indications. Urine cultures are also frequently obtained when not indicated. <h3>Methods</h3> Twenty-one catheter associated urinary tract infections (CAUTIs) were identified during the surveillance time-frame of October 2018 to March 2019. Chart review was done to identify provider order for urinary catheter insertion, documentation for appropriate indication of catheter and urine culture. <h3>Results</h3> Of the twenty-one CAUTIs, there was no provider order or documentation of appropriate indication for urinary catheter insertion in 48% of the charts that were reviewed. Sixty seven percent of these CAUTIs did not have daily documentation of urinary catheter necessity. Inappropriate continued urinary catheter use was identified in 57%. Urine culture was ordered when not clinically indicated in 48% of the patients. <h3>Conclusions</h3> Through this study, we identified opportunities to improve physician documentation for urinary catheter insertion, continued use and urine culture orders. Lack of diagnostic stewardship was noted, with half of the urine cultures obtained when not indicated. Efforts to improve physician awareness included education through presentation at grand rounds, medical staff orientation, communication in newsletters, emails and fliers in the physician's lounge. Urinary catheter order has been removed from all order sets with a few exceptions that are approved by the CAUTI committee (examples: preoperative, trauma, genital urinary). A request has been made to the Information Technology department to include the appropriate indications for urine catheter and urine culture to the respective orders and to have a hard stop option in the electronic medical record for provider documentation of daily catheter necessity. Our efforts have to date shown decreased Foley use. The house-wide utilization rate prior to these implementations was 0.22 compared to our current rate of 0.18. Critical care utilization rate decreased to 0.56 from 0.60.