Exploring initial inappropriate use of urinary catheters among hospitalised older patients in Taiwan.

Abstract

To explore the incidence, associated factors and adverse outcomes for initial inappropriate use of urinary catheters in hospitalised older patients. Urinary catheters can lead to substantial complications. The related factors and adverse outcomes associated with initial inappropriate urinary catheter use among hospitalised older patients have not been studied. Prospective cohort study. A total of 321 older patients admitted to the hospital in southern Taiwan having urinary catheters placed within 24hours of admission were recruited. Demographic factors, voiding function history, health conditions and care conditions of catheter placement were collected through a review of medical records, interviewing participants or their primary caregivers. Catheter-associated urinary tract infection during hospitalisation, transfer to a nursing home, length of hospital stay and change in activities of daily living determined as outcomes. Criteria for urinary catheter placement were developed to identify inappropriate use. The incidence of initial inappropriate use of urinary catheters among hospitalised Taiwanese older patients was 38·3%. The rationale most often reported for initial inappropriate use was 'convenience of care' (49·6%). Factors associated with initial inappropriate use were, chronic constipation, urinary tract infection history, medical treatment diagnosis, cognitive impairment, depressive symptoms and independence in activities of daily living and, insertion of catheter during evening and night shifts and lack of nursing documentation of the rationale for catheterisation. Patients with initial inappropriate use showed greater decline in activities of daily living function between admission and discharge. Older patients with greater care needs may become the victims of initial inappropriate use of urinary catheters. Inappropriate use may devastate the activities of daily living in older patients. Nurses' awareness of indications for urinary catheters may prevent inappropriate use. A policy to strengthen nurses' awareness of the use of urinary catheters is needed in Taiwan.