Implementation of a "Foley Light” Emergency Department to Reduce Catheter Utilization

Abstract

Background Decreasing the use of indwelling urinary catheters is a key prevention approach for catheter associated urinary tract infection (CAUTI). The Emergency Department (ED) is a common location where inpatient admits obtain an indwelling urinary catheter. These catheters are often clinically unnecessary and are more likely to remain in place once the patient is admitted. Methods Infection Prevention (IP) and the ED partnered to decrease utilization of indwelling catheters. A team consisting of ED leadership, Critical Care, Hospitalists, and IP developed a “Foley Light” protocol for limiting indwelling catheter insertion in the ED. Education on the protocol was given to all stakeholders. An electronic medical record report was created to identify catheter insertion, order, indication, and ordering provider. The catheter insertion rate and an in-depth weekly analysis of the report was sent to key stakeholders with recommendations for improvement. ED nursing leadership shared weekly updates with staff and provided individual nurse coaching as needed. The ED providers were updated periodically by IP on the program's progress and offered input opportunities. Results Catheter insertion rates decreased from 8.33% during the initial 4-month measurement period to 6.22% in the consecutive 3-month measurement period. Catheter insertions without a provider order decreased 1.4%. Early reviews and discussion with staff indicated increased use of Foley alternatives. The “Foley Light” protocol was a regular agenda item for nurse meetings. Conclusions Consistent feedback and a team approach is essential to tackle a complex issue such as CAUTI. This “Foley light” program provides a platform to increase understanding of the problem and supports the cultural shift needed in the ED to reduce catheter utilization. Decreasing the use of indwelling urinary catheters is a key prevention approach for catheter associated urinary tract infection (CAUTI). The Emergency Department (ED) is a common location where inpatient admits obtain an indwelling urinary catheter. These catheters are often clinically unnecessary and are more likely to remain in place once the patient is admitted. Infection Prevention (IP) and the ED partnered to decrease utilization of indwelling catheters. A team consisting of ED leadership, Critical Care, Hospitalists, and IP developed a “Foley Light” protocol for limiting indwelling catheter insertion in the ED. Education on the protocol was given to all stakeholders. An electronic medical record report was created to identify catheter insertion, order, indication, and ordering provider. The catheter insertion rate and an in-depth weekly analysis of the report was sent to key stakeholders with recommendations for improvement. ED nursing leadership shared weekly updates with staff and provided individual nurse coaching as needed. The ED providers were updated periodically by IP on the program's progress and offered input opportunities. Catheter insertion rates decreased from 8.33% during the initial 4-month measurement period to 6.22% in the consecutive 3-month measurement period. Catheter insertions without a provider order decreased 1.4%. Early reviews and discussion with staff indicated increased use of Foley alternatives. The “Foley Light” protocol was a regular agenda item for nurse meetings. Consistent feedback and a team approach is essential to tackle a complex issue such as CAUTI. This “Foley light” program provides a platform to increase understanding of the problem and supports the cultural shift needed in the ED to reduce catheter utilization.