MP08-04 INCIDENTS RELATED TO FOLEY CATHETER INSERTION AND MAINTENANCE AND THE EFFICACY OF A MEDICAL STAFF EDUCATIONAL PROGRAM FOR SAFETY MANAGEMENT

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety II1 Apr 2016MP08-04 INCIDENTS RELATED TO FOLEY CATHETER INSERTION AND MAINTENANCE AND THE EFFICACY OF A MEDICAL STAFF EDUCATIONAL PROGRAM FOR SAFETY MANAGEMENT Akira Komiya, Sanae Antaku, Junko Matsushima, and Hiroshi Okudera Akira KomiyaAkira Komiya More articles by this author , Sanae AntakuSanae Antaku More articles by this author , Junko MatsushimaJunko Matsushima More articles by this author , and Hiroshi OkuderaHiroshi Okudera More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2249AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We retrospectively reviewed the incidents related to Foley catheter insertion and maintenance. Additionally, we compared the rate of incidents before and after a medical staff education program to prevent Foley catheter-related incidents. METHODS Data regarding the incidents related to Foley catheter insertion and maintenance were collected from January 2011 to April 2014 at a single academic tertiary care center. The incidents were calculated, and the degree of harm and the characteristics related to such incidents were assessed. At the end of August 2012, a medical staff education program was implemented by the urology staff that included instructions regarding basic urological anatomy, urethral catheter insertion techniques and catheter safety, similar to the H.U.B. program described by Kashefi et al. (2008). The incidents before and after the intervention were compared, and the degree of harm was classified according to the conceptual framework of the International Classification for Patient Safety version 1.1 (World Health Organization, Technical Report, 2009). RESULTS During the study period, Foley catheter insertion was performed in 12,476 patients at our institution. Related incidents were reported in 66 patients (0.53%), including 22 cases (0.18%) occurring during catheter insertion and 44 cases (0.35%) occurring during catheter maintenance. Twenty-one patients (0.17%) experienced urethral injury. The degree of harm associated with catheter insertion incidents was moderate in 13 patients. Nine of these incidents occurred before the education program (9/6,799 cases, 0.13%) was completed, and four were reported after the end of the program (4/5,677 cases, 0.07%, p=0.2858). Transient suprapubic cystostomy was required in two patients due to urethral injury reported before the education program began. The degree of harm was none to mild in the remaining seven cases of insertion-related incidents. Among the 44 such incidents occurring during catheter maintenance, 37 catheters were removed or cut by the patient. Such incidents, with any degree of harm, occurred regardless of the education program. CONCLUSIONS The incidents related to Foley catheter insertion and maintenance was 0.53%. The medical staff education program did not reduce the symptomatic incidents related to catheter insertion, but such programs may prevent iatrogenic urethral injury requiring cystostomy. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e86 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Akira Komiya More articles by this author Sanae Antaku More articles by this author Junko Matsushima More articles by this author Hiroshi Okudera More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...