Abstract
BackgroundCatheter associated urinary tract infection (CAUTI) is one of the most commonly acquired health care associated infections within the United States. We examined the implementation of an initiative to prevent CAUTI, to better understand how health care providers’ perceptions of risk influenced their use of prevention practices and the potential impact these risk perceptions have on patient care decisions. Understanding such perceptions are critical for developing more effective approaches to ensure the successful uptake of key patient safety practices and thus safer care for hospitalized patients.MethodsWe conducted semi-structured phone and in-person interviews with staff from 12 hospitals. A total of 42 interviews were analyzed using open coding and a constant comparative approach. This analysis identified “risk” as a central theme and a “risk explanatory framework” was identified for its sensitizing constructs to organize and explain our findings.ResultsWe found that multiple perceptions of risk, some non-evidence based, were used by healthcare providers to determine if use of the indwelling urethral catheter was necessary. These risks included normative work where staff deal with competing priorities and must decide which ones to attend too; loosely coupled errors where negative outcomes and the use of urinary catheters were not clearly linked; process weaknesses where risk seemed to be related to both the existing organizational processes and the new initiative being implemented and; workarounds that consisted of health care workers developing workarounds in order to bypass some of the organizational processes created to dissuade catheter use.ConclusionsHospitals that are implementing patient safety initiatives aimed at reducing indwelling urethral catheters should be aware that the risk to the patient is not the only risk of perceived importance; implementation plans should be formulated accordingly.
Highlights
Catheter associated urinary tract infection (CAUTI) is one of the most commonly acquired health care associated infections within the United States
We found that when the Bladder Bundle tried to restrict the use of the urinary catheter through “appropriate indications,” health care providers developed workarounds to continue to use the urinary catheter in ways they deemed appropriate
We found that the electronic medical record (EMR) offered health care providers several opportunities to bypass organizational processes, to continue to use the urinary catheter
Summary
Catheter associated urinary tract infection (CAUTI) is one of the most commonly acquired health care associated infections within the United States. To guide health care providers’ assessments, hospitals are implementing patient safety initiatives aimed at reducing or eliminating risks Many of these initiatives have been developed at national and state levels and are designed to standardize patient care across hospital settings through disseminating guidelines or formalized efforts to encourage the use of certain practices [5,6,7]. Such efforts are meant to guide health care providers’ decisions and behaviors avoiding placing patients at unnecessary and unacceptable risks. Recent research has found that “risk” is often locally and, quite possibly, individually defined by health care providers’ and their responses to patient risk are influenced by such things as weak associations between risks and negative outcomes, and organizational processes that support or hinder reducing a patient’s risk for a negative outcome [8,9]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
