The prevalence of catheter associated urinary tract infections (CAUTI’s) has increased on your hospital unit by 20% in the last two quarters. As a member of the Quality Improvement (QI) committee, collaborate with your committee colleagues from other disciplines to develop an interprofessional action plan. What would your clinical question be that guides your QI project?
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An Interprofessional Approach to Reducing Catheter-Associated Urinary Tract Infections
Catheter-associated urinary tract infections (CAUTIs) represent a significant patient safety issue and quality improvement opportunity in many healthcare facilities. At our hospital, the rate of CAUTIs has risen 20% over the last two quarters on my unit. In response, as a member of the Quality Improvement (QI) committee, I collaborated with colleagues from nursing, medicine, infection prevention, and other disciplines to develop an interprofessional action plan to address this pressing problem.
Our initial step was to formulate a focused clinical question to guide our QI project. Using the PICOT format, we crafted the following question: “Among adult patients requiring indwelling urinary catheters in the medical-surgical unit, how does implementing a nurse-driven protocol for reviewing ongoing catheter need compared to usual care affect the rate of CAUTIs over a six-month period?”1 This question helped ensure our efforts targeted the specific patient population and unit experiencing increased infections.
To gain a deeper understanding of factors contributing to rising CAUTI rates, our interprofessional team conducted a root cause analysis.2 We reviewed medical records of recent CAUTI cases and interviewed frontline nurses, physicians, and infection preventionists. This revealed several opportunities for improvement: a lack of standardized protocols for assessing ongoing catheter need, inconsistent documentation of indications, and inadequate staff education on infection prevention bundles.3
Armed with these insights, our QI committee proposed a multi-pronged intervention. We developed a nurse-driven protocol for daily assessment of catheter necessity and prompt removal when no longer required.4 Nurses received targeted training on using the protocol and demonstrating catheter care techniques. Physician champions helped promote consistent documentation of catheter indications in patient records. Finally, we established a process of auditing compliance with our new protocols and providing timely feedback to frontline teams.5
In the ensuing months, our interprofessional team will closely monitor CAUTI rates on the target unit. We will evaluate the impact of our multi-faceted intervention using statistical process control charts.6 If successful, we aim to spread this approach to other high-risk units. Sustained collaboration across disciplines will be crucial to fully address the complex issue of CAUTIs and continually enhance patient safety.
