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Topic We present the findings of a completed audit cycle examining the use of urinary catheters and documentation of insertion in patients over 65 years at North Middlesex University Hospital (NMUH) in June 2014. Current evidence includes NICE guidelines on the standards of documentation for insertion of urinary catheters (NICE pathways (2012): prevention and control of healthcare-associated infections, available online). Trust guidelines at NMUH, published in 2008, also list appropriate clinical indications and standards for catheter insertion.
Intervention In 2008, an audit was undertaken on the three care of the elderly wards, acute medical units (AMU) and acute stroke unit at NMUH, examining where catheters were being inserted, clinical indication and documentation of insertion. Following this audit, a sticker on the catheter pack was introduced to facilitate documentation of catheter insertion by healthcare professionals. The sticker included space for documenting date of insertion, clinical indication and other details.
Improvement Data was collected for 24 patients over 65 years with urinary catheters in June 2014. Of 130 care of the elderly patients, 18.5% had a urinary catheter. The most common clinical indications were acute urinary retention and fluid balance. 96% of patients had a clear indication for catheterisation documented, compared to only 50% in 2008. The majority of patients were catheterised in A&E or AMU, with 25% of patients having long-term catheters on admission. In 2008, only half of inserted catheters had documentation of time/date of insertion and 25% the type of catheter used. In the present audit, 95% of catheters had clear documentation of these details.
Discussion In conclusion, the majority of catheters were inserted on appropriate clinical grounds and in the acute medical settings (A&E and AMU). The introduction of a sticker on the catheter pack was an effective and simple intervention in improving the documentation of catheter insertion.