Do Nurses Know Why Their Patients Have Indwelling Urinary Catheters?

Background:  

Indwelling urinary catheters increase a patient's risk of complications during hospitalization.  Nurses can play an important role in limiting overuse of indwelling urinary catheters. However, it is essential that nurses understand why their patients have urinary catheters in place if they are to serve as an advocate for removal of inappropriate catheters.

 

Objective:  

To assess nurses' knowledge of the indications for indwelling urinary catheters in their patients and to determine factors associated with lack of knowledge of the indications.

Methods:  

A 2-month prospective study was conducted in a Veterans Affairs hospital to determine if nurses could correctly identify the indications for indwelling urinary catheters in their patients. Infection Control practitioners interviewed randomly-selected nurses caring for patients with indwelling urinary catheters and the responses of the nurses were compared to the indications determined by medical record review.

Results:  

Of 509 nurse interviews, only 298 (59%) correct responses regarding the indications for indwelling urinary placement were provided. Of the 211 incorrect responses, 121 (57%) stated incorrect indications, 45 (21%) stated they did not know the indication, and 45 (21%) stated that the indication was a doctor's order. There was a wide variation in the percentage of correct responses for different wards, ranging from 12% to 76% (Figure). Nurses were more likely to provide incorrect responses if patients had inter-ward transfers during hospitalization (36% if no ward transfers [n=79], 53% if 1 ward transfer [n=30, RR=1.5, CI=0.9-2.3], 58% if 2 or more ward transfers [n=7, RR=1.6, CI=0.8-3.3]).

Conclusions:  

In our institution, nurses often do not know the indications for their patients' indwelling urinary catheters. If nurses are to serve as advocates for removal of unnecessary catheters, interventions will be needed to ensure that they know the appropriate indications for urinary catheters and receive information on the indications in their patients.