Catheter acquired urinary tract infections (CAUTI) represent 40% of hospital acquired infections and of those, 70-95% are linked to catheter use (Tyson et al., 2020). Contributing factors often include suboptimal insertion techniques, inconsistent maintenance practices, and prolonged catheter duration.
Kaiser Permanente San Rafael (KP SRF) has 12 licensed beds in the intensive care unit (ICU). The interprofessional care team provides expert care to critically ill patients with a range of acute and chronic medical and surgical conditions. Many patients require a urinary catheter as part of their plan of care at some point during their ICU stay.
While efforts were made in the ICU to minimize duration, in January 2024, KP SRF did not have a nurse-driven urinary catheter removal protocol. The evidence supports the use of nurse-driven urinary removal protocol (Russell et al., 2019; Tyson et al., 2020). As a result of the existing practice, urinary catheter removal was at times delayed.
In March 2024, an evidence-based nurse-driven urinary catheter removal protocol was shared during the KP Northern California Nursing Professional Development leader peer group. This group includes a nurse manager and/or director overseeing nursing professional development at each medical center. Kim Shankel, MSN, RN, CNL, nursing professional development manager for KP SRF, attended the meeting. To understand its potential positive impact for the ICU, Shankel shared the evidence with the ICU clinical nurse specialist, Gopi Ganesh, MSN, RN, CNS, CCRN. Shankel and Ganesh partnered to build out a timeline and action plan to implement the nurse-driven urinary catheter removal protocol to reduce the CAUTI rate in the ICU.
In April 2024, the nursing professional development team at KP SRF coordinated and planned the agenda, curriculum, and educational materials. Shankel and Ganesh scheduled nursing skills days for May and June 2024, which included the nurse-driven protocol. Additionally, educational materials were created to address the urinary catheter removal protocol, inclusion and exclusion criteria, order sets, and proper documentation in the electronic health record. A HealthStream module was created for ICU nurses to complete by June 2024.
Shankel and Ganesh led skills days sessions in May and June of 2024. They enlisted Maya Rosenzweig, BSN, RN, CCRN; Lisa Roberts, BSN, RN, CCRN; Molly Conner, BSN, RN, CCRN; and Catherine Moore, BSN, RN, CCRN, ICU clinical nurse champions to support the practice change. These clinical nurse champions educated their peers during shift huddles, staff meetings, and at the unit council in May and June 2024. Education was provided through verbalization, flyers, and demonstrations in the electronic health record.
The education was completed, and protocol was fully implemented by the end of June. As a result of implementing a nurse-driven urinary catheter removal protocol, the CAUTI rate decreased in the ICU, aligning with a goal in the nursing strategic plan.