Schiessler Melissa M, Darwin Lisa M, Phipps Amber R, Hegemann Lindsay R, Heybrock Brenda S, Macfadyen Andrew J
Performance Improvement, Pediatric Intensive Care Unit, and Infection Prevention Departments, Children's Hospital & Medical Center, Omaha, Neb.
Pediatr Qual Saf. 2019 May 24;4(4):e183. doi: 10.1097/pq9.0000000000000183. eCollection 2019 Jul-Aug.
Despite the use of sterile technique for indwelling urinary catheter insertion, as well as use of the defined catheter-associated urinary tract infection (CAUTI) bundle elements per Children's Hospitals' Solutions for Patient Safety, the CAUTI rate in the pediatric intensive care unit (PICU) at a free-standing pediatric hospital was increasing. In 2017, the PICU accounted for 87% of the organization's CAUTIs and 65% of the total indwelling catheter device days. With an important risk factor for CAUTIs being the duration of catheterization, the indication for catheters became an organizational executive priority.
An early 2017 review of the bundle elements identified that the indication for catheterization was not consistently addressed in daily patient rounds. A multidisciplinary project team applying the Plan, Do, Check, Act methodology developed an evidenced-based, nurse-driven indwelling urinary catheter removal protocol. This protocol allows nursing autonomy when removing a catheter by providing clinical indications for catheter use and promoting prompt removal when no longer indicated.
Indwelling urinary catheter device days in the PICU decreased by 28% within 6 months of protocol implementation. The PICU CAUTI rate declined from 4.8 (per 1,000 device days) in 2017 to 0.8 in 2018, 1 year after protocol implementation.
Providing the bedside nurse with an evidence-based protocol that is driven by specific patient indications and diagnoses allows them to practice autonomously in catheter removal. Prompt removal of indwelling urinary catheters results in decreased device days and decreased incidence of CAUTIs.
尽管在留置导尿管插入过程中采用了无菌技术，并且按照儿童医院患者安全解决方案中规定的与导尿管相关的尿路感染（CAUTI）集束要素执行，但一家独立儿童医院的儿科重症监护病房（PICU）的CAUTI发生率仍在上升。2017年，PICU的CAUTI病例占该机构的87%，留置导管装置日数占总数的65%。由于CAUTIs的一个重要风险因素是导尿持续时间，导管的使用指征成为机构管理层的优先事项。
2017年初对集束要素进行审查发现，在日常查房中未始终如一地讨论导尿指征。一个应用计划、执行、检查、行动方法的多学科项目团队制定了一项基于证据、由护士主导的留置导尿管拔除方案。该方案通过提供导管使用的临床指征并在不再需要时促进及时拔除，在拔除导管时给予护士自主权。
在方案实施的6个月内，PICU的留置导尿管装置日数减少了28%。PICU的CAUTI发生率从2017年的4.8（每1000装置日）降至2018年（方案实施1年后）的0.8。
为床边护士提供一项基于特定患者指征和诊断的循证方案，使他们能够自主进行导管拔除操作。及时拔除留置导尿管可减少装置日数并降低CAUTIs的发生率。
