Quinn Martha, Ameling Jessica M, Forman Jane, Krein Sarah L, Manojlovich Milisa, Fowler Karen E, King Elizabeth A, Meddings Jennifer
Jt Comm J Qual Patient Saf. 2020 Feb;46(2):99-108. doi: 10.1016/j.jcjq.2019.10.004. Epub 2019 Dec 23.
Indwelling urinary and vascular catheters are valuable devices in patient care, but prolonged or unnecessary use increases the risk of infectious and noninfectious catheter harms.
To understand persistent barriers to detecting and removing unnecessary catheters, researchers conducted a multimethod qualitative study that included observations and in-person interviews with clinicians working on a progressive care unit of a large hospital. Observations consisted of shadowing nurses during shift change and while admitting patients, and observing physicians during morning rounds. Observational data were gathered using unstructured field notes. Interviews were conducted using a semistructured guide, audio-recorded, and transcribed. Qualitative content analysis was conducted to identify main themes.
Barriers to timely removal identified during 19 interviews with clinicians and 133 hours of field observations included physicians not routinely reviewing catheter necessity during rounds, catheters going unnoticed or hidden under clothing, common use of "Do Not Remove" orders, and little or no discussion of catheters among clinicians. Five overall themes emerged: (1) Catheter data are hard to find, not accurate, or not available; (2) Catheter removal is not a priority; (3) Confusion exists about who has authority to remove catheters; (4) There is a lack of agreement on, and awareness of, standard protocols and indications for removal; and (5) Communication barriers among clinicians create challenges.
To address barriers and facilitate detection and timely removal, clinicians need ready access to accurate catheter data, more clearly delineated clinician roles for prompting removal, effective tools to facilitate discussions about catheter use, and standardized catheter removal protocols.
留置导尿管和血管导管是患者护理中的重要设备，但长期或不必要的使用会增加感染性和非感染性导管相关危害的风险。
为了解检测和移除不必要导管方面的持续障碍，研究人员开展了一项多方法定性研究，包括对一家大型医院进阶护理病房的临床医生进行观察和现场访谈。观察包括在交接班和收治患者时跟随护士，以及在晨巡时观察医生。观察数据通过非结构化现场记录收集。访谈采用半结构化指南进行，进行录音并转录。进行定性内容分析以确定主要主题。
在对临床医生进行的19次访谈和133小时的现场观察中发现的及时移除导管的障碍包括：医生在查房时未常规检查导管的必要性、导管未被注意到或藏在衣服下面、普遍使用“请勿移除”医嘱，以及临床医生之间很少或没有关于导管的讨论。出现了五个总体主题：（1）导管数据难以查找、不准确或无法获取；（2）导管移除不是优先事项；（3）对于谁有权移除导管存在困惑；（4）在移除导管的标准方案和指征方面缺乏共识和认识；（5）临床医生之间的沟通障碍带来了挑战。
为解决这些障碍并促进检测和及时移除，临床医生需要能够方便地获取准确的导管数据、更明确界定促使移除导管的临床医生职责、便于讨论导管使用的有效工具，以及标准化的导管移除方案。
