Indwelling catheters: developing an integrated care pathway package

Why have an integrated catheter care pathway package (ICCPP)?
Implementing quality strategies and reducing nosocomial infections is a priority for NHS trusts - and busy nursing teams need support and assistance in meeting these challenges. However, it is not always possible for nurses to find the time or the resources necessary to develop a local integrated pathway and to change practice.

Recognition of these demands resulted in a meeting of a focus group of specialists in January 2002 to discuss catheter care. The following points were raised:

- Local audits have demonstrated the need for improvements in catheter use;

- There is no evidence-based national pathway for catheter care;

- There are regional variations in clinical practice;

- Integrated continence services are developing and will be expected to implement evidence-based pathways (Department of Health, 2000).

Developing an ICCPP requires a significant investment of time and resources. It was decided that developing a comprehensive pathway was the way to address not only these problems but also to comply with clinical governance and government policies.

Some of the potential benefits of using an integrated care pathway include:

- Ensuring that patients and carers are provided with consistent information;

- Having documentation that can help teams to visualise the process of care;

- Reducing inconsistencies through coordinated care;

- Making patients the focus of the care cycle.

Developing the ICCPP
A panel of specialist nurses embarked on the development of the ICCPP in consultation with a reviewing panel that comprised continence advisers, other health professionals with expert knowledge and professional associations.

The aim of the project was to prepare a dynamic and flexible ICCPP for indwelling catheter use that could be applied nationally and would fulfil the following requirements:

- Provide a best-practice approach for managing indwelling catheters, based on evidence or clinical experience where evidence was not available;

- Enable nurses to make informed choices when selecting, inserting and managing catheters to ensure optimum benefit to the patient;

- Facilitate consistency of care wherever and to whomever the patient presents;

- Provide a range of supporting assessment and management tools for local adaptation;

- Be suitable for use by nurses in all clinical settings;

- Be practical, transferable, user-friendly and suitable for auditing.

Structure of the ICCPP
The ICCPP was the result of one year's hard work and is structured in an easy-to-use format. The pathway includes the following range of flexible tools:

The indwelling catheters integrated care pathway package An evidence-based information and resource booklet describing what nurses need to know about catheter management.

The management pathway algorithm An easy-to-follow poster that clearly outlines the step-by-step staged approach to catheter management (see p50). A key theme focuses on catheterisation as a process that requires continuous assessment and review.

The care pathway assessment form This is the core assessment and individual patient documentation form. It outlines standard statements for catheter management. This allows for variance tracking and ensures that nurses follow the pathway and that they document the care that is provided.

The trouble-shooting guide A valuable booklet that provides advice and tips on how to deal with catheter-related problems.

CD-ROM This contains examples of a discharge letter, patient information leaflet and catheter record card.

Conclusion - For the first time, nurses now have access to a resource that is not only timely and relevant but can also be easily applied in their individual workplaces. The pathway has been designed to act as a template for optimal patient care and is intended to be adapted to suit local need.

FOOTNOTE
The development of the ICCPP was supported and sponsored by an educational grant from Bard Limited. For more information on the pathway contact Bard directly on 01293 527888.

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