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'Passionate teams are needed to monitor data on catheter care'

Indwelling catheters is justified for some patients. But they come with the risk of a urinary tract infection, which extends length of stay and imposes an extra burden of care and cost on the NHS.

Yet evidence suggests that, in many cases, catheterisation is not needed.

Improving catheter-related care for these patients depends on good education, implementation of best practice, adequate resources, and effective devices and treatments. There are many reasons why patients would need urinary catheterisation, and a long-standing debate continues about best practice in managing urinary catheters (Getliffe and Dolman, 2003).

Energising for Excellence (E4E) is a framework that supports nurses to deliver care in a safe, effective and efficient way; it brings together tools, techniques and policies in one place on the Department of Health (DH) website. E4E’s metric 3, on the care of patients with an indwelling urinary catheter, includes the Protection from Infection high impact action.

Healthcare organisations have set goals for increasing the proportion of patients who complete episodes of care without experiencing a catheter-associated urinary tract infection (CAUTI). These will allow comparison between organisations.

E4E metric 3 says that organisations should demonstrate a dramatic reduction in the rate of CAUTIs and that, each month, all trusts should submit age-related data on the number of patients with urinary catheters to their strategic health authority. This excludes children aged under one, patients with suprapubic urinary catheters and those who are performing clean intermittent self-catheterisation.

The Safety Express Quality, Innovation, Productivity and Prevention (QIPP) programme is a call to action for NHS staff who want a safer, more reliable service, with better outcomes at a lower cost. It aims to see at least a 50% reduction in the proportion of patients with an indwelling urinary catheter being treated for a CAUTI.

The urinary catheter Commissioning for Quality and Innovation (CQUIN) payment framework recommends organisations undertake ongoing assessment of urinary catheter use to make sure they are using them as little as possible; it advocates catheter removal at the earliest opportunity (DH, 2010). Each organisation will set realistic targets for hitting CQUIN targets.

Trusts can adopt strategies to ensure compliance and monitor progress. Dynamic leadership and a safety culture are needed, along with reliable care and supporting infrastructure. Education and training are indispensable, as are active risk management and appropriate equipment.

The collaborative approach of using E4E and Safety Express to achieve CQUIN targets is attainable, but requires a passionate implementation team to monitor and collate the data on a monthly basis. NT

Sue Foxleyis a consultant nurse, continence care, King’s College Hospital NHS Foundation Trust, London

Readers' comments (4)

  • "...extra burden of care and cost on the NHS."

    All the NHS, government ever seem concerned about is burden, costs and meeting hypotetical and illusionary targets. How about thinking of the discomfort, damage and effect on the lives of patients due iatrogenesis caused by medical, nursing, hospital and other system failures for a change.

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  • It's unfortunate that the 'Anonymous' contributer above has taken the statement out of context. Energising for Excellence aims to improve the patient experience and secure better health outcomes for all patients, namely, avoiding the potential iatrogenic consequences of invasive procedures such as inserting a urinary catheter.
    If we don't start focussing more time on preventing avoidable infections, the burden and cost on our health service will impact on rationing other areas of health care. Let's not divorce the cost of the service from the quality of healthcare as if they are uncomfortable bed partners. Patients want us to spend their taxes wisely!!

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  • my comment above is not out of context. it is merely a general comment about what one constantly hears and reads in the press which gives the impression that cost and burdens to the health service appear to be the main concern rather than focussing on the patients and the effects of inappropriate or inadequate care on them. I am sure any nurse led schemes to research and prevent iatrogenesis are laudable provided they are also cost effective and produce the desired outcomes for the safety and wellbeing of patients first and foremost and central to their concerns.

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  • 19 OCTOBER 2011

    Dear Nursing Times

    I am not a nurse or medic or healthcare professional.

    I would be most grateful to enquire why it is that CQUIN is so important? Why are Trusts encouraged to meet these targets as set by the DH?

    What is is that is inherently potentially dangerous to patients with catheters?

    Why are patients placed on catheters at all? I ask this in all seriousness, as it appears from CQUIN that questions are being posed as to why some people are being catheterised in any event and that some might be unnecessarily catheterised.

    Are some patients being catheterised for the fact that there are staff shortages in some facilities and it is easier for the staff to have someone catheterised rather than having to provide a commode or bring a bedpan or assist someone to the bathroom?

    Any invasive procedure surely has inherent risks of bacterial infection? And is not catheterisation an invasive procedure for males and females with indwelling catheters?

    And can the patient feel that their genital area is itching and sore?

    Are all nurses and doctors aware of the complications of catheterisation? What training is given?

    I would be grateful for some guidance in these matters please.

    Thank you very much


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