DB: Nurse Driven Protocol to Prevent CAUTIs

The majority of the urinary tract infections in the acute care setting is Catheter-

Associated Urinary Tract Infection (CAUTI). CAUTIs is the highest occurring healthcare-

acquired infection (HAI) in the United States. In 2008, The Center for Medicare and Medicaid

services implemented penalties for certain hospital-acquired conditions, CAUTIs being on the

list. Health care organizations are moving to nurse-driven protocols to facilitate discontinuation

of indwelling catheters promptly. This is an issue as indwelling urinary catheter over utilization

leads to increased length of stays, increase cost, increased patient discomfort, and decreased

patient satisfaction.

This writer’s organization had an over utilization of indwelling catheters leading to

Health care-associated conditions (HAC). CAUTIs were on the rise; physicians were not

proactive with discontinuing orders, nurses would leave catheters in longer without questioning

why, therefore, the nursing leadership established a team and charged the team to develop a

nurse-driven protocol based on best practice to discontinue indwelling catheters promptly. This

writer chaired the team where a decision was made to develop a workflow for a nurse-driven

protocol to discontinue indwelling catheters. The workflow to follow implies indwelling urinary

catheters are used for specific clinical indications which should be assessed on a daily basis to

determine if the catheter can be removed. Orders to continue a catheter are necessary and should

reflect the indication for use. Catheters may be removed by the nurse for patients that do not

meet criteria for an indwelling catheter and who do not have orders to continue the catheter.

Several processes were trialed prior to flowing the process and were not as successful as needed.

After revision of the process and posting workflows, the nursing staff bought into the process,

and CAUTIs decreased to zero.