1. Reducing avoidable harm in patients with catheters
No catheter, No CAUTI (catheter associated urine infection)
Reducing avoidable harm in patients with catheters
January 2015
Faculty: <insert faculty>

2. No Catheter, No CAUTI - Background
GSTT/ Health Innovation Network for South London
Project lead – Dr Adrian Hopper
Reduce patient harm from catheterisation specifically catheter associated urinary tract infections (UTI’s)
Catheter associated UTI’s are a major cause of hospital acquired bacteriemia
devastating impact on patients
Introduction to short session in order to contextualise learning and where the origins of this course are from
Aims of the project
Why do you think there may have been a need for a patient safety project around catheters?
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3. No Catheter, No CAUTI - The facts
significant financial burden
extended hospital stay
can contribute to delirium & falls
26% of catheters inserted in A&E are inappropriate
1/3 of urinary catheter-days have been shown to be unnecessary
Risk of CAUTI begins to increase after 48 hours of insertion
Source: xxxxx
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4. No Catheter, No CAUTI - The facts
Examples of Serious Harm Caused by CAUTIs...
Patient JC - 13 emergency admissions, 2 months period in hospital over 18 months due to CAUTI or blocked catheter
2. Patient CR - dementia diagnosis: died from severe sepsis despite critical care treatment following a CAUTI
Source: KHP 2014
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5. No Catheter, No CAUTI-The background
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6. No Catheter, No CAUTI Group work
Indications & contraindications of catheters. Why insert a catheter & why not?
Group 2
Risks & complications of catheters. List & discuss implications inc to patients & services
The course today is about the management of catheters in the hospital and the community
We are going to have a think about what we already know about catheters in small groups
Split into two groups
Group 1-Think about the indications and contraindications of catheters-why would you have a catheter and why would you not.
Group 2-Think about the risks and complications of catheters-
You have 5 minutes to explore these areas – feedback to whole group.

7. Catheters - appropriate use
Acute urinary retention or chronic urinary retention only if associated with renal impairment
Clinical need to monitor urine output
Severe sacral pressure ulcers
Measurement of post void residual urine volume-if bladder scanner is unavailable
Instillation of medication-e.g.. Chemotherapy
Urethral stricture therapy
Urological investigations
Management of intractable urinary incontinence
Involuntary micturitionmay occur as a result of:
unconsciousness
injury to the spinal nerves controlling the urinary
bladder
irritation due to abnormal constituents in urine
disease of the urinary bladder
damage to the external sphincter
inability of the detrusor muscle to relax.
Urinary retention may occur as a result of:
obstruction at the bladder neck
enlarged or inflamed prostate
obstruction of the urethra (stricture)
contraction of the urethra during voiding
lack of sensation to pass urine
neurological dysfunction
urinary tract infection
the effects of medication
pain overriding normal bladder sensation
psychological causes.
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8. Catheters-inappropriate use
Urinary incontinence (NB complete continence assessment - inc patient choice in provision of pads & products)
Advanced age
Immobility
Urinary tract infection
Signs of urethral trauma
Patient refusal
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9. Risks/ Complications Injury/ trauma - urethra / bladder wall punctured
Perforation of prostate gland
Catheter associated urine infections
Narrowing of urethra - secondary to scar tissue caused by repeated use of a catheter
Bladder stones (usually develop after years of catheterisation)
Psychological effect
Pain/ Bladder spasm
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10. Anatomy and catheter placement
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11. Keeping our patients safe- what can we do
Consider risk/ benefits before insertion
Use clinical guidance to support decision making
Review catheters every shift
Are they needed? Can they be removed?
Ensure documentation complete
EPR insertion & continuing care forms to support decision making
Daily clinical reviews
Catheter passport
Empowering & educating patients

12. Keeping our patients safe- what we can do?
QA and summarise session

13. Coffee Break
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14. References
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