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Reducing avoidable harm in patients with catheters

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Presentation on theme: "Reducing avoidable harm in patients with catheters"— Presentation transcript:

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? © SaIL Centre 2015

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 © SaIL Centre 2015

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 © SaIL Centre 2015

5 No Catheter, No CAUTI-The background
© SaIL Centre 2015

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. © SaIL Centre 2015

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 © SaIL Centre 2015

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 © SaIL Centre 2015

10 Anatomy and catheter placement
© SaIL Centre 2015

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 © SaIL Centre 2015

14 References © SaIL Centre 2015

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