Date Available
4-16-2025
Year of Publication
2025
Document Type
DNP Project
Degree Name
Doctor of Nursing Practice
College
Nursing
Department/School/Program
Career, Technology and Leadership Edu.
Faculty
Dr. Candice Falls
Committee Member
Dr. Brooke Judd, Dr. Anna Kalema
Faculty
Dr. Holly Chitwood
Abstract
Background: Catheter associated urinary tract infections (CAUTI) are the most prevalent healthcare acquired infection (HAI) in the acute care setting. Unfortunately, CAUTIs can lead to high morbidity and mortality rates, longer length of stay (LOS) and increased healthcare costs. Unfortunately, in critically ill patients which often suffer multi-organ failure/injury, there remains an increased risk for infection and poor outcomes.
Purpose: The purpose of this project is to increase medical intensive care unit (MICU) nursing staffs’ knowledge of existing nurse driven indwelling urinary catheter removal protocol and to implement an electronic medical record (EMR) prompt for removal of unnecessary urinary catheters to ultimately increase protocol compliance, decrease CAUTIs, catheter utilization rates (CUR), and indwelling urinary catheter (IUC) dwell days.
Methods: The design was a pre- and post- quality improvement initiative with retrospective and prospective chart reviews of patient data. The study was set in the 48-bed medicine intensive care unit (MICU) at University of Kentucky Healthcare and took place over 12 weeks. Interventions were an educational session and implementation of an EMR prompt for nurses advising removal of unnecessary IUCs.
Results: There was no positive effect on MICU nurses’ compliance rates after an educational session and EMR prompt despite increased knowledge and attitudes of the protocol. Similarly, the outcomes of CAUTIs, CUR, ICU length of stay and IUC dwell time also were not impacted.
Conclusion: Despite increased knowledge and attitudes, compliance rates did not improve in this study. We also found continuing education and identifying barriers to compliance (increased nurse workloads) can impact patient outcomes and compliance. Most noncompliance occurred in mechanically ventilated patients who required no vasopressor use. Further, integrating this type of prompt into EMR systems can improve data collection for tracking protocol compliance rates.
Recommended Citation
Pfister, Kendall L., "Implementation of a Process to Improve Compliance with a Nurse Driven Foley Catheter Removal Protocol in Nursing Staff of a Medicine Intensive Care Unit" (2025). DNP Projects. 481.
https://uknowledge.uky.edu/dnp_etds/481
