Sinead Stoneman

288Are we Appropriately Catheterising our Older Inpatients

Background: Older patients are perceived to be catheterised inappropriately during hospitalisation, leading to an increased number of urinary tract infections – an issue of concern, in the context of the emergent increase in resistant microorganisms (1). Methods: We predefined the following indications as valid reasons for catheterisation: acute urinary retention, need for accurate fluid balance, maintain skin integrity, long term catheter that needs to be changed, palliative care. The clinical notes of 114 patients admitted under medical teams on five wards were reviewed, over a four day period, using the retrospective analysis method. We looked for documentation about the indication and insertion of urethral catheters. Where we could not find an explicit indication, we read all the notes prior to catheterisation to ascertain whether catheterisation was indeed necessary. The data acquired from the medical notes was then compared with local and international guidelines (2). Results: Out of 114 patients in total, 20 older patients had an indwelling urinary catheter inserted during their admission. 15 catheters were inserted in ED and 5 on the wards. Catheterisation met the predefined criteria for appropriateness in 16(12 in ED & 4 on the wards) out of 20 cases, the indication being explicit in 6 cases and implicit, from notes review, in 10. 16 out of 20 cases had incomplete documentation about the procedure, whilst this information was absent in 4 cases. Conclusions: We have determined that, in 4 out of 20 cases, urethral catheters were inserted inappropriately. The indication for insertion was not specified in 14 cases. The documentation about the procedure and the post-insertion care was absent in 4 cases and incomplete in 16 cases. We feel that time has come to introduce a clear protocol for urinary catheter insertion. References: 1. Catheter-Associated Infections Pathogenesis Affects Prevention, Barbara W. Trautner, Rabih O. Darouiche, 2. www.nice.org.uk/guidance/qs61/chapter/quality-statement-4-urinary-catheters