Urethral Catheters Essay -- Health, Diseases, Urinary Tract Infection

Urethral catheters are small tubes inserted through the urethra to drain urine. These devices are often linked with high rates of urinary tract infections (UTI) and are frequently used in the older population. This contributes to lengthier hospital stays leading to increased medical costs. In 2008, the Centers of Medicare and Medicaid Services (CMS) included catheterassociated bacteriuria (CAB) as one of the preventable hospital-acquired conditions (HAC) that will affect reimbursement if contracted by a patient in the acute and long-term setting. This paper focuses on three best evidence-based practices and nursing strategies to prevent CABs. Background Van Buren is the second largest city in the Fort Smith, Arkansas (AR)-Oklahoma (OK) metropolitan statistical area and is the county seat of Crawford County, AR. The city of Van Buren has numerous subsystems dedicated to the well-being of the community, which includes one medical facility, five medical clinics, three nursing homes, three ambulance services, and the Crawford County Health Department (Yellow Pages, 2010). The medical facility, Summit Medical Center, provides full-service general acute care to approximately 160,000 residents annually in Crawford, Franklin, and Sebastian Counties in AR and Sequoyah County in OK. The facility has 103 beds, has more than 100 nurses on staff, and has over 140 physicians in the medical clinics (Summit Medical Center, 2011). In 2009, the medical facility emergency department (ED) treated 170 residents from nursing homes, 70 of which were hospitalized after examination and treatment in the ED, 58 were treated as â€Å"ED outpatient† visits, and 42 were direct hospitalization visits (Summit Medical Center, 2011). The majority of... ...See Figure I). The decision tree is used as a guide for clinicians in making clinical decisions to either continue or discontinue indwelling urethral catheters. Conclusion Urethral catheterization in the older population should be considered as a last option because it can lead to catheter-associated bacteriuria, bloodstream infection, sepsis and death. It should not be used for staff convenience, or to manage urinary incontinence manageable by other means. CAB is a condition that can be prevented with the application of evidence-based best practice strategies. These include criteria for catheter placement and discontinuation, use of silver-alloy catheters for short-term catheterization, and limiting bladder irrigation. An algorithm for urethral catheter insertion, care and removal is used as a tool to help prevent CABs and achieve better patient outcomes.