Persistent Barriers to Timely Catheter Removal Identified from Clinical Observations and Interviews.
Journal
Joint Commission journal on quality and patient safety
ISSN: 1938-131X
Titre abrégé: Jt Comm J Qual Patient Saf
Pays: Netherlands
ID NLM: 101238023
Informations de publication
Date de publication:
02 2020
02 2020
Historique:
received:
12
02
2019
revised:
23
09
2019
accepted:
15
10
2019
pubmed:
28
12
2019
medline:
29
7
2021
entrez:
28
12
2019
Statut:
ppublish
Résumé
Indwelling urinary and vascular catheters are valuable devices in patient care, but prolonged or unnecessary use increases the risk of infectious and noninfectious catheter harms. To understand persistent barriers to detecting and removing unnecessary catheters, researchers conducted a multimethod qualitative study that included observations and in-person interviews with clinicians working on a progressive care unit of a large hospital. Observations consisted of shadowing nurses during shift change and while admitting patients, and observing physicians during morning rounds. Observational data were gathered using unstructured field notes. Interviews were conducted using a semistructured guide, audio-recorded, and transcribed. Qualitative content analysis was conducted to identify main themes. Barriers to timely removal identified during 19 interviews with clinicians and 133 hours of field observations included physicians not routinely reviewing catheter necessity during rounds, catheters going unnoticed or hidden under clothing, common use of "Do Not Remove" orders, and little or no discussion of catheters among clinicians. Five overall themes emerged: (1) Catheter data are hard to find, not accurate, or not available; (2) Catheter removal is not a priority; (3) Confusion exists about who has authority to remove catheters; (4) There is a lack of agreement on, and awareness of, standard protocols and indications for removal; and (5) Communication barriers among clinicians create challenges. To address barriers and facilitate detection and timely removal, clinicians need ready access to accurate catheter data, more clearly delineated clinician roles for prompting removal, effective tools to facilitate discussions about catheter use, and standardized catheter removal protocols.
Sections du résumé
BACKGROUND
Indwelling urinary and vascular catheters are valuable devices in patient care, but prolonged or unnecessary use increases the risk of infectious and noninfectious catheter harms.
METHODS
To understand persistent barriers to detecting and removing unnecessary catheters, researchers conducted a multimethod qualitative study that included observations and in-person interviews with clinicians working on a progressive care unit of a large hospital. Observations consisted of shadowing nurses during shift change and while admitting patients, and observing physicians during morning rounds. Observational data were gathered using unstructured field notes. Interviews were conducted using a semistructured guide, audio-recorded, and transcribed. Qualitative content analysis was conducted to identify main themes.
RESULTS
Barriers to timely removal identified during 19 interviews with clinicians and 133 hours of field observations included physicians not routinely reviewing catheter necessity during rounds, catheters going unnoticed or hidden under clothing, common use of "Do Not Remove" orders, and little or no discussion of catheters among clinicians. Five overall themes emerged: (1) Catheter data are hard to find, not accurate, or not available; (2) Catheter removal is not a priority; (3) Confusion exists about who has authority to remove catheters; (4) There is a lack of agreement on, and awareness of, standard protocols and indications for removal; and (5) Communication barriers among clinicians create challenges.
CONCLUSION
To address barriers and facilitate detection and timely removal, clinicians need ready access to accurate catheter data, more clearly delineated clinician roles for prompting removal, effective tools to facilitate discussions about catheter use, and standardized catheter removal protocols.
Identifiants
pubmed: 31879072
pii: S1553-7250(19)30421-0
doi: 10.1016/j.jcjq.2019.10.004
pmc: PMC7244360
mid: NIHMS1056762
pii:
doi:
Types de publication
Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
99-108Subventions
Organisme : AHRQ HHS
ID : K08 HS019767
Pays : United States
Organisme : AHRQ HHS
ID : P30 HS024385
Pays : United States
Informations de copyright
Copyright © 2019 The Author(s). Published by Elsevier Inc. All rights reserved.
Références
Crit Care Med. 2010 Aug;38(8 Suppl):S292-8
pubmed: 20647786
Am J Med. 2000 Oct 15;109(6):476-80
pubmed: 11042237
JAMA Intern Med. 2018 Aug 1;178(8):1078-1085
pubmed: 29971436
Am J Infect Control. 2015 Mar 1;43(3):206-21
pubmed: 25575913
N Engl J Med. 2015 Sep 24;373(13):1220-9
pubmed: 26398070
Am J Crit Care. 2019 Jul;28(4):290-298
pubmed: 31263012
JAMA Intern Med. 2013 May 27;173(10):881-6
pubmed: 23529627
J Hosp Med. 2018 Feb;13(2):76-82
pubmed: 29377971
Ann Intern Med. 2015 Sep 15;163(6 Suppl):S1-40
pubmed: 26369828
Am J Infect Control. 2011 Sep;39(7):e39-43
pubmed: 21652113
Am J Infect Control. 2010 Nov;38(9):683-8
pubmed: 21034978
Chest. 1998 Jul;114(1):207-13
pubmed: 9674471
Ann Intern Med. 2014 Oct 21;161(8):562-7
pubmed: 25329204
Science. 1974 Mar 8;183(4128):922-32
pubmed: 17756742
Qual Health Res. 2005 Nov;15(9):1277-88
pubmed: 16204405
Ann Intern Med. 2015 May 5;162(9 Suppl):S1-34
pubmed: 25938928
Epidemiol Infect. 2017 Oct;145(14):3047-3055
pubmed: 28868995
Arch Intern Med. 2012 Feb 13;172(3):255-60
pubmed: 22231611
Infect Control Hosp Epidemiol. 2012 Jan;33(1):50-7
pubmed: 22173522
Health Serv Res. 1999 Dec;34(5 Pt 2):1189-208
pubmed: 10591279
Clin Infect Dis. 2011 Jun;52(11):1283-90
pubmed: 21596671
J Urol. 2012 May;187(5):1662-6
pubmed: 22425122
Ann Intern Med. 2013 Sep 17;159(6):401-10
pubmed: 24042368
JAMA Intern Med. 2016 Apr;176(4):548-51
pubmed: 26881938
Arch Intern Med. 1995 Jul 10;155(13):1425-9
pubmed: 7794092
Clin Infect Dis. 2011 Jun;52(11):1291-3
pubmed: 21596672
Infect Control Hosp Epidemiol. 2010 Apr;31(4):319-26
pubmed: 20156062
J Infect Dis. 1990 Nov;162(5):1145-50
pubmed: 2230239
MMWR Morb Mortal Wkly Rep. 2011 Mar 4;60(8):243-8
pubmed: 21368740
J Thromb Haemost. 2017 Oct;15(10):1951-1962
pubmed: 28796444
BMJ Qual Saf. 2014 Apr;23(4):277-89
pubmed: 24077850
J Hosp Med. 2017 Nov 8;13(2):105-116
pubmed: 29154382
J Urol. 2011 May;185(5):1756-60
pubmed: 21420117
J Crit Care. 2008 Jun;23(2):207-21
pubmed: 18538214
Am J Med. 1995 Apr;98(4):349-56
pubmed: 7709947
BMC Health Serv Res. 2013 Apr 26;13:151
pubmed: 23622427
Infect Control Hosp Epidemiol. 2013 Oct;34(10):1048-54
pubmed: 24018921
N Engl J Med. 2018 Nov 1;379(18):1732-1744
pubmed: 30380384
N Engl J Med. 2016 Jun 2;374(22):2111-9
pubmed: 27248619
J Infect Dis. 1992 Jan;165(1):14-8
pubmed: 1727882