Indwelling devices like catheters cause roughly 25 percent of hospital infections, and most problems with catheter use stem from poor physician-nurse communication, a study posted on the website of the University of Michigan (UM) on Monday states.
UM researchers interviewed a small group of nurses, physician assistants, nurse practitioners and physicians about problems monitoring and communicating among their teams about patients’ indwelling catheters.
All respondents said poor communication delayed removal of unnecessary catheters. Communication broke down for various reasons and on many levels: poor relationships between doctors and nurses, hierarchical differences or misalignment of workflows that prevented nurses from being present for daily rounds.
Catheters are hidden beneath blankets, so physicians don’t automatically know who’s using one, especially if a nurse isn’t there to point it out.
Catheters often remain in too long, which can cause infection, or they aren’t necessary at all. It’s estimated that 60 percent to 90 percent of intensive care patients, and 10 percent to 30 percent outside the ICU have urinary catheters, according to the study.
“Any foreign object in the body carries an infection risk, and a catheter can serve as a superhighway for bacteria to enter the bloodstream or body,” said Milisa Manojlovich, a professor at the UM School of Nursing.
Electronic health records also cause confusion, sometimes nurses and doctors have different information, or there’s a lag updating charts, or a reliance on both paper and computer records causes problems, Manojlovich says.
Research shows that some patients and caregivers request catheters, believing they’re preferable to getting up to use the toilet. However, they should understand that catheters bring risk of infection, and non-infection risks such as pain, trauma or bleeding, and should talk to their nurse or physician about complications.
The study is slated for the July issue of the American Journal of Critical Care