MedicalResearch.com Interview with:
Jerome A. Leis, MD MSc FRCPC
Staff physician, General Internal Medicine and Infectious Diseases
Physician Lead, Antimicrobial Stewardship Team
Staff member, Centre for Quality Improvement and Patient Safety
Sunnybrook Health Sciences Centre
Assistant Professor, Department of Medicine, University of Toronto
Medical Research: What is the background for this study? What are the main findings?
Dr. Leis: Overuse of urinary catheters leads to significant morbidity among hospitalized patients. In most hospitals, discontinuation of urinary catheters relies on individual providers remembering to re-assess whether patients have an ongoing reason for a urinary catheter. We engaged all of the attending physicians to agree on the appropriate reasons for leaving a urinary catheter in place and developed a medical directive for nurses to remove all urinary catheters lacking these indications. This nurse-led intervention resulted in a significant reduction in urinary catheter use and catheter-associated urinary tract infections, compared with wards that continued to rely on usual practice.
Medical Research: What should clinicians and patients take away from your report?
Dr. Leis: Rather than relying on a system where re-assessment of urinary catheters is haphazard, a standardized model of care can be developed to eliminate overuse. Medical directives can empower nurses to play a central role in providing coordinated re-assessment and removal of urinary catheters, followed by post-catheter care.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Leis: The medical directive that we developed at our institution led to a sustainable reduction in urinary catheter use. Further studies are needed to evaluate its use across other hospitals and adapt it to other patient populations to see if we can achieve similar results.
Leis JA, Corpus C, Rahmani A, et al. Medical Directive for Urinary Catheter Removal by Nurses on General Medical Wards. JAMA Intern Med. Published online November 16, 2015. doi:10.1001/jamainternmed.2015.6319.
Jerome A. Leis, MD MSc FRCPC (2015). Standardized Model Empowers Nurses To Decrease Urinary Catheter Use