Enhancing integration of community out-of-hours urinary catheter care in South Dublin

Introduction: Patients are often discharged from the hospital with an indwelling urinary catheter or suprapubic catheter. Due to complications which may arise, assessment and intervening is often necessary. Visiting Emergency Departments for this service is time consuming and exhausting to patients. Nursing can often provide services such as irrigating catheters, catheter replacement, septic screening, either in a patient’s residence or in a health centre, alleviating ED visits. A previous audit of ED visits for catheter care was conducted for a local Dublin hospital, and determined the vast majority of ED visits did not result in admissions. Objectives: The goal is to improve out-of-hours urinary catheter maintenance service for people who have urinary catheters and are living in their homes, thereby avoiding Emergency Department visits. This involves training nurses who visit patients to flush catheters, insert male catheterization, and service suprapubic catheters. It also involves empowering patients to manage their own care where possible. Methods: South Dublin Community Intervention Team (CIT) is involved with providing male catheter and SPC competency training. The education training is integrated with the local nurse educators in the SVH, SJH, and Tallaght Hospitals. They offer theory catheter competency training with male catheterization and suprapubic catheter (SPC) care. Community nurses, public health nurses, nursing home nurses and disability nurses attend in-house training in the local hospitals. Following the in house hospital training the nurses have the choice to be assessed by CIT assessor in the community for competency of skills with SPCs and male catheterization. Education is also required for patients and families and carers. Outcomes: The outcome can be assessed by a patient satisfaction survey, as well as a comparative audit to determine the number and experiences of patients who attend an Emergency Department for catheter care. Conclusions: There is justification in continuing to offer the service of emergency catheter care through South Dublin CIT seven days a week in order to avoid Emergency Department visits, and to provide a much needed service to the elderly population in South Dublin. Emergency catheter care episodes by CIT nurses and phone calls requesting these services need to be audited for evaluation of the educational and service intervention.