Quality improvement project to reduce the unnecessary use of urinary catheters in patients cared for by a community nursing team

Background Urinary catheters (UC) significantly increase the workload for community nursing services and are a major burden for health care associated infections. Referrals often lack information about why UC are required. In 2023, a community nursing team found 21% of their patients had UC with the clinical indication unknown for at least 44%. This improvement project aimed to reduce the number of inappropriate UC on a community nursing teams’ caseload by enabling the assessment of patients and removing any identified as inappropriate. Methods The model for improvement was used to understand the factors contributing towards the problem, and identify and implement changes to address them. Interventions included awareness and staff training on the use of a decision support checklist (HOUDINI), creation of UC champions and multidisciplinary support group. Changes were tested using plan-do-study-act cycles. Success was measured by auditing how many inappropriate UC were identified and removed, and questionnaires to assess staff knowledge and confidence. Results 43/83 UC were assessed during the study period, 51% (22/43) were identified as inappropriate and successfully removed. This reduced the UC caseload by 24% in 3 months. Strategies to embed the assessment and removal processes are being implemented. Discussion The community nursing team have improved their knowledge about UC and their confidence in decision making to removing them. They now rapidly assess newly referred patients and remove those without appropriate indications. The removal of unnecessary UC improves the quality of patient care and reduces the risk of catheter-associated urinary tract infections.