Empowering Optimal Care: A Tiered Approach to Preventing Inappropriate Urinary Catheter Use in Hospitalized Older Patients

Fang-Wen HuTaiwan Speaker Empowering Optimal Care: A Tiered Approach to Preventing Inappropriate Urinary Catheter Use in Hospitalized Older PatientsThe prevalence of urinary catheter use in hospitalized older patients is approximately 25%, with an estimated 43.9% to 54% deemed inappropriate. Indwelling urinary catheters are associated with extended hospital stays and increased mortality. To address these concerns, we developed a tiered approach framework aimed at reducing inappropriate urinary catheter use and its associated adverse outcomes. This three-year interrupted time series study employed a systematic approach to design, implement, and evaluate the effectiveness of this model. In the first year, we assessed the incidence, risk factors, and outcomes related to inappropriate catheter use among hospitalized older patients. Additionally, we explored knowledge, attitudes, perceptions, and practices concerning catheter use among physicians, nurses, hospitalized older patients, and their primary caregivers. Using a modified Delphi method, we developed a tiered approach model comprising four components: (1) restricting catheter use to appropriate indications (Tier 1A), (2) encouraging the use of alternatives when feasible (Tier 1B), (3) ensuring aseptic techniques for catheter insertion and maintenance (Tier 1C), and (4) facilitating timely catheter removal (Tier 1D). Based on findings from the first year, we implemented educational interventions during the second year, targeting healthcare professionals, patients, and caregivers. Simultaneously, the tiered approach was integrated into routine clinical care processes and subjected to pilot testing. In the third year, the model was fully implemented across clinical settings, and its effectiveness in reducing inappropriate urinary catheter use in hospitalized older adults was systematically evaluated.Empowering Optimal Care: A Tiered Approach to Preventing Inappropriate Urinary Catheter Use in Hospitalized Older Patients