Difficult Urinary Catheter Navigation Guidelines

Background: Knowledge, confidence, and proficiency are paramount for patient safety during urinary catheter (UC) placement, especially when placement becomes difficult. Placement is difficult when the first attempt is not successful. Nurses encountering difficult UC placements are left to try again, call urology for a consult, or rely on variable experience of other nurses. A hazardous knowledge gap exists without standardization for addressing difficult UC placement. Existing education is limited and only teaches basic placement steps on a mannequin which lacks correlation for actual placement in consideration for numerous potential anatomical variations. Method: This project was designed to evaluate if evidence-based best practice guidelines for navigating difficult UC placements would increase knowledge and comfort. This was evaluated through data collected via feedback during focus groups, pre and post-education surveys with open-ended, short answer survey questions and ordinal Likert scale questions. Participants were educators from acute care floors, at the study site. Guidelines were shared and then improved with feedback from focus groups and pre and post-education surveys. Key Findings: Nurses feel inadequately prepared to approach unfamiliar UC situations. Creating guidelines provided an easy to use format with rationale which decreased pain and complications. There was a shift which revealed an increase in knowledge and comfort with standardized guidelines from the pre (3.54 +/- 0.73) to the post-education survey (3.86 +/- 0.5). Conclusions: Nursing education lacks guidelines for navigating difficult UC situations. Evidence-based guidelines improved knowledge and comfort. Healthcare is impacted by Medicare withholding reimbursement for hospital-acquired infections (HAI) and emerging data indicates that noninfectious urethral trauma occurs four times as often as infectious urethral trauma. Proactively mitigating difficult placement before harm will improve the culture of reliability and can prevent noninfectious urethral trauma from reaching HAI status.