QAPI 98 - A Structured Approach to Decrease Device Utilization Through Assessing Foley Appropriateness

Background: Prevention of catheter-associated urinary tract infections (CAUTI) is dependent on the appropriate use of indwelling catheters (foleys) and compliance with bundle elements. There is a lack of standardized tools to assess the appropriate use and timely discontinuation of foleys. We set out to develop a standardized tool to assess and track device appropriateness in order to reduce device utilization.

Methods: Infection Prevention (IP) reviewed literature for best practices on appropriate criteria for device utilization. Literature review findings were shared with a multi-disciplinary team, including senior leadership, to determine if there were gaps in practice. In order to track and trend appropriateness and ensure timely discontinuation, an electronic rounding tool was implemented in March 2021 using the Joint Commission Resources (JCR) application. The team defined a schedule for key stakeholders to assess for foley appropriateness and enter data into JCR on inpatients with foleys on medical/surgical and critical care units. The pre-intervention timeframe was September 2017-February 2021. The post-intervention timeframe was March 2021-August 2022. The normality of the data was tested via the Shapiro-Wilk test and the Kruskal-Wallis H test was used to determine significance. A p-value of < 0.05 was considered statistically significant and all statistical analysis was performed on SAS Studio 3.8 on SAS 9.4.

Results: Following the literature review and gap analysis, no practice gaps were identified. Pre-intervention standardized utilization ratio (SUR) was 0.656. The post-intervention SUR was 0.536, resulting in an 18% decrease in the SUR, which was statistically significant (p < 0.00001).

Conclusions: This study found that having a structed process to assess the device appropriateness daily, prompts discontinuation of foleys and leads to a significant decrease in the device utilization. The engagement with key stakeholders, including senior leadership, was crucial to the success and sustainment of these interventions.