Dr Dushiyanthi Rasanathan is a PGY2 house surgeon who is currently working at Waitemata DHB and graduated from Auckland Medical School in 2018. The clinical audit that she is presenting today was completed during her time as a stroke team house officer in 2019.
Trial Removal of Indwelling Urinary Catheters in Stroke Patients: A Clinical Audit
Aims: To identify if the trial removal of indwelling urinary catheters (TROC) in stroke patients complies with the 2016 American Heart Association/American Stroke Association (AHA/ASA) AHSA guidelines, and to identify any precipitating factors that prevent compliance with the guidelines.
Methods: We performed a clinical baseline audit that identified patients who were admitted to Ward 2 at North Shore Hospital with a diagnosis of stroke from 26 November 2018 – 24 May 2019 and had an indwelling urinary catheter (IDC) inserted during their admission. The audit consisted of both retrospective and prospective components. Data was collected on patient demographics, the documented indication for IDC insertion, total number of catheter-days, the incidence of urinary tract infections (UTI) and the outcomes following catheter removal.
Results: A total of 49 patients were included in this audit. 4.1% of patients had catheters removed within 24 hours (95% confidence interval: 0.011 to 0.137). The average number of catheter-days before removal of IDC was approximately five days. 24.5% of our patient sample went on to develop a urinary tract infection. Conclusions and/or Clinical Practise Point: Stroke patients have a number of risk factors that predispose them to acute urinary retention and thereby requiring urinary catheterisation. Stroke patients are particularly prone to developing UTI due to immunosuppression, bladder dysfunction and increased use of urinary catheters. The longer an IDC is in place, the greater the likelihood of bacteria and UTI. A minority of patients in our audit had TROC within the recommended guideline period. Daily electronic reminders and prompting by all members of the rehabilitation team concerning TROC are important to reduce catheter-days and reduce UTI rates. Insufficient documentation and inappropriate indications for IDC insertion were features noted during this audit. UTI and catheter use can prolong the period of immobility for stroke patients as systemic illness, intravenous antibiotics and urinary catheters make it more difficult to begin intensive physical therapy. UTIs are related to undesirable outcomes including deterioration in neurological state, increased length of hospitalisation and long term disability. The simple measures of eliminating the use and duration of unnecessary IDCs have the potential to decrease the incidence of UTI, reduce the time to mobilisation, improve patient comfort and ultimately result in improved outcomes for our stroke patients.