Inappropriate use of urinary catheters in elderly patients at a midwestern community teaching hospital.
BACKGROUND
An estimated 4 million patients per year in the United States are subjected to urinary catheterization. Approximately 25% of patients who are hospitalized have an indwelling urinary tract catheter placed at some time during their hospital stay and nosocomial urinary tract infections develop in 5% per day, with associated bacteremia in 4% of patients.


OBJECTIVE
We sought to assess the prevalence and the appropriateness of the use of urinary catheters at a community teaching hospital in medical patients age 65 years and older.


METHODS
We randomly selected 285 charts from a total of 2845 patients admitted during the year 2000 who were 65 years and older and had an indwelling urinary tract catheter inserted during the first 24 hours after admission. We excluded patients who had a urinary catheter placed before admission and patients admitted for operation.


RESULTS
On chart review we found an appropriate indication for catheterization for 46% of these patients. A physician or nurse explicitly documented the reason for catheter placement in only 13%. No order for catheterization was written in 33% of the charts. Mean duration of catheter use was 3 days.


CONCLUSIONS
Less than half of urinary catheterizations in this teaching hospital were indicated and even fewer had an explicit indication recorded in the chart. Other investigators have had similar findings at other hospitals. Interventions are needed to decrease the inappropriate use of urinary catheters.
Gokula
Radha Ramana Murthy
RR
Sparrow/Michigan State University Family Practice Residency Program, Michigan State University, East Lansing, USA. rgokula@hotmail.com
Hickner
John A
JA
Smith
Mindy A
MA
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004866:Equipment Contamination; D005260:Female; D006760:Hospitalization; D006764:Hospitals, Community; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D008297:Male; D008824:Michigan; D018570:Risk Assessment; D012737:Sex Factors; D019564:Unnecessary Procedures; D014546:Urinary Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000706:statistics & numerical data*; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000209:etiology