Use of urinary collection devices in skilled nursing facilities in five states.
OBJECTIVE
To assess use of urinary collection devices (external, intermittent, and indwelling catheters; pads or briefs) and examine predictors of indwelling catheters in skilled nursing facilities (SNFs).


METHODS
Retrospective cohort study.


METHODS
SNFs in California, Florida, Michigan, New York, and Texas.


METHODS
All patients admitted to SNFs in 2003 who remained there for 1 year (N=57,302).


METHODS
Characteristics of patients who used different collection strategies (indwelling, intermittent, and external catheterization; pads or briefs) and predictors of indwelling urinary catheterization from the Nursing Home Minimum Data Set using multinomial logistic regression.


RESULTS
The prevalence of indwelling catheterization was 12.6% at admission and 4.5% at the annual assessment (P<.001). Intermittent and external catheterization were infrequently used (<1% at admission and annual assessment). Paraplegia, quadriplegia, multiple sclerosis, and comatose state were strongly associated with indwelling catheterization. Male residents were more likely to use an indwelling catheter at every assessment, as were obese patients; individuals with diabetes mellitus, renal failure, skin conditions, deep vein thrombosis, aphasia, or end-stage disease; and those who were taking more medications.


CONCLUSIONS
Coinciding with federal regulations, urinary catheterization was lower than has been reported previously and declined over time. Further reduction should be targeted at the evaluation of skin problems, appropriateness of multiple medications, and alternative measures in patients with diabetes mellitus, obesity, deep vein thrombosis, and communication problems.
Rogers
Mary A M
MA
Division of General Medicine, Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan 48109-0429, USA. maryroge@umich.edu
Mody
Lona
L
Kaufman
Samuel R
SR
Fries
Brant E
BE
McMahon
Laurence F
LF
Saint
Sanjay
S
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000453:epidemiology; D001037:Aphasia / Q000453:epidemiology; D002408:Catheters, Indwelling / Q000706:statistics & numerical data*; D015331:Cohort Studies; D041382:Diapers, Adult / Q000706:statistics & numerical data*; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006620:Hip Fractures / Q000453:epidemiology; D006801:Humans; D016013:Likelihood Functions; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D009765:Obesity / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*; D014481:United States; D014546:Urinary Catheterization / Q000706:statistics & numerical data*; D014549:Urinary Incontinence / Q000453:epidemiology / Q000451:nursing*; D014600:Utilization Review