title: Emergency Department Placement and Management of Indwelling Urinary Catheters in Older Adults: Knowledge, Attitudes, and Practice.
abstract: Indwelling urinary catheters (IUCs) are placed frequently in older adults in the emergency department (ED). Though often a critical intervention, IUCs carry significant risks. Our objective was to examine current knowledge, attitudes, and practice of emergency nurses and other providers regarding IUC placement and management in older adults.
  
  
  METHODS
  We surveyed ED providers at a large, urban, academic medical center. We developed questionnaires using items from previously validated instruments and questions created for this study. We also assessed providers' management of 25 unique clinical scenarios, each representing an established appropriate or inappropriate indication for IUC placement.
  
  
  RESULTS
  129 ED providers participated: 43 nurses and 86 other providers. Ninety-one percent of nurses and 87% of other providers reported comfort with appropriate indications for IUC placement. Despite this, on the clinical vignettes, nurses correctly identified the appropriate approach for IUC placement in only 40% of cases and other providers in only 37%. Practice varied widely between individual providers, with the nurse participants reporting appropriate practice in 16%-64% of clinical scenarios and other providers in 8%-68%. Few nurses or other providers reported reassessing their patients for IUC removal at transfer to the hospital (28% of nurses and 7% of other providers), admission (24% and 14%), or shift change (14% and 8%).
  
  
  CONCLUSIONS
  Although emergency nurses and other providers report comfort with appropriate indications for IUC placement, reported practice patterns showed inconsistencies with established guidelines. Wide practice variation exists between individual providers. Moreover, nurses and other providers infrequently consider IUC removal after placement.
authors: New York, NY.
authors: Kartik
authors: K
authors: Viswanathan
authors: New York, NY. Electronic address: aer2006@med.cornell.edu.
authors: Tony
authors: T
authors: Rosen
authors: New York, NY.
authors: Mary R
authors: MR
authors: Mulcare
authors: New York, NY.
authors: Sunday
authors: S
authors: Clark
authors: New York, NY.
authors: Jaime
authors: J
authors: Hayes
authors: New York, NY.
authors: Mark S
authors: MS
authors: Lachs
authors: New York, NY.
authors: Neal E
authors: NE
authors: Flomenbaum
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D002408:Catheters, Indwelling / Q000706:statistics & numerical data*; D002983:Clinical Competence; D016529:Emergency Nursing / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009741:Nursing Staff, Hospital / Q000523:psychology / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014546:Urinary Catheterization / Q000523:psychology / Q000706:statistics & numerical data*; D062885:Urinary Catheters / Q000706:statistics & numerical data*
keywords: Catheter-related UTI; Emergency nursing; Geriatrics; Patient safety; Quality improvement; Urinary catheters