title: Securement of the indwelling urinary catheter for adult patients: a best practice implementation.
abstract: OBJECTIVE
  The evidence-based project sought to improve knowledge and practice in the care and securement of indwelling urinary catheters.
  
  
  METHODS
  The project utilized a pre and post-implementation audit strategy, with the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice programs. The best practice recommendations on the care and securement of indwelling urinary catheters were retrieved from the Joanna Briggs Institute Clinical Online Network of Evidence for Care and Therapeutics database. A proposed urinary catheter securement practice, which included the use of a specifically designed securement device, was developed and implemented based on these recommendations. The implemented practice was evaluated with an audit tool which comprised two criteria recommended by the Joanna Briggs Institute Practical Application of Clinical Evidence System on the topic: Appropriate Catheter Use and Management. Audit criteria outcomes included staff compliance to training for urinary catheter securement and care and effectiveness of the implemented practice utilized to secure urinary catheters. The project was conducted in a general surgical ward over a period of 14 months, from December 2013 to January 2015. A sample of 30 inpatients was recruited at each audit phase. The sample size was decided based on recommendations from the Joint Commission International guidelines.
  
  
  RESULTS
  A comparison between baseline and post-implementation audit findings indicated significant improvements in both audit criteria outcomes. For the first criterion, 100% compliance (P < 0.001) was achieved with all ward nurses being trained in application and care of the proposed urinary catheter securement practice. Criterion 2, which measured the effectiveness of the implemented practice, showed a nine-fold improvement from 10 to 90% (P < 0.001). A sustenance audit conducted 6 months post-implementation showed that compliance rates maintained at 100% for criterion 1 (P < 0.001), with further improvement from 90 to 100% for criterion 2 (P < 0.001).
  
  
  CONCLUSIONS
  The proposed indwelling urinary catheter securement practice is an effective alternative to existing nursing practices. The use of a specifically designed securement device is found to complement and enhance the quality of urinary catheter securement. Nurses exhibited greater competency and knowledge in the application and care for urinary catheter securement.
authors.affiliation: aDepartment of Nursing bEvidence-Based Nursing Unit, National University Hospital cThe Singapore National University Hospital (NUH) Center for Evidence-Based Nursing: A Collaborating Center of the Joanna Briggs Institute dNational University Health System, Singapore.
authors.forename: Angela
authors.initials: A
authors.lastname: Shum
authors.forename: Kai Sim
authors.initials: KS
authors.lastname: Wong
authors.forename: Kalarani
authors.initials: K
authors.lastname: Sankaran
authors.forename: Mien Li
authors.initials: ML
authors.lastname: Goh
mesh_terms: D000328:Adult; D002408:Catheters, Indwelling; D055318:Evidence-Based Nursing; D006801:Humans; D007318:Inservice Training; D012846:Singapore; D013503:Surgery Department, Hospital; D053832:Surgical Tape; D014546:Urinary Catheterization / Q000295:instrumentation* / Q000379:methods / Q000451:nursing; D062885:Urinary Catheters