A/Prof. Stephane Bouchoucha1,3, Adjunct Prof. Bernice Redley1, Ms. Ebony Andersen1, Prof. Helen Rawson2
1Deakin University – QPS in the Institute for Health Transformation, Melbourne, Australia, 2Monash University, Melbourne, Australia, 3Manipal Academy of Higher Education (MAHE), Manipal, India
Biography:
Stéphane is an Associate Professor in Nursing and Associate Head of School (International) in the School of Nursing and Midwifery at Deakin University. Stéphane has over 20 years experience in the clinical setting and facilitating the learning of both undergraduate and post-graduate nursing and midwifery students in Australia, Hong Kong, the UK and Singapore. Stéphane research program has a focus on Infection Prevention and Control.
Abstract:
Introduction
Catheters associated urinary tract infections (CAUTIs) cause preventable harm to patients. The Emergency Department (ED) is a setting where indwelling catheters (IDC) are commonly inserted. Documentation is a key aspect of prevention, with guidelines recommending documentation of the insertion indication and regular reviews of necessity. The aim was to explore healthcare professionals’ documentation practices for management of IDCs in situ on presenting to the ED, or inserted in the ED and in wards where patients were discharged. In addition, documented practices were compared to best evidence guidelines, and local organisation guidelines, policies and procedures.
Methods
A quantitative descriptive study design was used to perform a retrospective review of 100 EMRs of patients treated in the ED with an IDC.
Results
4640 records were screened to identify a sample of 100 patients. Overall, 81% had an IDC inserted in the ED. 26% were diagnosed with CAUTI with the most frequent pathogen E. coli. 73% of patients received antibiotics: 95% treated with IV antibiotics, and 56% oral post IV administration. An antimicrobial stewardship review was completed for 40% resulting in antibiotics changes for 23%. Discrepancies, inconsistencies, duplication, and gaps were uncovered in clinicians’ documentation about the care and management of the IDC in the ED, and subsequent care in the inpatient wards.
Conclusion
CAUTI was frequent and clinical practices inconsistent with best-evidence. Poor documentation practices contributed to poor CAUTI identification and management. Essential actions are required to optimise EMR system to support comprehensive documentation that could assist in reducing CAUTI prevalence.