| Summary: | 碩士 === 國立成功大學 === 護理學系碩博士班 === 101 === SUMMARY
Inappropriate use of indwelling urinary catheters (IUCs) and their related complications is one of the most important problems in hospitals. The aim of this study was to explore the risk factors and clinical outcomes for initiation of inappropriate urinary catheterization among hospitalized elderly in Southern Taiwan from October 29, 2012 to May 19, 2013. A total of one hundred and fifteen hospitalized elderly who used indwelling urinary catheters during 48 hours after admission were recruited. We reviewed the chart, interviewed the patient, and assessed the need for the urinary catheter daily until the patient was discharged. Data collected included demographic characteristics, co-morbidity, urinary tract infection, urinary incontinence, cognitive function, depression, activities of daily living, unit of catheterization, bed rest order, time of catheters placement, age of caregiver as well as outcomes including catheter-associated urinary tract infection, length of hospital stay, nursing home admission, mortality, and catheters reinsertion. The result indicated that the incidence rate of inappropriate use of IUCs was 37.4%. The diagnosis of urinary tract infection (OR=7.75, p=.005), lower scores of SPMSQ (OR=0.77, p=.02), and higher Katz ADL scores (OR=1.17, p=.012) were risk factors associated with inappropriate indwelling urinary catheterization. Inappropriate catheterized patients also had a poor recovery in activities of daily living at discharge (6.72 vs. 2.44, p〈.001). These findings can be provided to clinical care providers and improve the incidence rate of inappropriate catheterization. Education about appropriate indications for indwelling urinary catheters also should be available.
INTRODUCTION
There is approximately 73% of catheterized inpatients are elderly, of which up to 33%–49% are improperly used (Hazelett et al., 2006; Hampton, 2006). Indwelling of urinary catheters is not only associated with prolonged length of hospital stay, increased cost of treatment, but also associates with increased mortality rate, and causes of other complications (Holroyd-Leduc et al., 2007; Inelmen et al., 2007). Therefore, the purpose of this study is to explore the risk factors for inappropriate use of indwelling urinary catheters (IUCs) and determine the association between inappropriate catheters use and outcomes. Furthermore, the incidence rate of inappropriate use of IUCs and the reasons for indwelling urinary catheters use were also explored.
MATERIALS AND MATHODS
The subjects were selected with a purposive sampling method at a medical center in Southern Taiwan. A prospective study was conducted to collect data from hospitalized elders who used IUCs within 48 hours after admission. One hundred and fifteen patients were recruited. Data was collected including: demographic variables, Charlson Comorbidity Index, Katz Index of Independence in Activities of Daily Living, Geriatric Depression Scale Short–Form, Short Portable Mental Status Questionnaire, and information of IUCs placement. The outcomes associated medical care was collected at discharge. SPSS software for windows version 19.0 was applied to analyze the data through descriptive statistic, chi-square, t-test, and binary logistic regression analyses.
RESULTS AND DISCUSSION
The results indicated that the incidence rate of inappropriate use of IUCs was 37.4%. The most frequent indication for catheterization was surgical intervention (43.1%), the second most frequent indication was accurate assessment of urinary output (37.5%). The most common reasons that inappropriate IUCs use was for convenience (62.8%), and used for manage acute urinary retention without assessment (18.6%).
The findings of logistic regression analysis suggested that the diagnosis of urinary tract infection (OR=7.75, 95%CI=1.84-32.73, p=.005), lower scores of SPMSQ (cognitive function) (OR=0.77, 95%CI=0.62-0.96, p=.02), and higher Katz scores (activities of daily living) (OR=1.17, 95%CI=1.04-1.33, p=.012) were risk factors associated with inappropriate IUCs use among hospitalized elderly. Inappropriate catheterized patients also had a poor recovery in activities of daily living at discharge (Figure 1), but were not associated with such outcomes as catheter- associated urinary tract infection, length of hospital stay, nursing home admission, mortality, and catheters reinsertion.
CONCLUSION
Urinary catheters were inappropriately used more commonly among the diagnosis of urinary tract infection, poor cognitive function, and better activities of daily living status in older patients. Careful attention to this aspect of medical care may increase the degree of recovery in activities of daily living at discharge.
Given the significance of these results can help identify groups at increased risk for inappropriate urinary catheters placement. Multiple approaches are needed to reduce inappropriate utilization, including avoiding the placement of unnecessary urinary catheters and education about appropriate indications for indwelling urinary catheters.
ACKNOWLEDGMENTS
The author would like to acknowledge the patients who made this study possible, and thank Prof. Ching-Huey Chen, Fang-Wen Hu, and Dr. Chia-Ming Chang for their help with the design and coordination of this study.
REFERENCES
Hampton, T. (2006). Urinary catheter use often “inappropriate” in hospitalized elderly patients. Journal of the American Medical Association, 295(24), 28–38.
Hazelett, S. E., Tsai, M., Gareri, M., ＆ Allen, K. (2006, October 12). The association between indwelling urinary catheter use in the elderly and urinary tract infection in acute care. BioMed Central Geriatrics, 6(15). Retrieved February 22, 2012, from http://www.biomedcentral.com/1471-2318/6/15
Holroyd-Leduc, J. M., Sen, S., Bertenthal, D., Sands, L. P., Palmer, R. M., Kresevic, D. M., …Landefeld, S. (2007). The relationship of indwelling urinary catheters to death, length of hospital stay, functional decline, and nursing home admission in hospitalized older medical patients. Journal of American Geriatrics society, 55(2), 227–233.
Inelmen, E. M., Sergi, G., ＆ Enzi, G. (2007). When are indwelling urinary catheters appropriate in elderly patients? Geriatrics, 62(10), 18–22.
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