The Documentation of
Urethral Catheterisation
Are we Getting It Right?
S.Nandhra, J.Martson, E.Clapham,
G. Urwin, R.Wilson
Audit Aims and Objectives

To ensure correct and accurate documentation of
urethral catheterisation.

To enhance the care of catheterised patients by:


Encouraging consideration of the indication and the appropriate
infection control methods.
Good Documentation is fundamental in clinical care and
provides a legal record 1, 2, 4, 6

If it’s not documented it didn’t happen!!
Why is this audit important

Documentation of important information helps with diagnosis
and management 1




Infection control prevention:




Eg AUR with residual of 500ml vs 2000ml
Enables effective planning for TWOC 3
Allows communication between healthcare professionals
60% of healthcare acquired UTIs are related to catheter insertion 6
20% of patients with a catheter develop asymptomatic bacteriuria
and 2-6% symptomatic UTI. 4
Of which 1-4% develop a bacteraemia accounting for
approximately 1500 deaths annually in the UK. 5
Each hospital acquired UTI results in an increased length of
stay of 5-6 days, costing £1327 to treat. 4
Current guidance

Audit criteria based on approved guidance and recommendations
from the Royal College of Nursing1, NHS Quality Improvement
Scotland4 and the Department of Health6


Recommendations were used to create specific items of necessary
documentation.
Our end aim was to achieve 90% of the criteria completed for each
catheter.
Our Proforma

15 specific items that included
 Patient demographics
 Indication for catheterisation and specifics about the process
 Urine observations including residual
 The type of catheter
Data Collection

3 sessions of data collection during January 2011
 Both medical and nursing notes reviewed

Range of wards included surgical and medical

Catheters inserted in theatre were excluded

Catheter inserted by investigators were excluded

In total a data set of n=51 results were collected during the first
cycle of the audit
Documentation Results
Criteria

3/5ths had both the date
and time documented
Date

Alarmingly no
documentation at all in
1/3
Time
Name
Role

90%
In roughly half of the pts
the healthcare
professional was not
identifiable.
No
docume
ntation
at all
Yes
No
65%
35%
Yes
No
63%
37%
Yes
No
51%
49%
Doct
or
Nurs
e
Othe
r
Not
State
d
24%
29%
2%
45%
29%
NO
NO
NO
NO
Documentation Results

98% had no allergy
status documented.
Criteria
Allergies

One latex allergic patient
had a latex catheter in
situ.
Consent
Draining
Urine

Just over a tenth of pts
had consent
documented.
Difficulty
>90%
Yes
No
2%
98%
Yes
No
12%
88%
Yes
No
55%
45%
Easy
Difficu
lt
Not
State
d
33%
2%
65%
NO
NO
NO
NO
Documentation Results
Criteria


61% did not have a
volume recorded.
(interestingly the majority
being from the AUR
group).
Over half had no
documentation at all
Volume
Appearance
Dipstick
Specimen
Sent

In total only 2% of
catheters have >90%
documentation (out of
the 15 items needed)
No
Documentatio
n at All
> 90%
Yes
No
39%
61%
Yes
No
27%
73%
Yes
No
16%
84%
Yes
No
18%
82%
53%
NO
NO
NO
NO
How does York compare?

Tempest et al, 20052 (USA):
 Only 3% full documentation without stickers
 Rose to 84% with stickers at re-audit

Bhardwaj et al (2010)5 (Newcatle, UK):
 89% with some written documentation

Brennan & Evans (2001)8:
 No documentation in 19.6%

Bray & Sanders (2007)9 London:
 (Paediatric) Unable to identify duration of catheterisation in 13%

Conybeare et al (2002)7 Boston, lincolnshire:
 Indication not documented for any patient
 Only 25% documented in medical notes
Urethral Catheter Insertion Documentation
Implementation

Posters for awareness

Matron/ward manager

Infection control
Date:
Time:
.
Consent: Yes/emergency/incapacitated
Indication:
.
Aseptic Technique: Yes/No
Ease of insertion: Easy/resistance/hard
Attempts:
.
Latex Allergy: Yes/No
Urine Draining: Yes/No
Colour: Clear/Haematuria/cloudy
Volume of residual:
mls
Catheter: (affix catheter sticker here)
Size: 12Ch/16Ch/22Ch
Type: 2-way/3-way
Duration: Long T/Short T
Balloon Vol:
mls
Dipstick requested: Yes/No
Dipstick result:
CSU requested: Yes/No
Name:
Designation:
.
.
.
Re-audit Documentation
Criteria
>90%
Criteria
Allergies
Date
Yes
No
100%
0%
Name
Role
Yes
No
100%
0%
Yes
No
100%
0%
Doctor
Nurse
79%
No
docum
entatio
n
0%
21%
Yes
No
93%
7%
Yes
No
93%
7%
Yes
No
100%
0%
Easy
Difficu
lt
Not
State
d
79%
14%
7%
Yes
Yes
Consent
Time
>90%
Yes
Yes
Other
0%
Indication
Difficulty
Not
Stated
0%
Yes
Yes
Yes
Yes
Documentation – urine
observations

Volume – improvement
but not >90%

However this is most useful in
AUR where it was completed in
the majority of cases.

Dipstick and MSU now
being requested where
indicated.
Criteria
Volume
Appearance
Dipstick
Specimen Sent
No
Documentatio
n at All
> 90%
Yes
No
79%
21%
Yes
No
93%
7%
Yes
No
79%
21%
Yes
No
79%
21%
0%
NO
Yes
NO
NO
Conclusions

Successful implementation with excellent uptake




Positive feedback from the nursing and medical staff.
Not felt to add to work load or burden.
Massive increase in compliance in all categories -High proportion
100% compliance
Most >90% standard compliance met
Outcome

York Teaching hospital Trust-wide implementation


Successful integration into the surgical directorate
Rolled out across the trust – awaiting printers
Thank you

Any Questions?
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
Royal College of Nursing (2008). Catheter Care. RCN guidance for nurses.
Tempest HV, Kumar N, Rucker J, Knight A, Saleemi A (2005). An Audit Investigating
Documentation of Hospital Urethral Catheterisation and the Improvement Using
Proforma Stickers. Clinical Governance: An Internation Journal. 10(2) p 165-167
Nazarko L (2009). Providing Effective Evidence Based Catheter Management. British
Journal of Nursing. 18(7) p S4-S12
NHS Quality Improvement Scotland (2004). Best Practice Statement – Urinary
Catheterisation and Catheter Care. www.nhshealthquality.org, Edinburgh.
Bhardwaj R, Pickard R, Rees J (2010). Documented Adherence to Standards and
Guidelines: An Audit. British Journal of Nursing. 19(18) p S26-S30
Department of Health (2007). Saving Lives. High Impact Intervention No 6. Urinary
Catheter Care Bundle.
Conybeare A, Pathak S, Imman I (2002). The Quality of Hospital Records of Urethral
Catheterisation. Ann R Coll Surg Engl. 84 p 109-110.
Brennan ML, Evans A (2001). Why catheterise? Audit findings on the use of urinary
catheters. British Journal of Nursing. 10(9) p 580-590
Bray L, Sanders C (2007). Urethral catheter audit. Paediatric Nursing. 19(3) p 14-16.