An Alternative to the Indwelling Foley Catheter in Incontinent Female Patients

Christine Tran, BA, BSN, RN, OCN® & Debra Rodrigue, MA, RN-BC, AOCNS® Memorial Sloan Kettering Cancer Center & Hunter-Bellevue School of Nursing

Significance/Background Methods What nursing staff and patients had to say... • Catheter-Associated Urinary Tract Infections (CAUTIs) • A quality improvement project examining PureWick® was are the most common type of healthcare-associated piloted on two inpatient units for one month “Small amount of infections • Nursing staff received education on criteria and proper urine noted on  Longer hospital stays usage before the launch  Decrease quality of life • Cost-Benefit analysis was completed to identify potential bed pad but  Mortality cost-savings “It’s the majority went into best  Increased hospital costs Cost-Benefit Analysis canister” ever!” • Decreasing number of indwelling catheters placed for Cost of not Cost of “convenience” in incontinent patients can decrease using using “We love Costs for a single patient use CAUTI rates PureWick® PureWick® it!”

• The literature shows a lack of effective urine collection Average Cost Per CAUTI $1,000 devices for incontinent females; default options are generally diapers Cost of indwelling catheter kit $ 13.64 “After repositioning Cost of incontinence bed pad $0.73 (x 6 per $ 4.38 the device it worked  Discomfort day/patient)  Moisture-associated skin injuries well [for this more Cost of PureWick® $11 (x 2 per day/patient) $22  Frequent bed pad changes complicated Suction canister (x 1 per day/patient) $ 1.53 patient]” Suction tubing (5 feet long) $0.29 • Although many external collection devices have been Total Cost to Organization $1,018.02 $ 23.82 Discussion developed for women throughout the last few years, it Potential Cost Savings $ 994.20 per patient • PureWick® provides an effective way to non-invasively has been a challenge to find a device that effectively collect and measure urine in incontinent females contains urine while avoiding damage to perineal skin without using diapers or indwelling catheters Data Collection and Analysis Purpose • Surveys were given to patients, nurses and patient care • In one month, $ 994.20 was potentially saved per Evaluate the PureWick® External Catheter as an technicians (PCT) to evaluate comfort, ease of use, skin patient by avoiding indwelling catheter placements and integrity and overall satisfaction CAUTIs alternative to the indwelling catheter in incontinent female patients 3 Foley catheters avoided • The PureWick® was piloted with 12 patients

Intervention Findings/Outcomes PureWick® External Catheter was piloted in incontinent, bed-bound female patients as an alternative to the Total potential cost savings in 1 month indwelling catheter $ 2,982.60

• Annually savings could exceed $35,000 Patient Outcomes Nurse/PCT Feedback • Findings show an increase in comfort, effective urine (N= 13) collection, absence of skin breakdown and overall 100% eligible patients satisfaction with product during one month pilot were satisfied No skin injuries/breakdown • External catheters such as PureWick® should be related to device considered for incontinent females instead of indwelling catheters 67% felt the device was comfortable 93% felt device was Patient population: easy to use Implications

Female, bedbound, incontinent of urine, post- Accurate urine collection. increased patient quality of life Output was able to be surgical/procedural immobility and increased patient satisfaction in incontinent females tracked on all patients 85% satisfied with the product is able to be accomplished without increased risk for Contraindicated/not recommended for patients with: CAUTIs Urinary retention, latex allergy, vaginal surgery/fistula, .08% patients had leakage menstruation, altered mental status, pre-existing skin 85% would use again for a patient breakdown on perineum, bowel incontinence (unless a fecal collection device is used), male patients