Purpose: Medication errors remain a threat to patient safety. Therefore, the purpose of this study was to determine the relationships among characteristics of the nursing practice environment, nurse staffing levels, nurses’ error interception practices, and rates of non-intercepted medication errors in acute care hospitals. Summary: LTICs are used in patients of various ages, but are most frequently seen in older adults. LTICs are placed in patients due to a number of reasons such as urinary retention, incontinence, immobility and spinal cord injury. The body’s natural and main defense mechanism against UTIs occurs when voiding, and in the bladder’s wall where antibacterial activity arises. However, when an LTICs are present, the risk for UTIs increase due to reasons such as: exasperation due to catheter parts, pressure caused by the inflated balloon, residual urine in the bladder from the placement of the balloon, and the “ischemic damage to the bladder mucosa caused by bladder distention” (Muzzi-Bjornson & Macera, 2011).
Essentially, the body’s natural defense is altered, and thus this irritation increases the risk for UTIs. In addition, biofilm formation on the LTIC, also poses a risk for CAUTIs. Biofilm formation on a urinary catheter is a layer of microorganisms on the catheter surface. Ultimately, the longer duration (days) catheters remain in place, the risk of CAUTIs increases. A major problem associated with LTICs and urinary catheters in general, are their tendencies to block and possibly damage the urethra, resulting in an inflamed urinary mucosa. Thus, it is critical to take preventative measures to decrease the risk for CAUTIs for those using LTICs. For instance, these measures include: basic nursing care especially keeping a sterile environment, intake of cranberry juice or extract, use of appropriate catheter, antibiotics, and oral drug with deactivated/killed bacteria. Nursing Implications:
1. Despite the setting, whether the patient is at home or in the hospital, sterile conditions are vital. Perform hand hygiene and use aseptic technique upon insertion of indwelling catheter. 2. Assess catheters regularly to reduce infection. Keep in mind that catheters should be removed as soon as possible. Remember that the longer the catheters are in place, the greater risk of infections. Also, be aware of patient’s symptoms of CAUTI. 3. Ensure that the catheter is a closed drainage system, and secure the device in place. This will aid in reduction of bladder wall and lining irritation, reduce the patient’s pain, and promote good urine drainage into the collection bag. 4. Obtain urine sample with culture for patients on drug therapy, and monitor/maintain patient’s fluid intake. 5. If not contraindicated, follow orders and give patient cranberry juice and/or extract. Cranberry juice has been speculated to lower urinary pH levels, which impedes bacterial growth. 6. Strictly monitor patient if on prophylactic antibiotics; be aware of dangers/adverse effects.
Flynn, L. , Liang, Y. , Dickson, G. , Xie, M. , & Suh, D. (2012). Nurses’ practice environments, error interception practices, and inpatient medication errors. Journal of Nursing Scholarship, 44(2), 180-186.