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Aarnes L, Harris K, Skare ÅI, Andersen JR.2016. Guideline compliance related to indwelling urinary catheters in 34 Norwegian nursing homes - findings and implications. PeerJ Preprints4:e1820v2https://doi.org/10.7287/peerj.preprints.1820v2
Background For patients in health institutions urinary tract infections often have significant negative health consequences. Indwelling urinary catheters and inappropriate practice related to this is a strong risk factor for urinary tract infections. Thus, a national guideline promotes best practice for handling indwelling urinary catheters. The aim of this study was to assess the prevalence of patients with indwelling urinary catheters in 34 Norwegian nursing homes. Furthermore, we wanted to study whether health professionals followed the national guidelines related to indwelling urinary catheters. If the study reveals room for improvements, it may indicate interventions which can contribute to improvements in the health care institutions. Methods We conducted a quantitative survey in health care professionals who worked in nursing homes in from Sogn og Fjordane county (Norway), and asked them to which extent guidelines related to indwelling urinary catheters were used at their work place. The study also included data on the prevalence of indwelling urinary catheters in 830 patients (565 women and 265 men) in the 34 nursing homes. We also conducted a clinical audit in these nursing homes in order to study the how the guidelines were implemented. An overall assessment was made (satisfactory or not satisfactory) on whether 11 dimensions of the guidelines were followed (Table 2). When ≥ 80% of the nursing homes had a score = yes/usually to the items above it was considered satisfactory. The evaluations from the clinical audits were based on an overall judgment of the finding at the nursing homes. The study was approved by the Western Norway Hospital Trust as part of a quality assessment strategy. An approval from the regional ethical committee was not needed as the study was a quality assessment project and did not include any individual patient data. Results Our findings shows that 92 of 830 patients had a indwelling urinary catheter the day of prevalence assessment, and significantly more men (21.1%) than women (6.7%) had a indwelling urinary catheter (Fisher's exact test; P <0.001. Overall, the survey showed that compliance with the guidelines was unsatisfactory with one exception; the doctor prescribed the posting of indwelling urinary catheters (Table 2 and 3). Conclusions In conclusion, most areas we investigated need improvements. The survey itself may be a key to change the nursing staff`s attitudes and culture and to gain increased competence. In addition, it seems necessary to have good data solutions as well as leadership anchoring in further work on implementing best practice in handling indwelling urinary catheters.
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Report in Norwegian
This a report written in Norwegian about this project.