Letter to the Editor by John Michael Harris to “Electronic Health Record: Evidence-Based Catheter-Associated Urinary Tract Infections Care Practices”

Patient Safety: Who Guards the Patient?

October 30, 2014

Response by John Michael Harris to “Electronic Health Record: Evidence-Based Catheter-Associated Urinary Tract Infections Care Practices” by Lois Weldon, MSN, RN (August 6, 2013)

With Reply from Author

Dear Editor:

I would like to thank Ms. Lois M. Weldon for the informative article on “Electronic Health Record: Evidence-Based Catheter-Associated Urinary Tract Infections Care Practices” (2013). The article supports practices that are now a standard of care in the unit in which I work, such as clinical decisions for catheter insertion and recognition for the duration of catheter placement. 

As a nurse of 7 years, I have witnessed several patients that acquired urinary tract infections related to lengthy catheter usage. Wanting to make a difference, the unit practice council examined ways to decrease the number of catheter related hospital acquired infections in the unit. In the beginning, the focus gravitated toward the equipment utilized along with various technological advances with catheter coatings and techniques of insertion. The unit trialed different catheter products and provided in-services on proper foley catheter insertion to the staff. The unit practice council noted the staff responded positively to the in-services on catheter insertion. Over time a decrease in unit infection rates was noted. 

Presently, federal reimbursement policies are driving many evidence-based practices in healthcare.  While performing joint commission audits, the practice committee noted a lack of proper care documentation with regards to urinary catheter insertion. Not obtaining proper documentation places the facility at risk for failing to administer proper care to patients. To comply with federal standards, the practice committee utilized the electronic records system to ensure proper documentation of this procedure.  The practice committee examined ways to assess the need for catheter insertion along with the continued use of catheters.  Like Weldon, the practice committee worked with the information and technologies department to develop appropriate methods of documentation that demonstrated appropriate care. Assessment tabs were added to the electronic health record (EHR) system, allowing the nurse to select from a list of appropriate criteria.  The selection process provided supportive reasoning for catheter insertion. Only then could the nurse advance to the next screen.  This method of selecting appropriate criteria was carried over to the continuation of catheter therapy.  Selecting from a menu of criteria educated the nurse on what criteria were required to implement catheter insertion as well criteria for continued use catheter therapy. Feedback given in staff meetings was positive and infection rates decreased even further.

Since the practice committee examined ways to decrease catheter associated urinary tract infections, a shift in practice occurred.  The insertion of catheters into patients has decreased, along with the duration of catheter usage where applicable. Utilizing information within the EHR proved to be useful in educating the nurse about criteria for catheter insertion and duration to decrease the instance of urinary tract infection. I hope to continue to be part of more positive changes within the unit as well throughout my career as a nurse.


John Michael Harris
2213 Camellia Drive
Wilmington, N.C. 28403