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New England Section of the American Urological Association

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An Effective Foley Catheter Training Protocol for all Intern Residents
William J. Devan, MD, Brian Jumper, MD, Moritz Hansen, MD, Christina Gentile, MPH, Bethany Hundt, MA.
Maine Medical Center, South Portland, ME, USA.

BACKGROUND: Bladder catheterization by means of foley catheter is a simple, effective medical intervention when utilized appropriately. Unfortunately, incorrect or improper usage is problematic. Catheter associated urinary tract infections (CAUTI) are a leading cause of nosocomial infections (>30% of hospital acquired infections) and are associated with significant increases in patient morbidity and mortality as well as health care costs and hospital reimbursement. CAUTIs are associated with multiple catheterization attempts and poor technique which both stem from inadequate education. Given these reasons, Maine Medical Center had prior policies limiting foley catheter placement to properly trained nurses with an exception for urology and ob-gyn providers. There is also a lack of overall knowledge regarding foley catheterization. The Canadian Journal of Urology reports that 70% of foley catheter consults to an academic urology service did not need an adjunct device (wire, cystoscope, etc). The authors argue this creates higher costs to the healthcare system for poor appropriation of resources. Finally, a report from 2004 paper show approximately 50% of represented medical schools are not attaining the Association of American Medical College (AAMC) objective of rigorously teaching and evaluating technical procedures (including foley catheterization).Given these reasons, we developed a training program for foley catheterization for new intern residents.
METHODS: We obtained institution review board approval. We then created a training program that incorporated the following learning materials: instructional videos, educational infographic, reference powerpoint slides, multiple choice test, and an in-person simulation using a pelvic model scored via a 10-point rubric. All educational materials were available on an online learning system. We trained all incoming interns who started on July 1 2019. The training was considered mandatory for all incoming interns. For the data collection component, we offered incoming residents an optional electronic survey prior to commencing their catheter training and again another optional paper survey immediately following the completion of their simulation component. Surveys contained a Likert scale confidence score and four question objective test that was scored from 0-100%.
RESULTS: There were a total of 65 interns that participated in the foley catheter training. These 65 represented eight intern programs. 53 interns (response rate 81.5%) completed the pre-training survey and 60 interns (response rate 92.3%) completed the post-training survey. 94.2% of incoming residents reported some form of foley catheter training during medical school, but of these, only 34.7% had undergone formal simulation. Prior to our training 51.1% of respondents were confident in their ability to place a foley catheter and their objective test score was 50%. After our intervention there was a significant difference in pre and post training confidence levels and objective test scores, 3 (2-3) vs 4 (4-4.75) [Median (IQR)] p < 0.001 and 50% (50-75) vs 100% (100-100) p < 0.001 respectively. Mann-Whitney U test p-values reported.
CONCLUSIONS: Our data shows that interns are both lacking confidence and objective competence in placing foley catheters. We also demonstrate that our training protocol is a successful intervention by showing improvement in both metrics.


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