The researchers suggest that systems that seem to work elsewhere involve programs that impose an automatic reminder either on the electronic medical record or through some other mechanism, requiring a physician, physician's assistant or registered nurse to check daily on whether the catheter is still required.
Also effective are "stop orders," in which the order for a catheter expires in the same fashion as an order for restraints in a patient with behavioral issues or antibiotics in a patient with an infection.
"Stop orders directed at physicians required an order to renew or discontinue the catheter on the basis of review at specific intervals, such as every 24 to 72 hours or on specific post-procedure days," the report said. Stop orders directed at nurses might empower nurses to remove the catheter on the basis of indications without requiring the nurse to first obtain a physician-signed order.
"Overall, decreased catheter use was reported in all 11 studies publishing at least one outcome of catheter use, with 8 studies revealing a statistically significant decrease between non-intervention groups and the first post-intervention measure."
The authors wrote that they "hope that our results will encourage more hospitals to adopt reminders or stop orders as low-cost interventions that enhance patient safety."