For some nurses, removing a catheter may mean they have to spend more time helping patients go to the bathroom, "and that means they don't have as much time for other patients," Krein says.
A second habit identified by survey responders is that catheters are initially placed, or not removed as soon as they could be, because patients or their family members request them, which surprised Krein and Saint. Patients and families request them perhaps because the patient is incontinent, or feels humiliated, she says.
"When family members requested it, it was usually a loved one who thought it might be painful for the patient to get out of bed."
The third "key culprit" is placing catheters that don't really need to be inserted. Krein says, it is emergency department staff who place them out of habit and convenience, and because they are busy, regardless of whether the patient really needs an indwelling catheter.
Survey responders complained that they were frustrated because so many patients were being admitted with them. "They'd say to the ED, 'Hey guys, we have these criteria to get rid of these devices, but you keep sending them to us, sometimes without orders.' "