Government statistics show that in 2022-23, a little over 20,000 aged care residents (8 per cent) needed support for a catheter of some type – most likely a long-term indwelling urinary catheter, or IDC.
Although IDCs are potentially beneficial, many people experience complications such as infection, particularly if the IDC is used long-term.
A recent survey of aged care homes conducted by the National Ageing Research Institute for the Victorian Department of Health found the frequency of IDC-related complications in aged care homes was high.
The 28 managers reported residents with an IDC experienced the following problems on average once or twice a month:
- catheter leakage (39 per cent)
- catheter-related infection (29 per cent)
- catheter blockage (21 per cent)
- haematuria (18 per cent)
- admission to an emergency department for an IDC-related complication (7 per cent)
- unplanned/traumatic catheter removal (4 per cent)
- IDC-associated pain (4 per cent).
Delays in responding to these complications, particularly infection and blockage can have devastating effects on a person, increasing their risk of bacteraemia, sepsis, damage to the upper urinary tract and premature death. Because of these risks, guidelines recommend removing IDCs as soon as possible after insertion or managing long-term neurologic bladder dysfunction with intermittent catheterisation.
Almost all guidelines about IDCs fall short of providing support
However, these options are not always appropriate or feasible. Indeed, for some people, having an IDC is the only way to manage their bladder condition.
Research conducted by NARI found almost all guidelines about IDCs fall short of providing support. This is because they focus on short-term management and hence, offer inadequate guidance about the prevention and management of complications associated with long-term IDCs.
Moreover, the consultation NARI conducted with managers, aged care employees and residential-in-reach clinical staff points to a need to better support Australia’s aged care workforce to deliver evidence-based person-centred care for residents with IDCs.
If we were able to better support the aged care workforce with evidence-based and person-centred resources about the emotional and clinical aspects of IDCs, we may be able to improve the identification and management of IDC-related problems. This could in turn reduce avoidable transfers to hospitals and emergency departments, which would be a win-win for both providers and residents with an IDC.
The IDC-IMPROVE Project, led by NARI, is a nurse-led interdisciplinary research collaboration funded by the Medical Research Future Fund under the 2022 Clinician Researchers Initiative.
It represents a partnership between NARI, the Continence Foundation of Australia, the University of Melbourne, the University of South Australia, Central Queensland University, Flinders University, the University of Alberta, Darling Downs Hospital and Health Service, the Australian Prostate Centre, Austin Health, Regis Aged Care, the Australian Nursing and Midwifery Federation, the Continence Nurses Society Australia and the Australian and New Zealand Urological Nurses Society.
It is guided by a project advisory group of key stakeholders including aged care residents with IDCs, family carers of residents with IDCs, and aged care employees.
The aim of the project is to strengthen the capacity of the aged care workforce to identify, prevent and manage IDC-related problems. For nurses, this includes how to perform an uncomplicated routine catheter change onsite.
The project has two stages. Stage one involvedthe development and validation of an evidence-based intervention titled the IDC-IMPROVE Catheter Care Bundle. The bundle consists of:
- principles for person-centred catheter care
- a catheter care toolkit for managers/senior leaders
- a catheter care audit tool
- catheter care capabilities for nurses and personal care workers
- an evidence-to-practice support model
- an online course for registered and enrolled nurses about person-centred IDC care
- an online course for personal care workers about person-centred IDC care.
NARI has also partnered with the Continence Foundation of Australia to deliver site-based catheterisation skills workshops for nurses to develop and practice catheterisation skills in a safe environment.
Stage two of the project involves establishing the feasibility of implementing the IDC-IMPROVE Catheter Care Bundlein aged care homes in Australia though a multi-centre, facility-level cluster randomised controlled feasibility trial.
The bundle has to be acceptable, implementable, cost effective, scalable, and transferable across contexts
NARI is currently recruiting 24 aged care homes across Victoria, South Australia and Queensland to participate in the trial. Half the homes will receive all components of the bundle and half will act as controls and receive some elements at the end.
The project has four objectives:
- to determine the acceptability of the IDC-IMPROVE Catheter Care Bundle to key stakeholders in aged care homes
- to explore the fidelity of the implementation of the bundle
- to investigate the compatibility of the bundle with current aged care home catheter care practices, procedures and policies
- to explore the effects of the bundle on rates of IDC-related complications and on staff knowledge and confidence to provide person-centred IDC care.
Establishing the feasibility is important, particularly given the challenges providers are currently navigating. The bundle has to be acceptable, implementable, cost effective, scalable, and transferable across contexts.
It is designed to support providers to meet their responsibilities under the Aged Care Act when it comes to the emotional and clinical care of a person with an IDC: not only their responsibility to minimise and manage the physical risks of catheter-associated urinary tract infection and blockage, but also to uphold and protect the person’s emotional wellbeing, independence, dignity and quality of life.
If you or your provider wish to participate in the trial or would like to know more about the IDC-IMPROVE Project, please email j.ostaszkiewicz@nari.edu.au or idcimprove@nari.edu.au or call 03 9969 6500.
Dr Joan Ostaszkiewicz is program director at National Ageing Research Institute
Also contributing to this article: Professor Briony Dow, Associate Professor Frances Batchelor, Wendy Taylor, Elizabeth Watt, Dr Andrew Gilbert, Dr Jessica Cecil, Marie Vaughan, Caitlin Tay, Isabella Hall
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