A quality improvement project to reduce the complications associated with indwelling urinary catheters.

The indwelling urinary (Foley) catheter is a widely utilized device in the modern hospital environment in the United States. Under certain established medical conditions, these devices serve as a valuable tool in patient care. However, many indwelling urinary catheters are either placed inappropriately or are left in place longer than their intended use. This article describes a quality improvement project undertaken at the University of North Carolina Healthcare, Memorial Hospital, 8 Bed Tower Nursing Unit that developed and implemented a nurse-driven protocol to manage some of the risks associated with the use of these devices. The hospital team involved in this project was able to decrease the overall prevalence of indwelling urinary catheters from 24% to 17%.

Managing hyperglycemia in hospitalized patients.

Insulin infusion is used in the critical care setting for prevention of hyperglycemia and is administered most safely under a structured, dynamic, dose-defining algorithm. The ordering of basal-prandial-correction SC insulin therapy, appropriate for most hospitalized patients who are eating, is simplified and standardized to excellence by the development of institutional order sets or computerized order entry templates. Basal insulin therapy is prescribed as intermediate-acting insulin or long-acting insulin analogue. Prandial insulin therapy is delivered with meals to prevent excessive glycemic excursions from occurring after ingestion of meals and is prescribed as rapid-acting insulin analogue. Correction-dose insulin therapy is ordered as small doses of rapid-acting insulin analogue delivered to correct hyperglycemia and is prescribed with appropriate timing so as to avoid stacking with previously administered doses of rapid-acting insulin analogue. Patients knowledgeable in diabetes self-management will experience satisfaction under an institutional policy that allows self-management to continue under appropriate conditions during hospitalization. To craft appropriate institutional tools for patient care, the input and consensus of a multidisciplinary group of health care professionals, including primary care providers and hospitalists, as well as specialists in diabetes with backgrounds in endocrinology, nutrition and dietetics, nursing, pharmacy, laboratory sciences, and quality assurance, is required.