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Research Letter | Less Is More

Medical Directive for Urinary Catheter Removal by Nurses on General Medical Wards

Jerome A. Leis, MD, MSc1,2,3,4; Carla Corpus, RN, CIC5; Armin Rahmani4; Barbara Catt, CIC5; Brian M. Wong, MD2,3,4; Sandra Callery, RN, MHSc, CIC5; Mary Vearncombe, MD5,6
[+] Author Affiliations
1Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
2Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
3Department of Medicine, University of Toronto, Toronto, Ontario, Canada
4Centre for Quality Improvement and Patient Safety, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
5Department of Microbiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
6Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
JAMA Intern Med. 2016;176(1):113-115. doi:10.1001/jamainternmed.2015.6319.
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Impacts of a Medical Directive for Urinary Catheter Removal by Nurses

Leaving a urinary catheter (UC) in place without indication has been identified as one of “Five Things Physicians and Patients Should Question” by the Society of Hospital Medicine and the Canadian Society of Internal Medicine.1,2 On a busy general medical (GM) ward, delays in reassessment of UCs can lead to catheter-associated urinary tract infection (CAUTI).3 Interventions aimed at physicians reduce unnecessary UC use,4 but empowering nurses to remove UCs through the use of medical directives remains an underused strategy.5

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A medical directive for nurses to remove urinary catheters among general medical patients lacking prespecified exclusion criteria, and provide postcatheter care.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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