Dr Karen McNeil

Introduction The aim of this project was to develop and implement an innovative nurse-led model of care in the use and management of indwelling urinary catheters (IUC) utilising evidence-based 'bundle interventions' to reduce the incidence of catheter-associated urinary tract infections (CAUTI). Design and method A pre and post intervention study designed to progress in three phases was conducted in the orthopaedic ward and urology ward of a large tertiary referral facility. Phase one involved a clinical data collection pre intervention on all inpatients receiving an IUC over a 3-month period from February to April 2013. A staff survey assessed knowledge and skills and an evidence-based care bundle, nurse-led protocols, and education resources were developed through collaboration with clinicians. Phase two involved implementation and Phase three was an evaluation with the primary outcome targets being reduced IUC usage, days IUC in situ and incidence of CAUTI. Results Pre audit data revealed a high rate of IUC use: 31% of all inpatients in the orthopaedic ward and 25% in the urology ward. Compliance with current guidelines was inconsistent and documentation related to IUCs was poor. Overall CAUTI rate was relatively low at 2.2% of all patients with an IUC and was higher in the orthopaedic ward. Conclusion The development of a systematic and standardised approach to IUC care for inpatients using bundle care interventions will potentially reduce IUC use, provide a clear pathway for nurse-initiated IUC removal and reduce the incidence of catheter-associated urinary tract infections (CAUTI).

Aim: To describe the research protocol that will be used to investigate factors contributing to effective interprofessional practice in a rural context in Australia. Background: Interprofessional practice is a key strategy for overcoming rural health challenges; however, our knowledge of interprofessional initiatives and consequences in rural areas is limited. Design: A modified realistic evaluation approach will be used to explore the structures, systems, and social processes contributing to effective interprofessional outcomes. This 'context-mechanism-outcome' approach provides a useful framework for identifying why and how interprofessional practice works in rural contexts. Method: Initial propositions regarding the factors that explain effective collaborative practice will be generated through interviews with lead clinicians, policy-makers, and clinician managers. Clinician interviews, document analysis, and multi-participant focus groups will be used as evidence to support, refine, or redevelop the initial propositions. This will allow the development of a model of rural interprofessional practice that will explain how and why collaborative approaches work in rural environments. This study is funded by an Institute of Rural Clinical Services and Teaching grant (January 2010). Discussion: Rural healthcare challenges are well documented; however, studies investigating the nature of interprofessional practice in rural contexts are not common. Rural contexts also present research design, particularly data collection, challenges. This proposed research is one of the first to identify the factors that facilitate or constrain effective interprofessional work in rural settings. This is particularly important, given the continuing workforce shortages and maldistribution and poorer health outcomes in rural communities globally. © 2013 Blackwell Publishing Ltd.