“Oh CRUDD!” Student-Developed, Novel, Evidence-Based Acronym for Urinary Catheter Assessment

Presenter(s)

Cynthia Purcell, Emma Kramer

Abstract or Description

“Oh CRUDD!” Student-Developed Novel, Evidence-Based Acronym for Urinary Catheter Assessment

PURPOSE

The purpose of this quality improvement project was to develop an evidenced-based tool for use at the bedside when assessing indwelling urinary catheters. Long-term goals associated with tool development include increased nursing knowledge of the key components of assessment, reduced urinary catheter-related infection rates, and improved documentation of urinary catheter assessment on a surgical care unit.

BACKGROUND

Catheter-related urinary tract infections (CAUTIs) are the fourth most common hospital-acquired infection. CAUTIs pose a significant patient safety issue leading not only to thousands of dollars in increased hospital costs but also increase the risk of complications such as bacteremia, renal damage, and death. Infection prevention practices can prevent up to 69% of CAUTIs. Nurses are responsible for accurate and ongoing assessment of urinary catheters to prevent CAUTIs.

CAUTI bundles have become standard of care in hospitals; however, these bundles lack a standardized, evidence-based tool for nursing assessment of urinary catheters. Forms and flowsheets for documentation of the elements of catheter assessment are contained in electronic medical records systems, but at the bedside, there is not a system by which to remember these elements of assessment.

An undergraduate nursing student performed a random survey of nurses and staff members of a surgical care unit with the highest rate of CAUTIs in the facility. Seven of the 12 staff members surveyed stated that they use an acronym tool (“I-TRACE”) developed for use with intravenous lines and pumps to assess urinary catheters. None of the staff surveyed could recall all elements of assessment or documentation for urinary catheters.

METHODOLGY

A quality improvement project was undertaken to create a tool for use during in-dwelling urinary catheter assessment. Deming’s Model for Improvement and the FOCUS-PDSA process served as the means to implement use and measure impact of the tool. A review of the literature demonstrated a lack of bedside urinary catheter assessment tools. Evidence-based interventions provided key elements of urinary catheter assessment which have been shown to have some impact on reducing CAUTIs.

Using these key elements, the novel and memorable mnemonic & acronym "Oh CRUDD" was developed. Elements of the "Oh, CRUDD" acronym are reminders of: securement device placement on the thigh (Oh), tubing clipped to the sheets (C), red-seal intact (R), assessment of urine volume, color, and consistency (U), dependent loops (D), and date of insertion documented on the collection bag (D). The acronym itself is memorable as a mnemonic tool with as the word “crud” is synonymous with “filth”, “muck” and “grime” which could be associated with sources of infectious bacteria.

RESULTS

The use of mnemonics and acronyms as aids for patient safety in healthcare is well-established. Extensive literature and internet search failed to show any use of the "Oh CRUDD" mnemonic/acronym, or any mnemonic/acronym developed specifically for use in urinary catheter assessment. Implementation of the use of the Oh CRUDD mnemonic/acronym is pending, and research is needed. Increased knowledge of the key elements of urinary catheter assessment, improved documentation, and decreased rate of CAUTIs for this unit are the goals.

CONCLUSIONS AND RECOMMENDATIONS

Research on implementation and effectiveness of the "Oh CRUDD" mnemonic/acronym is needed. Initial steps in the implementation and use of the acronym would be active and passive education of nursing and unlicensed patient care assistants (PCAs). Visual aids such as small posters could be used as passive education in high traffic staff areas to convey the elements of the acronym. Active education could include an explanation of the mnemonic/acronym to nurses and PCA’s during shift-change huddles and distribution of “badge buddy” reference cards to nurses and PCAs which attach to the facility ID badge worn with the uniform. Finally, research on the impact of the "Oh CRUDD" mnemonic/acronym on CAUTI rates, nursing knowledge and patient care documentation is needed. This simple, easy to remember mnemonic/acronym could be an effective tool in the CAUTI bundles for patient safety and improved outcomes.

REFERENCES

1.     Gaughan, A. A., MacEwan, S. R., Gregory, M. E., Eramo, J. L., Rush, L. J., Hebert, C. L., & McAlearney, A. S. (2024). When infections are found: A qualitative study characterizing best management practices for central line-associated bloodstream infection and catheter-associated urinary tract infection performance monitoring and feedback. Nursing Reports, 14(2), 1058–1066. https://doi.org/10.3390/nursrep14020080

2.     Toolkit for Reducing Catheter-Associated Urinary Tract Infections in Hospital Units: Implementation Guide. Content last reviewed October 2020. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/hai/cauti-tools/impl-guide/index.html 

3.     Patel, P. K., Advani, S. D., Kofman, A. D., Lo, E., Maragakis, L. L., Pegues, D. A., … Meddings, J. (2023). Strategies to prevent catheter-associated urinary tract infections in acute-care hospitals: 2022 Update. Infection Control & Hospital Epidemiology, 44(8), 1209–1231. doi:10.1017/ice.2023.137

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