Use of urinary collection devices in skilled nursing facilities in five states

OBJECTIVES: To assess use of urinary collection devices (external, intermittent, and indwelling catheters; pads or briefs) and examine predictors of indwelling catheters in skilled nursing facilities (SNFs). DESIGN: Retrospective cohort study. SETTING: SNFs in California, Florida, Michigan, New York, and Texas. PARTICIPANTS: All patients admitted to SNFs in 2003 who remained there for 1 year (N=57,302). MEASUREMENTS: Characteristics of patients who used different collection strategies (indwelling, intermittent, and external catheterization; pads or briefs) and predictors of indwelling urinary catheterization from the Nursing Home Minimum Data Set using multinomial logistic regression. RESULTS: The prevalence of indwelling catheterization was 12.6% at admission and 4.5% at the annual assessment (P <.001). Intermittent and external catheterization were infrequently used (< 1% at admission and annual assessment). Paraplegia, quadriplegia, multiple sclerosis, and comatose state were strongly associated with indwelling catheterization. Male residents were more likely to use an indwelling catheter at every assessment, as were obese patients; individuals with diabetes mellitus, renal failure, skin conditions, deep vein thrombosis, aphasia, or end-stage disease; and those who were taking more medications. CONCLUSION: Coinciding with federal regulations, urinary catheterization was lower than has been reported previously and declined over time. Further reduction should be targeted at the evaluation of skin problems, appropriateness of multiple medications, and alternative measures in patients with diabetes mellitus, obesity, deep vein thrombosis, and communication problems.