Why Consent For Urinary Catheters Should Be Mandatory
By: John
H. Fisher
The presence of a urinary catheter is the single most important
risk factor for healthcare associated infections. A urinary catheter is
a hollow flexible tube inserted into the bladder to drain urine. This catheter
drains urine from your bladder into a bag outside your body. Common reasons
for a urinary catheter include urine leakage (incontinence), not able to
urinate, and surgery lasting more than three hours.
If you have a urinary catheter, germs can travel along the catheter and
cause an infection in your bladder or kidney. This is called a catheter-associated
urinary tract infection. The bacteria that cause the infection may enter
the bladder during the insertion of the urinary catheter or during manipulation
of the catheter.
Urinary catheters are the number one cause of hospital-acquired infections
Urinary catheter-associated infections are the most common hospital-acquired infection amounting to 23% of all healthcare associated infections. The presence of a urinary catheter is the most important risk factor for hospital-acquired infections. About 80% of hospital-acquired urinary tract infections are related to urinary catheters. A urinary tract infection can lead to kidney damage or kidney stones and bladder stones.
Since October 1, 2008, the Centers for Medicare and Medicaid
Services (“CMS”) refuse to pay for extra treatment relating
to catheter-associated urinary tract infections. The reasoning of the CMS
is that such catheter-associated infections are “reasonably preventable”.
Catheter-associated infections fall into the category of the federal government’s
list of “never events”, i.e., preventable medical conditions
caused by medical errors, including decubitus ulcers, injury due to fall
or trauma and a venous thromboembolic condition (blood clots in the deep
veins of the leg).
In order for a patient to undergo an operation or receive anesthesia, they
must sign a consent informing them of the benefits and complications associated
with the operation and anesthesia. The operation will not begin until the
patient signs the consent. Once the advantages and disadvantages of the
operation have been explained in writing and verbally with the patient,
the operation can begin.
Why is there no informed consent
for urinary catheters?
No such informed consent is required for urinary catheterization.
Despite the common use of urinary catheters and the well-known infection
risks associated with urinary catheters, patients are not asked to sign
a written consent that discloses the advantages and disadvantages of urinary
catheters. Rarely are patients informed verbally of the risks of urinary
catheters.
In 21 years of evaluating hospital care throughout New York, I have not
seen a single consent form for urinary catheters. Since patients with urinary
catheters have a much higher chance of getting a urinary tract infection
than those who do not have a catheter, the question must be posed: why is
there no informed consent for urinary catheters?
Do patients really give “implied consent”
to urinary catheterization?
Physicians will explain the patients give “implied
consent” to urinary catheterization based on the theory that urinary
catheterization is a common and routine part of hospital treatment. Understandably,
patients cannot be asked to give their written consent for the most basic
medical treatment, as this might flood hospitals with forms that make
the patients’ experience even more intimidating and confusing.
However, in this author’s opinion, urinary catheter infections pose
such a common and significant risk to patients that their consent
should be informed. In order for a patient to be catheterized,
it should be required that they give permission for the procedure. Once
given information about the risks and benefits of urinary catheterization,
the patient can make a fully informed decision whether they wish to accept
the risk.
What is the downside of consent for urinary catheterizations? A little
more paperwork for hospital nurses, but isn’t a fully informed patient
worth this minor sacrifice? Patients should be informed that urinary catheter
insertion involves the risk of infection and a specific consent relating
to the pluses and minuses of a urinary catheter should be signed by the
patient.
How Consent for Urinary Catheters can improve patient care
Patients should be informed about the risks of infection
associated with urinary catheters so they can take steps to prevent infection.
Patients, for example, can insist that nurses always clean their hands
before and during catheter care. Once patients are informed about the
reasons for catheterization and its risks, they can become much better
advocates for their medical care.
Patients should be informed that the duration of catheterization is strongly
associated with the risk of infection, i.e., the longer the catheter is
in place, the higher the incidence of urinary tract infection. With such
knowledge of the risks associated with prolonged urinary catheterization,
patients may opt for more limited use of urinary catheters in order to
reduce the risk of infection.
When weighing the benefits of informed consent for urinary catheterization
versus the cost of additional consent forms, the goal of patient education
regarding the high risk of infection associated with urinary infections
outweighs the minor inconvenience to the hospital nurses of an additional
consent form that must be signed.
What you can do if you want more information about urinary catheter infections
John H. Fisher is a medical malpractice attorney in New York and he is the author of the book, The Seven Deadly Mistakes of Malpractice Victims, a book dedicated to providing malpractice victims with the answers to the most common mistakes made in medical malpractice law. John offers his book free to the public through his website, www.protectingpatientrights.com. You can order a free copy of John’s book through his website or by calling 1-866-889-6882.