Nurse-Led Evidence-Based Quality Improvement Programme to Reduce Urinary Leakage in Intensive Care Unit Patients with Urinary catheters: A Pre-Post Quasi-Experimental Study.

Background: Indwelling urinary catheters are commonly used in intensive care units. Urinary leakage around catheters may occur in critically ill patients because of mechanical ventilation, sedation and analgesia, constipation, increased intra abdominal pressure, bladder spasm, and altered consciousness. Nurses require adequate knowledge and skills to prevent and manage urinary leakage. Aim: This study aimed to reduce urinary leakage among ICU patients by developing and implementing a nurse led, evidence based Urinary Leakage Bundle. Methods: The Evidence-based Continuous Quality Improvement framework and the Promoting Action on Research Implementation in Health Services framework were used to guide the development, implementation, and evaluation of the Urinary Leakage Bundle. A quasi-experimental study was conducted in a 20-bed comprehensive intensive care unit, with outcomes including the patient urinary leakage rate, nurses' knowledge, attitudes, and practices related to urinary leakage, and nurses' adherence to the bundle interventions. Interventions: To support the translation of evidence into clinical practice, a multidisciplinary nursing group appraised and selected the evidence and developed the Urinary Leakage Bundle. The protocol included leakage prevention strategies, clinical management flowcharts, efficacy evaluation and quality control to support implementation in routine care. Results: The intervention improved ICU nurses' questionnaire scores for knowledge, attitudes, and practice, increasing from 3.36±0.31 at baseline to 4.40±0.31 after implementation. The urinary leakage rate decreased from 25.4% before implementation to 13.3% after implementation. Adherence to the Urinary Leakage Bundle also increased, with better compliance in key elements such as catheter selection, catheter securement, and management of catheter bypassing. Conclusion: The nurse led, evidence based Urinary Leakage Bundle was feasible in routine ICU care and was associated with improved nurses' knowledge, attitudes, and practices, higher adherence to care processes, and a lower urinary leakage rate. Relevance to Clinical Practice: The reductions in urinary leakage and the improved nurse adherence to evidence based interventions suggest that the Urinary Leakage Bundle can be implemented effectively in other clinical settings.