Vital to quality improvement is measurement, and this applies specifically to implementation of interventions. The chosen measures will help to determine whether an impact is being made (primary outcome), whether the intervention is actually being carried out (process measures), and whether any unintended consequences ensue (balancing measures).
Below are some recommended measures to use, as appropriate, to track your progress. In selecting your measures, consider the following:
- Whenever possible, use measures you are already collecting for other programs.
- Evaluate your choice of measures in terms of the usefulness of the final results and the resources required to obtain them; try to maximize the former while minimizing the latter.
- Try to include both process and outcome measures in your measurement scheme.
- You may use different measures or modify the measures described below to make them more appropriate and/or useful to your particular setting. However, be aware that modifying measures may limit the comparability of your results to others'.
- Posting your measure results within your hospital is a great way to keep your teams motivated and aware of progress. Try to include measures that your team will find meaningful and exciting (IHI, 2011).
For more information on measuring for improvement contact the Canadian Patient Safety Institute Central Measurement Team at
1. Rate of UTI
- Rate of non-CAUTI (CDC 2016)
- Rate of CAUTI (CDC 2016, Gould et al, 2010, APIC 2014)
- CAUTI per 1000 patient days
- CAUTI per 1000 catheter days
2. Rate of Bloodstream Infections (BSI) Secondary to CAUTI (Gould et al, 2010)
- BSI per 1000 patient days
- BSI per 1000 catheter days
Process Improvement Measures
1. Overall Catheter Days per Patient Days
2. Unnecessary Urinary Catheters or Unnecessary Catheter Days
3. Average Duration of Urinary Catheterization
4. Compliance with Educational Program (Gould et al, 2010)
5. Compliance with Documentation of Catheter Insertion and removal Dates (Gould et al, 2010)
6. Compliance with Documentation of Indication for Catheter Placement (Gould et al, 2010)
7. Per cent of Unnecessary Insertion of Urinary Catheters (IHI 2011)
- Inappropriate use:
- Management of incontinence
- Obtaining urine sample when patient able to void
- Prolonged postoperative duration without appropriate indication (e.g., structural repair of urethra or contiguous structures, prolonged effect of epidural anaesthesia, etc.)
8. Urinary Catheter Insertion Bundle Compliance (IHI 2011, APIC, 2014)
- Hand hygiene
- Trained persons
- Aseptic technique and sterile equipment (acute setting)
- Clean (i.e., non-sterile) technique for intermittent catheterization for patients requiring chronic intermittent catheterization (non-acute care setting)
- Properly secure indwelling catheters after insertion to prevent movement and urethral traction
- Use the smallest bore catheter possible, consistent with good drainage.
- Perform intermittent catheterization at regular intervals to prevent bladder over distension
- Consider using a portable ultrasound device in patients undergoing intermittent catheterization to assess urine volume and reduce unnecessary catheter insertions
9. Urinary Catheter Maintenance Bundle Compliance (IHI 2011)
- Urinary catheters maintained according to recommended guidelines (Sterile, continuously closed drainage system, Catheter properly secured, Collection bag below the level of the bladder, Unobstructed urine flow, Regular emptying of collection bag)
10. Daily Review of Urinary Catheter Necessity (IHI 2011).
11. Unnecessary Urinary Catheter Days (IHI 2011)