Green Nursing Challenge Trial without catheter - a structured approach

Project completed as part of the National 2025 Green Nursing Challenge by the Lewisham and Greenwich NHS Trust team

The team:

• Myra Robson - Clinical Lead, Bladder, Bowel & Pelvic Health
• Imogen Cotton - Graduate Management Trainee
• Erika Taparan - Catheter Lead
• Annie Curry - Head of Nursing, Adult Community

Issue  

Indwelling urinary catheters are among the most used invasive medical devices in the UK. It is estimated that at least 90,000 people in community settings across England require long-term catheter use. Evidence suggests that the longer a catheter remains in place, the higher the risk of infection, with figures indicating a 20% increased likelihood. This raises significant concerns, as approximately 2,100 deaths per year are directly attributed to catheter-related infections. Additionally, the financial burden on the NHS is considerable, with Catheter-associated Urinary Tract Infections (CaUTIs) costing approximately £2,000 per episode and the total annual cost of Foley catheter use estimated between £1 billion and £2.5 billion.

Despite these significant clinical and financial implications, there is currently no commonly known, standardised TWOC protocol - most likely because of the lack of clear evidence on how to manage the process., and may result in prolonged and repeated catheter use, unnecessary district nurse visits, ambulance callouts, and avoidable hospital stays. These inefficiencies not only compromise patient care, comfort and quality of life, but also generate considerable plastic waste from catheters, gloves, aprons, and maintenance solutions.  

Intervention

The team aimed to optimise the success rate of TWOC, ensuring that catheters are removed as soon as clinically appropriate, reducing over-use and the length of time catheters are left in situ.

The team created a structured approach to the Trial Without Catheter process, implementing a classification system (Green, Amber, and Red) for TWOC suitability and corresponding TWOC strategies.  They hoped they would improve staff confidence and practice through targeted training and support in catheter care.

Outcomes

Clinical

Catheter-related ambulance call outs reduced by 25%, suggesting more timely community interventions.  

Catheter-related hospital bed days reduced by 32% showing fewer prolonged admissions

Catheter-related hospital admissions fell by 12.5% , indicating fewer acute deterioration events.  

No catheter associated Urinary Tract infections were reported.

Environmental

The team demonstrated projected annual saving is 42,156.40, equivalent to driving 124,026 miles in an average car.

Economical

The project demonstrated sustained, high-value savings, with no economic investment costs required. On average, the initiative contributed to net savings of £36,809 per month, and when accounting for increased PPE, this equates to projected annual savings of £441,708 if sustained.

Social

The significant reduction in bed days meant that patients spent less time in hospital and more time at home.  The reduction in hospital admissions and number of bed days for catheter-related issues, supported by this project, can also be linked to improved emotional wellbeing for patients. greater opportunities for self-management could empower eligible patients, improving their sense of control and reducing unnecessary worry.

Staff felt increased confidence as knowledge and training around catheter management improved, which helped create a stronger foundation for sustainable practice. Care home staff, who had previously reported uncertainty about how best to support residents with catheters, began to benefit from clearer guidance and improved communication.

Key Learning Point

The project demonstrated that careful assessment, clear protocols, and strong clinical leadership are essential to reducing catheter overuse and enhancing sustainable care.