Co-development and optimisation of an Intermittent Catheter Needs Assessment Tool (IC-NAT)

Background Our MultiCath programme aims to improve the financial and environmental sustainability of intermittent catheters (IC). Around 70,000 people use single-use ICs (narrow tubes) to empty their bladders costing >£176 million pa with >100 million discarded as plastic waste. MultiCath is testing a reusable catheter as an alternative to single-use catheters and findings indicate that most users would prefer single-use catheters as well as, or instead of, a reusable catheter. To maximise the impact of our programme, we are requesting funding to enable patient-focused prescribing of ICs which reduces costs, improves sustainability and meets patient needs. Of the 250+ prescribable single-use catheters, most have additional features e.g. cases and grippers. Unit costs vary widely (40p-£3.20). Yet no guidance exists to support prescribers to identify catheters that meet patients needs. MultiCath participants report being prescribed catheters with unnecessary features or without helpful features. Needs-based prescribing and guidance on sustainable alternatives should lead to cost-savings through the appropriate prescription of cheaper, entry-level (fewer features) catheters and less plastic waste from unnecessary features, and maximise patient benefit from receiving the right catheter. This high expenditure has led to three national projects aiming to reduce and justify IC costs, but none address prescribing at the patient level. These projects support and complement our patient-focused application. Aims To co-develop and optimise 1) an Intermittent Catheter Needs Assessment Tool (IC-NAT) to support prescribers to identify catheters that best suit users needs and 2) strategies to support implementation locally and nationally. Development work plan Approach: A Person Based Approach framework, supported by an interdisciplinary Advisory Group and a Patient and Public Involvement (PPI) Group with integrated equality, diversity and inclusivity principles. Work package 1: Intervention planning – Development of the IC-NAT prototype including identification of implementation barriers and facilitators Prototype development: Using evidence from NICE Late-Stage Assessment plus Advisory Group meeting 1 and PPI group input we will develop a draft prototype IC-NAT. Focus Groups: Healthcare professionals, IC users and service commissioners/policy makers (total 22) will participate in a series of focus groups (total five) to inform prototype refinement, plus guide the implementation plan development. Work package 2: Intervention optimisation - Refinement of the IC-NAT and development of implementation plan Iterative refinement of the IC-NAT: Up to 30 healthcare professionals and 20 IC users will participate in qualitative interviews. Prototype refinement: We will undertake around five think aloud interviews with each group (up to five cycles). Development of an implementation plan: Using findings from the above and in collaboration with Health Innovation Wessex, an implementation plan will be developed at healthcare professional and service level. Impact and dissemination An IC-NAT available for immediate use An implementation plan for embedding the IC-NAT within the NHS aligned with the national projects. A fully developed funding application for feasibility testing, leading to national adoption, measurable changes in prescribing practices to meet patients needs, and decreased resource use (financial and environmental). Timeline for delivery Substantial essential background work has been done and therefore the project will be completed within 21 months.