التفاصيل البيبلوغرافية
| العنوان: |
Implementation of a standardized voiding management protocol to reduce unnecessary re-catheterization - A quality improvement project. |
| المؤلفون: |
Brackmann, Melissa1 (AUTHOR) mkwylie@med.umich.edu, Carballo, Erica2 (AUTHOR), Uppal, Shitanshu1 (AUTHOR) uppal@med.umich.edu, Torski, Julie1 (AUTHOR), Reynolds, R. Kevin1 (AUTHOR) rkr@med.umich.edu, McLean, Karen1 (AUTHOR) karenmcl@umich.edu |
| المصدر: |
Gynecologic Oncology. May2020, Vol. 157 Issue 2, p487-493. 7p. |
| مصطلحات موضوعية: |
*GYNECOLOGIC surgery, *URINARY tract infections, *RETENTION of urine, *EPIDURAL catheters, *FISHER exact test, *RF values (Chromatography) |
| مستخلص: |
To design and implement a standardized postoperative voiding management protocol that accurately identifies patients with urinary retention and reduces unnecessary re-catheterization. A postoperative voiding management protocol was designed and implemented in patients undergoing major, inpatient, non-radical abdominal surgery with a gynecologic oncologist. No patients had epidural catheters. The implemented quality improvement (QI) protocol included: 1) Foley removal at six hours postoperatively; 2) universal bladder scan after the first void; and 3) limiting re-catheterization to patients with bladder scan volumes >150 ml. A total of 96 patients post-protocol implementation were compared to 52 patients pre-protocol. Along with baseline demographic data and timing of catheter removal, we recorded the presence or absence of urinary retention and/or unnecessary re-catheterization and postoperative urinary tract infection rates. Fisher's exact test and student's t -tests were performed for comparisons. The overall rate of postoperative urinary retention was 21.6% (32/148). The new voiding management protocol reduced the rate of unnecessary re-catheterization by 90% (13.5% vs 2.1%, p = 0.01), without overlooking true urinary retention (23.1% vs 20.8%, p = 0.83). Additionally, there was a significant increase in hospital-defined early discharge prior to 11:00 AM (4.0% vs 22.0%, p = 0.022). There was no difference in the postoperative urinary tract infection rate between the groups (p = 1.00). Risk factors associated with urinary retention included older age (p < 0.01), use of medications with anticholinergic properties (p < 0.01), and preexisting urinary dysfunction (p < 0.01). Implementation of this new voiding management protocol reduced unnecessary re-catheterization, captured and treated true urinary retention, and facilitated early hospital discharge. • One in five gynecologic oncology patients experiences postoperative urinary retention. • Ultrasound-based bladder scan distinguishes bladder under-distension from true urinary retention. • Implementation of a standardized voiding management protocol led to a 90% reduction in unnecessary re-catheterizations. • Risk factors for retention include older age, anticholinergic medication use, and baseline urinary dysfunction. [ABSTRACT FROM AUTHOR] |
| قاعدة البيانات: |
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