Early Identification and Intervention for Urinary Retention in Total Hip and Knee Replacement Patients
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Author/Creator
Messick, Angela
Author/Creator ORCID
Date
2023-04
Type of Work
Department
Nursing
Program
Doctor of Nursing Practice
Citation of Original Publication
Rights
Subjects
Post-operative urinary retention (POUR)
Total hip replacement
Total knee replacement
Surgical complications
Total joint replacement
Screening
Total hip replacement
Total knee replacement
Surgical complications
Total joint replacement
Screening
Abstract
Problem Statement: Post-operative urinary retention (POUR) is a potential complication after surgery. In the total joint replacement patient population, including total hip and total knee replacements, POUR can increase the length of stay, potential infections, bladder damage, and a decrease in the quality of life if it becomes a long-term complication. The goal of the DNP project was to bladder scan patients earlier, identify POUR earlier, and intervene earlier before these potential adverse events were to happen.
Purpose: The clinical question of: "Can the late incidence of POUR be reduced in the total joint replacement population with early bladder scanning?" was used to guide the project. Using evidence-based practice to guide implementation, a protocol was developed in a regional hospital where bladder scanning was performed on arrival to the Post-Anesthesia Care Unit (PACU) along with intermittent catheterization if the bladder scan was over 500 milliliters. All total knee and total hip replacement patients were included.
Methods: The Johns Hopkins Nursing Evidence-Based Practice Model was utilized to design implementation. Data was collected through chart reviews ten weeks pre-implementation and ten weeks post-implementation. All data was compiled into an Excel spreadsheet and analyzed.
Results and Significance: Compliance with bladder scanning increased greatly, from 64% pre-implementation to 96% post-implementation. The average time until the patient was bladder scanned pre-implementation was one hundred and sixty eight minutes, and post-implementation was eighteen. The T-Value was found to be 12.8092 and the two-tailed P value is less than 0.0001, making the results statistically significant.