Early Identification and Intervention for Urinary Retention in Total Hip and Knee Replacement Patients

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.