Proactive Nursing Strategies to Hasten the Removal of Indwelling Urethral Catheter in Medical Rehabilitation Setting

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Authors (including presenting author) :
Wong MS(1), Lau KFA(1), Li SFc(1), Ip SMS(1), Yiu YY(1), Mok WK(1)
Affiliation :
Department of Medicine, Yan Chai Hospital
Introduction :
Acute retention of urine is one of the common problems indicating to have an indwelling urethral catheter (IUC) among elderly patients. However it would accompany with lots of caring problem and associated with nosocomial infection. Despite of these, it affects patient’s quality of life in various aspects including physical, psychological, financial and sexual function. For patients transferred to rehabilitation setting, the weaning off IUC becomes an option only. In our daily busy work, the presence of IUC is often hanged onto if doctor has formerly prescribed. It would become a long-standing treatment to hinder patient rehabilitation outcome.
Objectives :
1. Promote patient comfort and dignity 2. Support in patient’s activity of daily living 3. Minimize risk of infection 4. Decrease length of stay in hospital 5. Decrease the cost of hospitalization
Methodology :
1. Develop a practice protocol and checklist in hastening the process of removing IUC 2. Acknowledge the workflow to nurses and physicians seeking for commitment 3. Enhance the knowledge,skills and technique for nurses by clinical updated lectures and standardize nursing management for patients with IUC 4. Pilot in a male rehabilitation ward since January 2016 5. Extend the program to female rehabilitation ward from June 2017
Result & Outcome :
1. From January 2016 to November 2018, total 224 cases were recruited in male rehabilitation ward and 47 cases in female rehabilitation ward from June 2017 to November 2018.  126 (56.25%) male patients and 33 (70.21%) female patients were successfully to wean off IUC without complications.  36 (16.07%) male patients and 4 (8.51%) female patients failed to wean off IUC with referrals for follow up Urology Clinic upon discharge.  62 (27.68%) male patients and 10 (21.28%) female patients were not success to wean off IUC and was transferred back to receive acute care due to deterioration of patient’ condition or early discharged with catheter following up by Community Nursing Service. 2. The rate of HA-MRSA urine with IUC in male rehabilitation ward was 75% in 2016 and was decreased to 70% in 2016 and 67% in November 2018. And the rate of HA-MRSA urine with IUC in female rehabilitation ward was 100% in 2017 and was decreased to 50% in November 2018.

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