A Fast Tract Trial Without Catheterization in Urology Nurse Clinic for Non-complicated AROU patients from PMH AED

Abstract Description

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Authors (including presenting author) :

Wong KW(1),Yim MS(1),Ho FH(1),Chan CK(1),Chu TY(1),Shih YN(2),Lit CH(2), Sham SF (2),Leung PS(2),Leung SY(2)

Affiliation :

(1)Department of Surgery, Princess Margaret Hosptial,(2)Department of Accident & Emergency Services , Princess Margaret Hospital

Introduction :

AROU is defined as sudden and painful inability to void voluntarily and its relief was catheterization. AROU would associate with BPH and early TURP is gold standard. However, TURP would increase morbidity and risk of death during and after surgery. A successful trial without catheterization (TWOC) may lead to the avoidance of TURP in 23% of patients presenting with AROU. Previously, AROU patients were discharged from PMH AED. On day 3 of catheterization, ability of spontaneous urination was assessed. If failed, assessed again on Day 6. Those AROU patients were referred to Urology Outpatient Clinic but without definited appointment. After triage by urologists,TWOC in urology nurse clinic again was 6-8 weeks. The referral system for TWOC was 6-8 weeks, it may prolong catheterization days and induce CAUTI. A fast tract TWOC in urology nurse clinic was establised with multidisciplinary approach. The stakeholders included Department of Surgery, Urology nurse, Department of Accident & Emergency Services and Department of Pharmacy. Protocol, information sheet, referral system and AED TWOC bundle were formed. Non-complicated AROU patients could direct referral from PMH AED.

Objectives :

1. To set up a fast tract TWOC in urology nurse clinic with multidisciplinary approach including of Department of Surgery, Urology nurse, Department of Accident & Emergency Services and Department of Pharmacy. 2. To shorten waiting time for TWOC from 6-8 weeks to 2 weeks. 3. To decrease CAUTI from shorten days of catheterization. 4. To minimize unnecessary emergency admissions for non-complicated AROU patients and complications from prolonged catheterization. 5. To improve patient quality of life and patient satisfaction from early TWOC.

Methodology :

The inclusive patients was male, ambulatory and non-complicated AROU.220 patients were included from 1/3/2018-31/12/2018. A comprehensive nursing assessment, health education and counselling were given. 59% patients were successfully in TWOC. Patients had titration of alpha-adrengeric blockers by urologists and urology follow up appointment was given in accordance with protocol.

Result & Outcome :

1. A fast tract TWOC in urology nurse clinic with multidisciplinary approach 2. All shorten waiting time for TWOC from 6-8 weeks to 2 weeks. 3. 59% patients experienced early free of urinary catheter in fast tract TWOC in urology nurse clinic. 4. Reduce 15% for unncessary admission for non-complicated AROU patients. 5. 59% patients improved in quality of life and patient satisfaction from shortern indwelling catheter days.