title: A Clinical Nurse Specialist-Directed Initiative to Reduce Postoperative Urinary Retention in Spinal Surgery Patients.
abstract: : Postoperative urinary retention (POUR) is the inability to void when the bladder is full after surgery. It is a common complication in postoperative patients, especially in patients undergoing spinal surgery. At our institution, patients who were discharged from the postanesthesia care unit (PACU) to the inpatient surgical unit typically had bladder distention and a bladder volume of more than 450 mL. In an effort to address this situation, an interprofessional group of advanced practice RNs and physicians formed a team, reviewed the existing literature, examined the PACU nursing practice guideline for evaluating and managing POUR, and devised a quality improvement (QI) project to raise the PACU nursing staff's awareness of the potential for POUR among postoperative patients and to develop an updated nursing practice algorithm for the evaluation and management of POUR in spinal surgery patients. A description of the QI process, including the revised algorithm and pre- and postintervention results, is reported here. In the preintervention group (n = 42), 19 indwelling urinary catheterizations were documented in patient records; no use of intermittent catheterization was documented. In the postintervention group (n = 43), seven indwelling urinary catheterizations were documented in patient records; the use of intermittent catheterization was documented in 11. As a result of our intervention, we decreased the number of indwelling urinary catheters inserted in the PACU, and supported the PACU nursing staff in more frequent and appropriate use of intermittent catheterization in patients undergoing spinal surgery.
authors.affiliation: Nicole Hoke is nurse manager of perioperative operations at the Hospital of the University of Pennsylvania in Philadelphia, and Christine Bradway is associate professor of gerontological nursing at the University of Pennsylvania School of Nursing in Philadelphia and the Hospital of the University of Pennsylvania. Contact author: Nicole Hoke, . The authors have disclosed no potential conflicts of interest, financial or otherwise.
authors.forename: Nicole
authors.initials: N
authors.lastname: Hoke
authors.forename: Christine
authors.initials: C
authors.lastname: Bradway
mesh_terms: D055318:Evidence-Based Nursing; D006801:Humans; D009720:Nurse Clinicians; D016528:Postanesthesia Nursing / Q000193:education; D011183:Postoperative Complications / Q000209:etiology / Q000451:nursing*; D011184:Postoperative Period; D058996:Quality Improvement; D012189:Retrospective Studies; D013131:Spine / Q000601:surgery*; D014546:Urinary Catheterization / Q000009:adverse effects; D016055:Urinary Retention / Q000175:diagnosis / Q000209:etiology / Q000451:nursing / Q000628:therapy*