Abstract
Background:
Urine retention is a common reason for catheterization in elderly patients in hospitals. Early focus on regular bowel movements, and bladder or prostate issues can facilitate timely TWOC planning. Inaccurate or incomplete documentation leads to unnecessarily prolonged catheter use, and extended hospital stays. Identified problems were –1: Fragmented documentation across different Portals.2: Dual Documentation Systems- paper and digital 3: Lack of documentation at Admission.4: Delayed TWOC planning.
Aims:
1. Standardization of Documentation: Transition to using the NerveCentre(digital) catheter bundle as the primary documentation portal. 2. Improvement in TWOC Planning: Ensure TWOC planning is initiated early, well before the patient reaches MFFD status.
Method:
1. Survey: The project begins with a survey of HCOP staff. Their feedback reflects the challenges of current practices.
2. Standard documentation instruction, teaching sessions, involvement of frailty in reach team at ED, posters at admission units, awareness of nurse in charge, discussion at board meetings and within hospitals internal communication groups.
3. Data collection of 25 patients before and after intervention.
Results: documentation in Nervecentre & paper improved. Accuracy improved from 60% to 100% and 32 % to 80%, respectively. An increase in TWOCs conducted before MFFD was observed, indicating progress toward earlier TWOC planning. The number of failed TWOCs slightly increased in Phase Two, but these were well-documented, and no patient experienced multiple failures. The delay of the first attempt of TWOC after 7 days also reduced from 44% to 24%.
Conclusion- Overall, the intervention addresses the issues of streamlining documentation and improving TWOC planning.
Comments
TWOC planning
This sounds like a really simple and effective project. Can you elaborate on TWOC planning? How did this look for your project beyond "TWOC when BO regularly" etc
TWOC planning was a conscious attempt to check why patients had retention. Retention may not be secondary to constipation. Yes, 'TWOC once BO 'was one of the plans. Then you did post post-void bladder scan . Plan on clerking documents highlighted the importance on the catheter care plan. We encourage TWOC within week unless pt is very unwell. Most of TWOCs were successful. No intervention was needed. If it failed some needed urology opinion. Good documentation made it easier. Thank you for your comment.