Cinny Cusack Physiotherapy Manager Mary O’ Reilly Practice Development Improving patient safety by early recognition and intervention for urinary retention in the Rotunda Hospital Cinny Cusack Physiotherapy Manager Mary O’ Reilly Practice Development

Q.I.P using PDSA cycle to reduce short and long term complications of urinary retention (UR) Clinical audit on management of UR 2012 Findings were inconsistency in diagnosis and management Patients with long term bladder issues requiring ongoing physio MDT workshops Education on UR, feedback on clinical issues Bladder care packs introduced on wards 2013 bladder care guidelines updated Further staff education sessions to embed clinical changes Measuring first 2 voids post delivery/surgery Patient empowerment by introducing patient fluid balance chart Re audit completed July 2014 Presentation of findings at Grand rounds, National patient safety conference 2015, Poster at ISCP conference

Project Outcomes Pain and constipation identified as risk factors with improved management. Prevention of delayed discharge due to indwelling catheter Improved post natal patient pathway by follow up in OPD Improved staff awareness of risks of developing UR and long term consequences Improved management though updated clinical guidelines and embedded changes in clinical practice Measuring first 2 voids Use of patient FV charts Changes in catheter management Introduction of self intermittent catheterisation Completed re audit over 6 months Jan to July 2014 Reduction in symptom severity and number of UR cases 2014 N= 62 2015 N= 47

Main Learning from Project Good team work and collaboration vital Education is key for both staff and patients Accurate documentation is vital Staff attitudes could be challenging- need staff buy in to change practice Practicalities and cost Following the removal of your catheter, try and empty your bladder every 2-3 hours or sooner if you feel the urge to go. Drink 2 litres of fluid slowly during the day. (3 litres if you are breastfeeding) Record the amount of urine passed and fluid taken. FLUID INTAKE CUP/GLASS URINE OUT IN MLS RESIDUAL VOLUME RECORD ANY SENSATION OF URGE OR BLADDER PAIN BEFORE VOIDING 6 am 7 am 8 am 9 am 10 am 11 am 12 noon 1 pm 2 pm 3 pm 4 pm 5 pm 6 pm 7 pm 8 pm 9 pm 10 pm 11 pm 12 pm 2 -3 am 4 -5 am Total