Authors (including presenting author) :
Wong SW Arale(1), Au HT(1), Chan CM (1), Chung YY(1), Cheng Elaine(2), Sha KY Edmund(2)
Affiliation :
(1) Continence Nurse Clinic (2) Department of Geri-medical, United Christian Hospital, KEC, HA
Introduction :
Acute Retention of Urine (AROU) is one of a common emergency situation, the most associated underlying causes included constipation, urinary tract infection and ingestion of provoking substances such as alcohol and cough mixture. In United Christian Hospital Continence Nurse Clinic, a co-joint program with Emergency Department (ED) was early implemented in 2013 to facilitate early urinary catheter (UC) management. In June 2021, Nursing Enhancement Program was optimized to provide even faster on-site attentive consultation to enhance better patient care management.
Objectives :
To review patient management outcomes To identify new service gap and formulate improvement plan
Methodology :
Retrospective study was done to review the AROU cases referred by ED, detail information was retrieved from Clinical Management System from November, 2021 to 2022. Trial wean off catheter (TWOC) episodes and management outcomes with co-related variables & factors was being studied.
Result & Outcome :
Total 370 AROU patients with UC were reviewed, there were 23 female and 284 male patients with average age 73.2. Average waiting time for patient to have specialty professional attendance (Continence Nurse, CN) was 3.3 days, which was 15 times faster than Urology Team (51.1 days). And 62.5% (N=192) of patient received immediate Day Zero attention by CN. For TWOC arranged by CN in nurse clinic, patient can TWOC in average 9 days which was 2 times faster compared to 17 days TWOC by community nurse and 5 times faster compared to 48 days TWOC by Urology Team. Overall, the readmission rate remained relatively low around 7.5 %. To review service gap, 3-6% of patients with missing record of retention urine volume, urology team referral and limited alpha-blocker dispensing was addressed, whereas the needed care was subsequently patched up by continence nurse. In the study, slightly higher TWOC failure rate (over 20%) for patient with increase residue urine (RU) volume more than 700ml compared to low TWOC failure rate (5%) with RU less than 500ml. Moreover, 18.6% of patient not fit for instant TWOC after assessment, with higher creatinine near or higher than 150 umol/L, keeping long term Foley catheter was preferrable which creatinine less than 150 umol/L was being arranged for prostate surgeries eventually. Continence nurse provides service for early assessment to optimize patient ‘s condition before TWOC which reduce patient waiting time for AROU management. By bridging the service gap, early TWOC could be arranged thus patient ‘s quality of life could be improved. By early TWOC and assessment, it could facilitate patient decision making for consideration of advance surgical management for AROU when attending urology specialty follow up.
