REMOVING THE INDWELLING URINARY CATHETER: WHAT NEEDS TO BE DONE NEXT?

Yolonda Klabunde, BSN, RN-BC, PCCN*; Erika Bonds, BSN, RN; Linda Breimon, RN; Joe Hersh, BA/BSN, RN; Elizabeth Schroeder, Nursing Student/Volunteer; David Serksnys, BSN, RN; Kristen Timm, BSN, RN; Mary Hagle, PhD, RN-BC, FAAN

Clement J. Zablocki VA Medical Center; Milwaukee, WI *414-384-2000 x 42446; email: [email protected]

Background /Significance: Nurses had opportunities to improve their assessments and interventions for patients whose indwelling urinary catheter was removed. Additionally, documentation could be improved, as it was difficult to locate patient data related to when the catheter had been removed, if the patient had voided, and if there was residual urine. A team was formed to summarize best evidence, through an EBP project, for nursing actions when an indwelling urinary catheter was removed. The resulting Practice Recommendation was approved by nursing shared governance. The team continues their work in seeking interdisciplinary approval of the Practice Recommendation and embedding the assessments and actions into the electronic medical record (EMR).

Purpose: For all inpatients and patients anticipating discharge who had their indwelling urinary catheter removed, all pertinent assessment elements and actions, such as bladder discomfort and voided urine amount, are easily found and retrievable in the EMR 100% of the time by May 1, 2016.

Framework: The Veterans Affairs Team Aim Map Measure Change Sustain (VA TAMMCS) quality improvement (QI) model guided this project.

Population/Setting: Adult patients on all acute care units (non-SCI) within an academic Midwest Federal medical center

Approach: The current state of documentation was identified through a chart review of 21 patients. Two of the elements with documentation issues are reviewed. Indwelling catheter removal was documented 86% of the time and was found in 3 different locations within the EMR. Documentation of first void was found 29% of the time. Two pathways were needed to solve this issue: (1) a standardized protocol for assessments and interventions following indwelling urinary catheter removal, and (2) a standardized documentation template in the EMR. The approved Practice Recommendation was used to develop the protocol, which will guide the documentation elements and be embedded into the EMR. These elements include documentation of removal and nursing actions taken for assessment and intervention. For example, within 6 hours of removal, the patient is assessed for initial voiding and possibly post- void residual, and if a bladder scan was done. After EMR template revisions, a follow-up chart review will be done to evaluate the ease and consistency of use by nurses.

Outcomes: The standardized protocol is in review by an interdisciplinary team of stakeholders and the EMR template is being revised.

Conclusions and Implications: It is anticipated that having a standardized template in the EMR will facilitate timely nursing actions following indwelling urinary catheter removal. Veteran comfort will be enhanced as well with patient-centered assessments and timely actions.