Education and early ambulation: a key in preventing postoperative urinary retention.

SSN Anith Al Bakri Mustafa, Singapore National University Hospital (NUH) Centre for Evidence-Based Nursing: A JBI Centre of Excellence

The Singapore National University Hospital (NUH) Centre for Evidence-Based Nursing has been a JBI Centre of Excellence since 2007. Over the years, the Centre has continuously promoted and cultivated evidence-based practice (EBP) in the hospital to nurses via training and education. Nurses are strongly encouraged to use JBI’s EBP resources, which are easily searched for and accessed using the JBI EBP Database. The JBI EBP Database provides wide, relevant and up-to-date evidence to guide practice.

JBI PACES software is fully integrated with the JBI EBP Database to allow easy access to the best available evidence to create a quality improvement project and generate project reports. We invited two of our nurses to share their experiences on adopting the JBI Framework to implement evidence into practice. 

Implementing an evidenced-based quality improvement project using the JBI EBP Database, JBI PACES and GRiP was something new to me, yet I’m amazed that it was easy to use, apply and integrate in my ward setting. SSN Anith Al Bakri Mustafa

Undergoing surgery is a common occurrence nowadays. While emergency surgeries must be done urgently, elective surgeries are planned and offer patients more flexibility in their care. With most patients opting for day surgery rather than an overnight stay, there is a need to ensure that the patient goes home well after day surgery. However, not all patients feel better post-surgery, and complications such as pain, nausea, vomiting and postoperative urinary retention (POUR) may occur.

Anith, a senior staff nurse and team member at Singapore National University Hospital (NUH) was concerned about the increase in the incidences of POUR in a short-stay and day-surgery ward. POUR prolongs patients’ stays, as patients must be inserted with an indwelling urinary catheter. Additionally, there were inconsistencies in practice among the nurses to prevent POUR. These issues prompted the team to search for evidence using the JBI EBP Database. Initially, there were no POUR-related evidence summaries; therefore, a request was made to the JBI program manager of the JBI EBP Database for the development of POUR-related evidence summaries and audit criteria in JBI PACES.

Anith and her colleagues applied the JBI Implementation Framework and used JBI PACES for a ward-based audit project to standardise the prevention of POUR by educating patients pre-operatively and promoting early ambulation post-operatively. JBI PACES, being fully integrated into the JBI EBP Database, makes it easy to access the best available evidence, audit criteria, and use the Getting Research into Practice (GRiP) approach.

Baseline audits and three follow-up cycle audits involving 45 patients in a short-stay and day-surgery ward were conducted from June 2019 to August 2020. The baseline audit of the project shows 0% on patients receiving POUR education pre-operatively and low compliances on early ambulation of patient at 30%. Subsequent follow-up audit results show significant improvement in patients receiving education and early ambulation. The third follow-up audit showed an 87% compliance rate for patients receiving education and 82% compliance rate for patients being ambulated early. Positive clinical outcomes, including a reduction in POUR incidences with early ambulation, were observed with patients developing POUR reducing from 17.5% at baseline to 2.9% on follow-up cycle three.

After successfully implementing this change, team members presented it at the surgical cluster meeting for other wards to adopt. Information on best practice is included in the ward orientation file for new staff and they are encouraged to adhere to the practice. Moving forward, early ambulation and education on POUR could be carried out with all patients undergoing surgery in the hospital.

Links to additional resources

Eddie CS, Norzan MNB, Mustafa, Al Bakri A, Ong SJ, Chan JH, et al. Prevent postoperative urinary retention in day surgery adult patients: evidence-based quality improvement project. JBI Evid Implement 2022;20(4):344-54. | DOI: 10.1097/XEB.0000000000000348