Clinical Practice Problem/EBP/PICO

This report examines the evidence surrounding postoperative urinary retention (POUR) and proposes a practice change recommendation based on current research and clinical guidelines.

Part A: Clinical Practice Problem of Urinary Retention After Surgery

Impact of the Clinical Practice Problem

Urinary retention after surgery is a significant clinical problem that can lead to discomfort, pain, and potential complications for the patient (Harland et al., 2023). The inability to void can result in bladder overdistension; it can also lead to increased risk of urinary tract infections and prolonged hospital stays. For the healthcare organization, this can mean increased costs due to extended hospitalization, potential readmissions, or the need for avoidable interventions such as catheterization. One result might a decline in patient satisfaction or even potential legal implications if the problem is not addressed promptly.

PICO Components

P (Patient/Population/Problem): Patients who have undergone surgery.

I (Intervention): Prophylactic strategies or interventions to prevent postoperative urinary retention (e.g., early mobilization, avoiding excessive fluid administration, bladder scanning).

C (Comparison): Standard postoperative care without specific interventions to prevent urinary retention.

O (Outcome): Reduction in the incidence of postoperative urinary retention, decreased need for catheterization, reduced hospital stay, and improved patient satisfaction.

Evidence-Based Practice (EBP) Question

In patients who have undergone surgery, how effective are prophylactic strategies or interventions in reducing the incidence of postoperative urinary retention compared to standard postoperative care?

Part B: Research-Based Article Appraisal

Background

The article titled "Systematic review of interventions for the prevention and treatment of postoperative urinary retention" by Jackson et al. (2019) in BJS Open aims to systematically review and evaluate the effectiveness of interventions designed to prevent and treat postoperative urinary retention (POUR). POUR is a common complication after surgery and can lead to different adverse outcomes.

Research Methodology

The study is a systematic review. The authors searched multiple databases, including MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials, to identify relevant studies. They included randomized controlled trials (RCTs), non-randomized studies, and observational studies that assessed interventions for preventing or treating POUR.

Level of Evidence using the JHNEBP Model

The level of evidence for a systematic review that includes randomized controlled trials and observational studies is Level I, given that systematic reviews are at the top of the evidence pyramid, especially when they incorporate RCTs. However, the authors themselves are not conducting any new experiments, so it could also be considered a Level III.

Data Analysis

The authors synthesized the data from the included studies and based on the data assessed the effectiveness of various interventions. They used meta-analytic techniques when data from multiple studies could be pooled and provided a narrative synthesis when pooling was not possible.

Ethical Considerations

Systematic reviews typically do not involve new data collection from participants, so there are no direct ethical concerns related to patient consent or intervention. The authors did not discuss whether the studies included in the review met ethical standards.

Quality Rating of the Research-Based Article

Using the JHNEBP model, the quality rating of this systematic review would be "High Quality" due to its comprehensive nature, inclusion of RCTs, and methodology.

Results or Conclusions

Jackson et al. (2019) presented the findings from the included studies and discussed which interventions were effective in preventing or treating POUR. The systematic review gave...…effectiveness of the protocol will be invaluable. Lastly is hospital administration, who are important for resource allocation and organizing training sessions.

Potential Barrier

One significant barrier to implementing this practice change could be resistance from healthcare staff due to the perceived increase in workload, especially in high-volume surgical units. Introducing new protocols can sometimes be met with skepticism, especially if it's seen as adding more tasks to an already busy schedule.

Strategy to Overcome the Barrier

To address this barrier, it is important to focus on the long-term benefits of the protocol, not just for patients but also for the healthcare system. Fewer complications mean shorter hospital stays and fewer readmissions, which can reduce the overall workload in the long run. Additionally, providing adequate training and support, celebrating early successes, and continuously gathering feedback can help in gaining staff buy-in.

Outcome Measurement

To measure the effectiveness of the recommended practice change, the primary outcome would be the reduction in the incidence of POUR in postoperative patients. This can be tracked by monitoring the number of patients who experience POUR after surgery compared to historical data. Secondary outcomes could include a reduction in CAUTIs, shorter hospital stays, and improved patient satisfaction scores related to postoperative urinary management.

In conclusion, by implementing a comprehensive postoperative urinary management protocol, healthcare institutions can significantly reduce the incidence of POUR and its associated complications. Engaging key stakeholders, addressing barriers, and monitoring outcomes are essential aspects of change.

Conclusion

The proposed comprehensive postoperative urinary management protocol offers a holistic approach to reduce the incidence and implications of POUR. With the collaboration of key stakehoders and continuous evaluation of outcomes, healthcare institutions…