University of Colorado Hospital Guideline:
Voiding Algorithm for Preventing Postoperative Urinary Retention (POUR)
Based on an extensive literature review, I wrote and implemented a voiding algorithm for preventing postoperative urinary retention (POUR) in Phase II patients (patients going home the day of surgery). See New Knowledge, Innovations & Improvements for more information on the POUR project.
To standardize the voiding algorithm, I wrote a unit-based guideline. The guideline defines POUR as a bladder volume greater than or equal to 400ml. It also explains the signs and symptoms of POUR, the various risk factors, pathophysiology, and how to use the algorithm. The guideline was approved in June 2014 by the Perioperative Guideline Task Force.
To standardize the voiding algorithm, I wrote a unit-based guideline. The guideline defines POUR as a bladder volume greater than or equal to 400ml. It also explains the signs and symptoms of POUR, the various risk factors, pathophysiology, and how to use the algorithm. The guideline was approved in June 2014 by the Perioperative Guideline Task Force.
Final Draft
First Draft
Second Draft
In June 2014, permanent charge nurse, Mary Hurlburt, brought to my attention concerns that PACU nurses were incorrectly applying the POUR algorithm. According to the charge nurse, a handful of RNs were taking the POUR risk factors too literally, causing them to assume that every Phase II patient has a high risk for POUR and should void. I made an addendum to the guideline that would clarify this issue (it's highlighted on page 2).
I wanted to communicate that this is a guideline, meaning that a nurse has to look at the big picture. Every patient has some risk for developing POUR, but that doesn't mean every patient should void before discharge. It's not practical, nor a good use of resources. The procedural risk factors are the more important ones. But still, POUR is not a black and white issue. The research even indicates this.
In June 2014, permanent charge nurse, Mary Hurlburt, brought to my attention concerns that PACU nurses were incorrectly applying the POUR algorithm. According to the charge nurse, a handful of RNs were taking the POUR risk factors too literally, causing them to assume that every Phase II patient has a high risk for POUR and should void. I made an addendum to the guideline that would clarify this issue (it's highlighted on page 2).
I wanted to communicate that this is a guideline, meaning that a nurse has to look at the big picture. Every patient has some risk for developing POUR, but that doesn't mean every patient should void before discharge. It's not practical, nor a good use of resources. The procedural risk factors are the more important ones. But still, POUR is not a black and white issue. The research even indicates this.
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