ANAHEIM, CALIFORNIA—An active voiding protocol after urologic/gynecologic surgery led to improvements in patient satisfaction, reduced costs, and allowed for a less time-intensive procedure for nurses, a speaker said at the Oncology Nursing Society (ONS) 39th Annual Congress.
Traditionally, a passive voiding protocol is used after urologic/gynecologic surgery to determine whether a patient can independently and fully empty their bladder. This protocol takes at least 8 hours, but it often extends to 26 hours. It involves bladder scans and up to three straight catheterizations.
Joanna Ferreri, BSN, RN, of the Lehigh Valley Health Network in Allentown, Pennsylvania, and colleagues investigated an alternative that involves active voiding for postoperative patients. During a podium session, she noted that this process requires far fewer steps and is less time-consuming.
On postoperative day 1, the patients on the active voiding protocol had 250 mL to 300 mL of saline installed through their urinary catheter, and then the catheter was immediately removed and the saline retained. The patient was asked to immediately void, and then the patient was cleared for discharge if more than 50% of the volume was voided with no other complications.
This study found that, compared with passive voiding, the active voiding protocol decreased length of stay, eliminated straight catheterization, decreased the potential for catheter-associated urinary tract infections and urethral trauma, and increased the accuracy of assessing urinary retention.
“In terms of nursing, there was more accuracy associated with the active voiding trial. In the passive voiding trial, you have to rely on bladder scanning using a portable ultrasound instrument. This doesn’t take into account variables that affect the ability to accurately collect information,” Ferreri said.
“Conversely, in the active voiding trial, a measured amount is installed into the bladder, and the immediate attempt to void by the patient allows for more precise assessment and determines whether the patient is discharged with a Foley catheter.”
The outcomes from the active voiding protocol are likely to reduce per-patient costs. Also, decreasing catheter-associated urinary tract infections and enhancing patient satisfaction is likely to increase third-party payor reimbursements.
The research team also noted that the active voiding protocol is less time-intensive for nurses than the traditional passive voiding protocol. This suggests that it can positively affect nursing workflow.
“The active voiding trial is an advancement in keeping with the times and stands to benefit patients. Our future planning includes rolling this out to gynecologic oncology patients to increase patient satisfaction and also help facilitate patient flow throughout our network,” Ferreri said.
Ferreri J. An active voiding trial protocol for the postoperative urologic/gynecologic surgical patient: A simple ‘just do it’ to impact satisfaction, cost, and quality. Presented at: Oncology Nursing Society (ONS) 39th Annual Congress; May 1-4, 2014; Anaheim, CA.