A Quality Improvement Program: Structured Exercise for the Outpatient Blood and Marrow Transplant Patient

Abstract

s / Biol Blood Marrow Transplant 20 (2014) S297eS315 S308 practice. The manufacturers of the indwelling urinary catheter had no recommendations regarding irrigation via the sample collection port. Methods, Intervention, & Analysis: A literature search using key search terms included indwelling catheter, catheterassociated urinary tract infections, bone marrow transplant and oncology resulted in limited findings. Therefore, University Healthcare Consortium (UHC) and nursing staff were surveyed for current bladder irrigation practices. Expert clinicians were consulted regarding the practice of closed catheter irrigation. Retrospective case samples of bone marrow transplant patients (n1⁄4 46) with indwelling urinary catheters were screened for catheter usage and triggers for catheter removal. BMT patients were screened weekly for urinary catheter presence and rationale for removal. Our institution has a nurse-driven indwelling urinary catheter protocol to decrease urinary catheter usage and infection. Registered Nurses on the BMT units were surveyed via an online Survey Monkey survey regarding number on years on the BMT unit; nurses perception of number of patient complaints related to lower abdominal cramping, spasms, or pain while having an indwelling urinary catheter; how nurses and physicians treated this complaint and nurses’ awareness of the nurse-driven catheter removal policy. Findings & Interpretation: The majority of indwelling urinary catheters were removed upon expiration, followed by physician order, followed day of discharge or to extended care facility. Only a small number of urinary catheters were removed per the urinary catheter removal protocol. The literature search was limited but consistently recommended maintenance of a closed drainage system, and not routine catheter irrigation. Five United Healthcare Consortium hospitals responded to the survey; three used closed-system irrigation for urinary catheters. Approximately 25% of BMT nursing staff surveyed used closed catheter irrigation when patients complained of pain, cramping, etc. One unexpected finding from the staff survey was that greater than 70% of those surveyed were unaware of the protocol allowing nurses to remove a urinary catheter without a physician’s order. Discussion & Implications: This study impacts safe patient care. BMT have many factors that can potentially lead to catheter obstruction. Timely removal of catheters when no longer needed could eliminate the problem. Staff education was provided regarding the urinary catheter removal protocol. Weekly urinary catheter surveillance continues to monitor the urinary catheter usage and staff nurses’ adherence to the catheter removal protocol. The nurse driven urinary catheter removal have been posted on the unit. Urinary catheter system remains closed when irrigation is needed thereby reducing the risk of infection. Also, by not having to treat the patient’s painful spams with anti-spasmodic medications and pain medication, this decreases the patient’s fall risk and risk of injury. Future studies could examine the incidence of bladder spasms and the impact of closed drainage system irrigation on a multi-site larger BMT patient sample.