Use of Education to Improve Compliance With Recommended Bladder-Management Practices for Patients in Labor With an Epidural

Abstract

The aim of this project is to change the nursing culture so bladder-management interventions are individualized for patients in labor with regional anesthesia. To achieve this aim, we sought to improve nursing compliance with intrapartum regional anesthesia bladder-management orders that were designed to reduce exposure to indwelling urinary catheters (IUCs). The hospital’s regional anesthesia-in-labor orders were changed to reflect the desired practices for bladder management. Electronic health records (EHRs) were reviewed for 30 patients who received regional anesthesia in labor for nursing compliance with orders pre- and posteducational intervention. Nursing education was provided in a staff meeting in an effort to improve compliance with bladder-management orders. Education included review of rates of urinary retention during labor with epidural anesthesia, Centers for Disease Control and Prevention (CDC) recommendations on catheterization, and review of current bladder-management orders. After education, 30 EHRs were reviewed for compliance with orders. The order-set changes were not effective in reducing use of IUC in patients in labor with an epidural. After the educational intervention, IUC use decreased by 50% (from 18 preintervention to 9 postintervention), there was no change in the number of patients that did not did not receive a catheter (5 preintervention and postintervention), there was a 100% increase in straight catheter use (7 preintervention to 14 postintervention), and there was a 66% increase in bedpan use (from 3 preintervention to 5 postintervention). Educational interventions achieved a moderate change in nursing compliance with bladder-management orders for patients with regional anesthesia. Future educational interventions are needed to increase nursing comfort in assessing for urinary retention and offering a bedpan in this patient population.