Table 1 Description of the content in the learning labs and the development of the urinary catheterisation protocol
Learning lab content | |
– Lecture on infection prevention, fluid balance and pre-optimisation in elderly patients. – Expert nurses and researcher review the literature. –Refresh assessment and communication tools: SBAR [43,44,45], early warning score and triage toola [46,47,48], ABCDE + F [49, 50], specifically related to patients’ need for catheterisation or not, CRM: decision-making, situational awareness and prioritisation related to urinary catheterisation [51, 52]. – Encourage thinking together i.e. ask a peer or physician for support in the decision process if needed, as a sign of growth, not a weakness. – Dialogue relating to:  i. Evidence-based catheter indications and removal plan and alternative to IDC such as suprapubic catheter.  ii. Patient cases.  iii. The risk of self-termination of invasive devices, which can occur in patients with cognitive dysfunction or acute confusion.  iv. The use of straight in-out catheterisation or alternative to indwelling urinary catheter.  v. Appropriate documentation to prevent the loss of information.  vi. Patient involvement i.e. to see them as competent individuals and experts on their body and function [53]. | |
Practical procedure | |
– Co-creating the nurse-driven urinary catheterisation protocol. – Introduce the national schedule for measuring residual urine via a portable bladder scanner, adapted to fit the study site bladder volume threshold of ≥400 ml, starting on admission [54], see below. – If in need of straight in-out catheterisation before transport to the pre-operative area, or a pre-operative urine volume of ≥200 ml before start of anaesthesia and anticipated > 3 hours to end of surgery, insert an indwelling catheter and remove within 24–48 hours. – If no catheter, perform bladder scan immediately at the end of surgery, after wound closure and continuous post-operatively according to the schedule. – Use a catheter with a thermistor to facilitate peri-operative measurement of patients’ temperature. – Document indication, removal plan and perform a daily evaluation for catheter placed > 48 hours. – Developed pocket-sized stickers with indication, removal plan and scanning schedule. | |
Bladder scanning schedule Residual urine: 100–150 ml – control after three hours 150–300 ml – control after two hours 300–400 ml – control after one hour ≥400 ml – perform straight in-out catheterisation or indwelling catheter depending on patient assessment, patient involvement and the further care plan |