Date post: | 13-Dec-2015 |
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Gynecology Care PathwayKimberly McKinley
Penticton Regional Hospital
Initial Drill Down – when and who?
Why are PRH post-op gyne. patients at increased risk for UTI?
Age Type of surgery Varying practice between
Health Care Team members Lack of “Best Practice” care
standard
not much we can do about these factors
there is room for improvement here
Where could we improve?
PAR STAFF
WARD STAFF
PHYSICIANS
INFECTION CONTROL
NSQIP TEAM
OR MANAGEMENT
QI
Post Void Residuals(Post Op Gyne Surgery with Repair)
Day 2 – 0600 hrsRemove Catheter
as ordered
Patient Teaching re: PVR process
Can patient learn to self
catheterize?
Commence I & O Self Catheter
teaching
Continue to monitor q 2 -3
hrs
Check for PVR 2 – 3 hrs post
catheter removal
Is PVR > 200 mL?
Nurse to do I & O Catheterization
Check for PVR 2 – 3 hrs post I & O catheter
Is PVR > 200 mL?
NO
YES
NO YES
4th Time
YES
X 3
No problem
Can patient self
cath?
Discharge Home Day 2 evening or Day 3
Insert In-dwelling
Foley
NO
NO
YES
Remove foley catheter on day 3 at
0600 hrs (Dr. Goncalves only)
Check PVR 2 – 3 hrs post
catheter removal (as per day 2)
What else are we doing?
Using gyne nursing staff to help audit
pathway compliance on charts
Education huddles weekly
Complete review of charts that do not follow
pathway guidelines – why were they outside
the norm?
Improvement?
too soon to tell
increasing numbers of patients are going
home with self catheterization instead of
indwelling catheters
still some barriers to overcome with some
staff (nursing and medical)
adding custom fields to improve tracking