To measure post void residual urine within 1 hour
of voiding for incontinent patients.
NC Heng LC, UNM Magdalene Lim, Dr Lieu PK, PNE Wee FC, NC Geetha KS,
SSN Zhang Jin, SN Isaivani A, PAN Magaswary RB
INTERVENTION
MISSION STATEMENT
To measure post void residual urine (PVRU) within an hour after
voiding for all patients on diaper in Wards 7B & 7D from July
2010 to February 2011.
provide in-service education to all nurses
implement the use of enuresis alarm
standardise documentation
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TEAM MEMBERS
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Magdalene Lim
Heng Lee Choo
Dr Lieu Ping Kong
Wee Fong Chi
Isaivani A.
Magaswary R.B.
Geetha K.S.
Zhang Jin
Ng Woei Kian
Carers
Steven Ho
place sensor
in the diaper
Facilitator
Nurse Clinician, Continence/Urology (Leader)
Snr Consultant, Geriatric Medicine
Nurse Educator, Nursing Service
Registered Nurse, Wd 7A
Enrolled Nurse, Wd 7B
Nurse Clinician, Wd 7C
Registered Nurse, Wd 7D
Nurse Clinician, Infection Control
(via feedback)
Vendor
RESULTS
EVIDENCE OF A PROBLEM WORTH SOLVING
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PVRU measurements for patient on diaper are usually not
accurate as the nurses do not know when patient passes
urine.
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PVRU of more than a hundred milliliters poses a
higher risk of urine infection (Tam, Wong & Yip, 2006;
Truzzi, Almeida, nunes & Sadi, 2008)
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Delayed PVRU measurements will give false high PVRU
amounts. This may result in:
Inappropriate management e.g. IMC/IDC
Risk of UTI (Gokula, Hickner & Smith, 2004; Saint, 2000)
Trauma, discomfort, cost, reduces self esteem of patient
Inconvenience to staff and patients
POTENTIAL COST SAVINGS
Pts Gender Class
Cathether Route
Per Cath Episode cost to Pts
FLOWCHART
Potential savings to
Potential reduction of Patient
Patients in term of
costs per bed day - est $400
hospital bill size
Nursing manpower savings Calculated at managing RU pts in
Ward 7B &D
Potential Savings
to hospital
Private
Indwelling
$65
1- 2 days
1- 2 days =
$700 - $1400
Subsidised
Indwelling
$33
1- 2 days
1- 2 days =
$700 - $1400
Male
Ward 7B & D are subsidised
patients.
(192hrs saved) x (NYP Staff nurse $13.75 /hr) =
MOH cost/patient bed (Ward C) is
$2,640 in Ward 7B & D
$1,390 and (Ward A) is $3,434
Private
Intermittent
$37 x 2 = $74
1- 3 days
1- 3 days =
$700 - $2100
Subsidised
Intermittent
$18 x 2 = $36
1- 3 days
1- 3 days =
$700 - $2100
Female
Potential cost saving due to reduction of the Length of Stay:
• Treatment for Urinary Track Infection (UTI).
• Reduction in nonsocomial infection
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PROBLEMS ENCOUNTERED
CAUSE AND EFFECT DIAGRAM
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Time consuming in collection of data
Difficult to change staff behaviour
Limited resources (vendor unable to supply number
of alarm required
STRATEGIES FOR SUSTAINING THE GAINS
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PARETO CHART
Do ad hoc audit
Collaborate with NE to include PVRU theory in their
orientation program for new nurses
Work with manufacturer to design a disposable sensor
Encourage feedback from staff for improvement
Continuous reinforcement and education (unit base
orientation)
LESSONS LEARNT
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Staff commitment and team work are important
We learn to use CPIP tool to systematically analyze,
prioritize and implement measures
Use technology to reduce burden of care
Collaboration is necessary
Constant feedback from ground helps to improve
compliance and sustainability