222 - "Go With the Flow" to aVOID POUR: An Evidence-Based Practice Project for Preventing Post-Operative Urinary Retention in Pediatric Surgical Patients.

Description: Post operative urinary retention (POUR) is identified as the inability to void after surgery. This is a common complication that is associated with bladder over distention, reducing its ability to contract effectively causing bladder contraction dissociation, or "Detrusor-Sphincter Dyssynergia" (DSD). It is a condition where the bladder muscle (detrusor) and the urinary sphincter (muscle that controls the urine flow), contracts at the same time. Instead of relaxing, this hinders urine flow. The pressure and tension cause lower abdominal pain, leading to sympathetic nervous system activation of catecholamines that is associated with "emergence delirium" in patients undergoing anesthesia and surgery. Post anesthesia care unit (PACU) nurses have observed and reported through safety events that children are experiencing POUR in the PACU causing not only distress, but also emergence delirium during their recovery that increases the patients' length of stay as well as cost. Currently, there are no pediatric peri-operative nursing interventions to prevent POUR and its subsequent complications in this vulnerable population. Methods/Evidence: Johns Hopkins Evidence-Based Practice Model for Nursing and Healthcare Professionals 4th ed. was used as a guide to appraise and level the evidence that supported the PICO question. Six different databases yielded 2,595 articles and 1,484 articles duplicate articles removed. Peer reviewers systematically reviewed titles and abstracts for 1,111 articles and 982 articles that did not support the PICO question. Peer reviewers reviewed full text of the last 29 articles and only 14 articles that supported the PICO were accepted for final appraisal and leveling the evidence. Six level I-A, seven level III-A and one level V- A for quality. All level I-A evidence recommended that preoperative/postop voiding; intra op/postop bladder scanning; intra op/postop catheterization; and one level III evidence recommended warm compress to lower anterior abdominal/pelvis area for comfort management. In addition, the medications: Tamsulin, Alfuzosin, and Drotaverine, all Level A medications were recommended to reduce POUR. In summary, Evidence overwhelmingly recommended: 1. All pediatric surgical patients three years and above be voided 1 hour before OR. 2. Intraoperative discussion during Briefing/Time Out to catheterize cases that will run >180 minutes. 3. Intraoperative/postoperative ultrasound bladder scanning. 4. Create a POUR banner on EPIC and discussion during debriefing postoperative catheterization for cases that overruns >180 minutes. 5. Warm compress to lower anterior abdominal/pelvis area. 6. Patient be voided after their surgery before discharge. These nurse-led interventions helped prevent POUR complications and improve comfort for children emerging from anesthesia in PACU. Future research plan is to translate nurse-led POUR evidence into practice by conducting a RCT on catheterizing patients in the OR at 180 minutes instead of the current practice of 240 minutes to prevent POUR.