Surgeons

Biography

Biography: Sarah Shammout

Abstract

Background & Aim: Th e use of urinary catheterization in neck of femur fracture patients is oft en debated as common best practice to manage and appropriate fl uid assessment. Routine catheterization increases the risk bacteraemia, genitourinary injury, worsening mobility, risk of pressure sores and predisposition to delirium and falls. Th ere is a need for increased awareness of urinary catheterization management in conjunction with healthcare-associated infections. NHS improvement has issued a letter aiming to half healthcare-associated Gram-negative bacteraemia, the majority of which is catheter-related. Th is project aims to identify barriers to safe catheter care in the orthopedic population by determining if management of urinary catheters is complaint with NICE quality standards (QS61). Introduction: Appropriate perioperative care can help manage the associated risk of neck of femur fractures. Th e British Hip Society and British Orthopedic Association have provided little guidance on postoperative care and risk management. Appropriate catheter care will improve overall patient care but reducing mortality and associated morbidity by shortening stay by early mobilization and management of complications. Method: All catheterized trauma and orthopedic patients in a district general hospital over one month (February) were included 67% of which had sustained neck of femur fractures. Data from nursing and doctors’ records on the following parameters were collected: Demographics, the reason of admission, indication/location for catheterization and responsible clinician; the number of days catheterized, the reason for the retention of catheterization and management of suspected/confi rmed catheter-related infection. Data were collected in April following the implementation. Intervention: A urinary care pathway was launched based on the Houdini algorithm and educational seminars for medical and nursing staff were conducted. Results: Mean age of patients was 78. Initial data was suggestive of poor documentation and prolonged, inappropriate retention of urinary catheterization and not in accordance with current guidance. Data was recollected in April aft er the launch of the pathway; data was indicative of marginal improvement of catheter care management, reduced time of catheter retention, improved documentation likelihood of review. Conclusion: Incorporating a catheter care pathway in managing orthopedic patients has shown improvement in the overall documentation and management of urinary catheterization. Despite this improvement demonstrated, implementation of the pathway is still substandard. Th is pathway will be incorporated into an innovative integrated neck of femur pathway in June.