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