Enhancing bladder management for intrapartum/postpartum women at a maternity hospital in Taiwan: a best practice implementation project

Abstract

Introduction and aims: Voiding dysfunction is a common perinatal condition. Appropriate bladder management and monitoring during labor and postpartum improves bladder function and reduces the incidence of infections and complications. This project aimed to promote evidence-based bladder management strategies for perinatal women at a maternity hospital in Taiwan. Methods:The project was implemented using the JBI framework and the JBI Practical Application of Clinical Evidence System. Implementation audits were conducted by examining nurses and intrapartum and postpartum women. Ten criteria were applied in the baseline audit, and two follow-up audits were conducted to assess actual compliance with best-practice recommendations. Through a Getting Research into Practice analysis, we identified three barriers to changing practice.Results: A comparison of the audit outcomes revealed that all criteria had improved by the second follow-up audit cycle. Specifically, the compliance rate increased from 37% and 50% to 100% for criteria 1 and 2, respectively; from 0% to 100% for criteria 3, 5, and 10; and from 7%, 28%, 50%, and 17% to 100%, 100%, 97%, and 100% for criteria 4, 6, 8, and 9, respectively. Following implementation, the frequency of intrapartum intermittent catheterization (53.44-38.30%) and the postpartum incidence of urinary retention (9.09-8.51%) decreased. The time to first voiding after vaginal delivery and between the first and the second voiding decreased from 5.51 and 4.01 h to 2.32 and 2.29 h, respectively.Conclusions: This evidence-based implementation project achieved substantial improvements in bladder management. Relational leadership theory, which integrates empowerment, purposefulness, ethical behaviors, and process orientation, underpinned the project.

Implementation of evidence in oral care for adult mechanically ventilated patients with orotracheal intubation using the framework of evidence-based continuous quality improvement: A quality improvement project

“…The baseline survey results show that the implementation rate of the review items was generally low, ranging from 22.5-80.0%. The results indicate a large gap between current clinical practice and the best evidence, which is consistent with the results of Pan [25]. Previous studies have shown that there are signi cant differences in oral care for patients mechanically ventilated through endotracheal intubation in different hospitals and among different nurses, and there is a lack of speci c and evaluable oral care tools or standards that make clinical oral assessment unsupported, resulting in di culty in ensuring the quality of nursing care [26].…”

Current opinion: postpartum urinary disorders

“…This study audited criteria such as encouraging regular voids intrapartum, recording strict fluid input and output both in the intrapartum and postpartum period, and ensuring individuals had two adequate spontaneous voids after delivery. After educational strategies were implemented, the study found reductions in both PUR incidence and the time to void after delivery [19]. Taken together, healthcare provider education on PUR is effective for properly identifying and managing abnormal voiding patterns and is important for improving patient outcomes.…”

“…Formal education increased the likelihood that trainees were able to identify concerning clinical scenarios suggestive of PUR. An additional auditing study found nurses overall had minimal training on identification and management of PUR [19]. This study audited criteria such as encouraging regular voids intrapartum, recording strict fluid input and output both in the intrapartum and postpartum period, and ensuring individuals had two adequate spontaneous voids after delivery.…”