Dr. Jennifer Ann Meddings on implementing a urinary retention evaluation protocol

In this video, Jennifer Ann Meddings, MD, MSc, discusses the JAMA Network Open paper “Urinary Retention Evaluation and Catheterization Algorithm for Adult Inpatients.” Meddings is an associate professor at the University of Michigan in Ann Arbor. The algorithm can be accessed at: https://msqc.org/wp-content/uploads/2024/01/Urinary-retention-and-safe-catheter-insertion_2024-version.pdf

Transcription:

Is there anything you would like to add?

There are a couple of things that we think are important for whenever you're implementing these things, particularly regarding a urinary retention protocol. One is making sure that not only are the nurses aware of it, but making sure the trainees are aware of it and making sure that the urologists are aware of it so that if they get called because the patient has a high risk, they're not surprised regarding why they're needing to do that. We have found it very helpful to chat with trainees because they're often the ones that are getting the calls first regarding, should I catheterize this patient or I've catheterized this patient, I've attempted, and this is what I do. Because keep in mind that many of the trainees—and we're not talking about urology fellows or urology residents, we're talking about medicine and surgery residents—they have less experience placing catheters than the nurses do. But they're the ones that are getting called. We're having to fill in this type of education. Keep in mind that medicine residents often get very little education regarding this. The last time they placed a Foley was when they were a medical student, and so we think that's very important to keep in mind. Our nurse practitioners and physician assistants will also need to be aware of this, but because they change less frequently, it doesn't have to be so much in your recurring curriculum. But we think that this is important, particularly in trainees. And July just happened, so there are a lot of new trainees out there that are answering questions from the nurses about urinary retention that you may not be aware of what they're saying or would've answered something different based upon your level of experience.

Another reason why our team was inspired to work on this algorithm, and particularly as I'm an internist, we would have these patients come in that had chronic retention but had not been catheterizing, and then they would end up with renal failure and other complications with it. And then we would ask them, why are you not catheterizing or why were they so resistant for the nurses to catheterize them in the hospital? And it was often because they had such a bad initial experience with their catheterizing, because often these [patients], particularly our men with chronic retention, they have enlarged prostates. We're not going to be able to capture this in our current study, but our hope is that if we can improve the experience of their initial treatment for urinary retention, then particularly the patients who actually need to catheterize to maintain their kidney health, they would not be afraid of catheterization. They would not have traumatic experiences from it. And we have learned, particularly with some of my colleagues who have done interviews for years with veterans regarding this. They have very vivid memories about poor and painful catheterization experiences. They may not remember exactly why they were in the hospital or what they were sent to the ICU for, but they will remember that they had a painful urinary catheter experience. And so we're really trying to, if we can reduce that, number 1, we'll improve their quality of care, we'll make them less concerned about coming back to the hospital. But if they do need to use catheters at home, maybe we'll give them a better experience to start with so they'll be less afraid.

This transcript was edited for clarity.