http://www.kirklees.nhs.uk/uploads/tx_galileodocuments/TWOC_Policy_2008

TRIAL WITHOUT CATHETER POLICY

Responsible Directorate:

Provider Services

Responsible Director:

Robert Flack

Date Approved:

21st May 2008

Committee:

Governance Committee

Version Control Document Title

Trial Without Catheter Policy

Document number Author

Joanne Whiteley

Contributors

Joanne Whiteley

Version

1

Date of Production

May 2007, amended February 2008

Review date

February 2010

Postholder responsible for revision

Joanne Whiteley

Primary Circulation List

Community Nursing Teams – Kirklees PCT Continence Service Urology Dept, Boothroyd Centre, DDH

Web address Restrictions

None

Standard for Better Health Map. Domain First domain safety Fourth domain patient focus Core Standard Reference

Core standard C4 C13b C14

Performance Indicators

1. Number of successful trial without catheters performed in community

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CONTENTS

Section

Page

1.

Introduction

3

1a.

Definitions

3

2.

Associated Policies & Procedures

3

3.

Aims & Objectives

3

4.

Scope of the Policy

3

5.

Accountabilities & Responsibilities

3

6a.

TWOC Policy

4

6b.

Training Needs Analysis

5

7.

The Future

5

8.

References

5

9.

Stakeholders

5

Proposal for TWOC’s in Community

6

Appendices 1

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1.

INTRODUCTION

This policy will apply to all qualified community nurses involved in trial without catheters. At present, this is a stand alone policy but is linked to the Kirklees PCT catheterisation policy that was ratified by the Clinical Governance Overview Group in October 2007.

By following this policy, registered nurses will provide patients with excellent standards of care.

1a.

DEFINITIONS OF TRIAL WITHOUT CATHETER

- is the removal of an indwelling urethral catheter. Following removal of a catheter, an individual’s urinary output must be closely monitored. (Robinson,2005). Any episodes of incontinence must also be documented.

Historically, patients have been readmitted to hospital for this procedure but this can now be carried out successfully in the community. This has occurred in community in Huddersfield since 2000

ASSOCIATED POLICIES & PROCEDURES

2.

This Policy / procedure should be read in accordance with the following PCT policies, procedures and guidance.

•

3.

Kirklees PCT Catheterisation Policy – ratified October 2007

AIMS & OBJECTIVES

•

To ensure procedure of trial without catheter is standardised across Kirklees PCT.

•

To provide guidelines to all nursing staff involved in trial without catheters.

•

To ensure that patients have the correct information pre and post trial without catheter.

•

To prevent admission to hospital for trial without catheter

4.

SCOPE OF THE POLICY / PROCEDURE

This policy / procedure must be followed by all PCT employees and staff on temporary or honorary contracts as well as pool staff and students.

5.

ACCOUNTABILITIES AND RESPONSIBILITIES

REASONS FOR UNDERTAKING TWOC

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•

To assess if a patient can pass urine without an indwelling urethral catheter.

•

Repeated complications for the patient with an indwelling catheter, such as infection, blockage, and bypassing.

•

If the reason that the catheter was inserted is unclear or the medical status of the patient has changed, eg healed pressure sore to sacrum.

PREPARATION OF PATIENT FOR TWOC A discussion prior to arranging a TWOC must take place with the patient; this would include why the TWOC has been suggested outlining benefits, expected outcomes and what the procedure involves, outlining both nurse and patient responsibilities.

Consent must be gained from the patient for the procedure to be initiated. (DoH 2001).

TWOC has been found to be a more successful procedure when performed in patients’ own homes in comparison to a hospital setting. (Warrilow at al, 2004). I t is also less disruptive to a patient. One of the main benefits is a reduction in the risk of a hospital-acquired infection.

6a.

TWOC PROCEDURE

•

Urethral catheters will be removed by community nursing service at 8.309.30am.

•

The patient is asked to drink at least one litre of fluid following catheter removal, and to chart volumes of fluid intake.

•

The patient is also required to chart volume of urine passed, any episodes of incontinence, and record if they had the sensation to void.

•

For patients who rely on carers, the carers are instructed as to what is required regarding fluid intake etc.

•

Patients should be provided with contact details for the district nursing team should they encounter any problems, such as abdominal pain.

•

The district nurse will revisit between 1400-1530 hours; a time will be specified on the day. The district nurse will assess what has occurred since removal of catheter.

•

The patient will be given a contact number should urgent attention be needed.

•

An abdominal examination is undertaken to feel if the bladder is distended.

•

The patient is asked to void. If the patient cannot void, a note should be made of the time of the last void.

•

A bladder ultrasound scan then takes place to assess for residual urine.

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•

If there is a residual urine of more than 200ml present then re-catheterisation or self-catheterisation must be discussed with the patient.

•

If catheterisation is necessary the Kirklees PCT catheterisation policy and procedure must be followed.

•

If the residual urine is less that 100ml, the patient should be advised on an adequate fluid intake and advised to consult the Continence Service or District Nurse should a problem arise.

If the residual urine is >100ml but less than 200ml, the patient should be given advice on fluid intake, double voiding, and re-scanned in one week. If the result is the same in one week, GP advice should be sought on suitability of the male patient for an alpha-blocker such as Alfuzosin. McNeill,(2004) recommends Alfuzosin 10mg once daily for men with acute urinary retention related to BPH. If medication is commenced, a scan should be repeated in two weeks. PLEASE NOTE ALFUZOSIN IS NOT LICENSED FOR USE IN FEMALES.

6b.

TRAINING NEEDS ANALYSIS

All nurses involved in trial without catheter should be competent at catheterisation and attend bi-annual training and updates.

Training has been available on bladder scanning in Huddersfield previously and more training will be available across Kirklees PCT on a continuous basis.

THE FUTURE

7.

Following the implementation of the trial without catheter policy regular audits will take place to ensure that the policy is been adhered to by community nurses and to evaluate benefits to patients. Alongside this any cost savings will be assessed and reported on. (See Appendix One)

8.

REFERENCES

DoH (2001) ‘Good practice in consent implementation guide: consent to examination or treatment’ November 2001 McNeill SA, Hargreave TB & members of the Alfaur Study Group (2004) ‘Alfuzosin once daily facilitates return to voiding in patients in acute urinary retention’, The Journal of Urology, 171 2316-20 Robinson J (2005) ‘Removing indwelling catheters: trial without catheter in the community’, British Journal of Community Nursing’, 10(12) 553-557 Warrilow M, Williams D, Guest J (2004) ‘The introduction if a ‘trial without catheter’ model in primary care’, British Journal of Nursing, 13 17 9.

STAKEHOLDERS •

Policy Development Group Page 5 of 7

APPENDIX 1 PROPOSALS FOR TWOCS IN THE COMMUNITY A proposal is in progress, at the present time, to perform trial without catheters in community across the Kirkless PCT population. This has been successfully taking place in patients own homes since 2000 in Huddersfield. There has been no reported clinical incidents relating to this procedure in this time.

At present patients living in North Kirklees are still seen as outpatients at The Boothroyd Centre at Dewsbury District Hospital for Trial without Catheters.

BENEFITS TO PATIENT: •

Less disruptive to have a procedure at home than attend hospital

•

TWOCs more successful in a patients home as they feel more comfortable using their own toilets.

•

More likely to drink an adequate fluid intake at home. available.

•

Risk of hospital acquired infection greatly reduced.

Fluids of choice

BENEFITS TO PCT: •

Less referrals to Secondary Care making a cost saving

From January 2007 – 31st December 2007 140 patients attended The Boothroyd Centre for TWOC, approximate cost for each procedure in accordance with NHS tariff £75.

Total potential saving £10,000 From this community nursing resources need to be calculated and deducted, work ongoing.

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