Evidensbaserad blåsövervakning vid ortopedisk vård : Patienters erfarenheter och personals följsamhet till riskbedömning vid höftkirurgi

Sammanfattning: Background: Hip surgery, a common healthcare procedure in Sweden and worldwide, is like other surgical procedures associated with risks of complications, such as urinary retention. Urinary retention is prompted by several factors experienced by the orthopaedic patient, such as pain, bed rest, medication (opioids, anaesthesia) and intravenous treatment with fluids. To prevent urinary retention or other voiding complications, there are evidence-based guidelines, supporting safe clinical care and averting unnecessary care injuries. Prior studies indicate that these guidelines are neither fully known nor used by orthopaedic staff, but bladder distension is still one of the most common adverse events in Swedish orthopaedic care. This licentiate thesis represents two studies, constituted by baseline data from 17 orthopaedic units in the Onset PrevenTIon of urinary retention in Orthopaedic Nursing and rehabilitation (OPTION) trial.   Aim: The overall aim was to explore patients’ experiences of bladder care and voiding issues due to hip surgery and to evaluate staffs’ adherence to risk assessment for urinary retention according to evidence-based guide-lines.  Design and method: Study I had a descriptive design and data was analysed using inductive content analysis. Study II was an observational study analysed with descriptive and comparative statistics, and logistic regressions.  Findings: Patients experienced that bladder care and monitoring seemed important, although the reason was not fully explained to them, nor the related risk between hip surgery and urinary retention. Those experiencing bladder issues postoperatively managed and sought care on their own, not associating such events with their hip surgery. The bladder issues were described as negatively affecting daily life.  Documentation in medical records (n=1382) indicated low adherence to recommended risk assessment for urinary retention (23.4%), and performed assessment was significantly associated with acute surgery or being treated at an academic hospital. Acute patients experienced urinary retention or other bladder issues more frequently, and among those patients completing a survey (n=447), 11.9% reported increased bladder issues after surgery.  Conclusions: With a lack of communication with patients about bladder care, and limited adherence to risk assessment for urinary retention, further efforts to reinforce guideline implementation are needed. This should include a more patient-centred approach in the attempts to provide better, safer and more equal care.