Management of acute urinary retention in older males

Background

This audit was conducted on a Care of the Elderly (COTE) ward in a district hospital focusing on males over 65 years of age who developed acute urinary retention (AUR) during their admission.

Introduction

AUR is a common emergency in males that is responsible for 30,000 hospital admissions a year. The suboptimal management of AUR can lead to failed TWOC, recurrence of AUR, as well as an increased risk of urinary tract infections and multiple hospitalizations. The aims of this audit were to review management of AUR on a COTE ward over a 3 month period and compared this against NICE standards.

Methods

Cases eligible for inclusion were retrospectively screened using a search function and then notes were scrutinized further to establish if the patient had experienced AUR. Following the data collation process, results were analysed for each of the key indicators using basic arithmetic calculations, descriptive and comparative statistics were used to determine the percentage outcomes within each of the data categories.

Results

For data collected in the second cycle of the audit after teaching sessions and departmental posters, there was an improvement in compliance to NICE standards in several domains including documentation of bladder scan, which increased from 79% to 88%, PR examination (from 33% to 50%) and time to catheterisation. However, 62% of male patients with AUR still did not have documentation regarding initiation of alpha blockers and only 50% had a digital rectal examination performed to establish the cause of retention.

Conclusion

There had been an improvement in compliance to NICE standards in two of the domains reviewed compared to the first cycle audit, showing the impact of teaching given, however there was still clear areas for improvement, particularly around initiating medication, suggesting a need for clearer guidelines and documentation practices.