Assessment of the incidence and risk factors of postpartum urinary retention after cesarean section delivery and implementation of the best practice in Alzahra and Taleghani educational and medical centers

Abstract

Postpartum urinary retention (PUR) is one of the most common cases in women after cesarean section. PUR in these women, although does not have a life-threatening effect, it leads to the discomfort of patients and the risk of complications such as bladder rupture and recurrent urinary infections. Objective: The aim of this evidence implementation project was to evaluate urinary retention after cesarean section in Alzahra and Taleghani educational and medical centers in Tabriz, Iran. Methods: A clinical audit, before-after study was undertaken using the JBI checklist. Sixty physicians and 30 nurses were participated in this study. A checklist including eight audit criteria, representing the best practice recommendations for evaluation of urinary retention after cesarean section was used for data collection. A baseline audit was conducted, followed by the implementation of multiple strategies. The project was finalized with a follow-up audit to evaluate changes in practice. The criterion was considered excellent compliance, moderate, and non-compliance if the number of yes answers was above 75%, between 50-75%, and below 50% respectively. Results: Results of this baseline audit showed that all criteria except one, was non-compliance with the best practice. As the next step, barriers to the non-compliance and strategies to improve these barriers were identified and implemented. These strategies include holding a one-day conference about PUR, holding a workshop about communicating with patients and guideline adaptation and applying it in the ward. Results of the follow-up audit indicated that all areas have improved after the implementation of the interventions compared to the baseline audit. Also, the compliance with the standard in all areas except criteria 2 and 7 was above 50% and acceptable. These two criteria were related to pre-operative screening of patients for PUR and bladder ultrasound screening.