Barriers and facilitators to optimising inpatient bladder management after spinal cord injury

Abstract

Study design

Qualitative survey.

Objectives

Examine clinicians’ perspectives on adherence to published evidence-based guidelines and clinician-perceived barriers, and facilitators to optimising inpatient bladder management within one Spinal Cord Injury (SCI) service.

Setting

Surgical Hospital (acute care) and SCI Unit (sub-acute, rehabilitation) in Western Australia (WA).

Methods

Clinicians reviewed an ‘Evidence Matrix’ summarising published clinical practice guidelines and recommendations for SCI bladder management. Focus groups examined the extent to which current practice adhered to recommendations and identified perceived barriers and facilitators to optimal management. Data were analysed thematically using a deductive approach.

Results

Current management closely mirrors published recommendations. Key facilitators included long-standing prioritisation of rapid progression from urethral indwelling (IDC) to a 6 hourly intermittent catheterisation (IC) protocol; regular competency audits of catheterisation technique; and a Spinal Urology Clinical Nurse Consultant (CNC) position. Barriers included limited resources/staffing; restricted access to Neuro-urology consultation; inter-disciplinary communication gaps; and delays in determining and implementing long-term bladder management.

Conclusions

Inpatient SCI bladder care in WA closely emulates published evidence, although adherence at other sites may reveal different practices. Bladder management was found to have been facilitated by a strong culture of practice led by Neuro-urologists, informed by evidence and embraced by Senior Clinicians. Further reduction in duration of initial IDC, provision of early and ongoing Neuro-urology consultations as part of standard care, increased interdisciplinary communication and dedicated SCI Urology theatre lists would further optimise management.

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Fig. 1: Interview guide for focus groups.

Data availability

Data are stored on a password protected USB and on NVivo. The datasets generated and/or analysed during the current study will be made available in The University of Western Australia’s research repository; https://research-repository.uwa.edu.au/en/datasets.

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Acknowledgements

We thank Ms S. Jonescu, Trauma Case Manager, Royal Perth Hospital, and Ms Anne Watts, Nurse Unit Manager, Fiona Stanley Hospital, for distributing study packs to relevant staff positions. Thank you also to Ms S. Knape, Registered Nurse, for professional and effective independent facilitation of study focus groups.

Funding

Project Grant (number: N/A), Neurotrauma Research Program, Perron Institute for Neurological and Translational Science, Western Australia. The University of Western Australia (in-kind funding via staff salary support).

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Contributions

LG & SD: Grant writing, study design, project oversight, data collection and analyses, paper, table preparation. GK: Data collection and analyses, intellectual input on paper. GK, DG, PB, AW, JB, JM: Intellectual input on study design and focus group questions; review, editing and approval of paper.

Corresponding author

Correspondence to Sarah A. Dunlop.

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The authors declare that they have no conflict of interest.

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All applicable Institutional and governmental regulations concerning the ethical use of data from consenting hospital staff participants were followed. The South Metropolitan Health Service Human Research Ethics Committee provided ethical approval (16-148).

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All participants (Clinicians) were provided with a Participant Information and Consent Form requiring their signatures.

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Goodes, L.M., King, G.K., Goodwin, D.M. et al. Barriers and facilitators to optimising inpatient bladder management after spinal cord injury. Spinal Cord (2020). https://doi.org/10.1038/s41393-020-0487-6

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