Early Identification and Intervention for Urinary Retention in Total Hip and Knee Replacement Patients
May, 13 2026
Sigma Theta Tau Evidence Based Practice Conference, Tidal Health
Purpose: To determine whether early bladder scanning in the PACU reduces delayed identification of post-operative urinary retention (POUR) in total joint replacement patients and supports timely intervention.
Methodology: An evidence-based protocol guided by the Johns Hopkins Nursing Evidence-Based Practice Model was implemented, requiring bladder scanning upon PACU arrival with intermittent catheterization for volumes greater than 500 mL. Data was collected via retrospective chart review for 10 weeks pre-implementation and 10 weeks post-implementation, entered into a secure database, and analyzed using comparative statistical methods.
Results: Bladder scan compliance increased from 64% pre-implementation to 96% post-implementation, demonstrating strong adherence to the protocol. The mean time to bladder scan decreased significantly from 168 minutes (N=75) to 18 minutes (N=81). Statistical analysis revealed a t-value of 12.81 with a two-tailed p-value < .0001, indicating a statistically significant improvement in timeliness of assessment. Earlier identification of urinary retention allowed for prompt intervention, reducing the risk of bladder overdistention and associated complications.
Nursing Implications: Implementation of an early bladder scanning protocol enhances nursing assessment practices, supports clinical decision-making, and promotes timely intervention. This approach has the potential to reduce complications, improve patient outcomes, and decrease hospital length of stay in the surgical population.
Conclusions: Early bladder scanning in the PACU significantly improves compliance and reduces delays in identifying POUR, supporting its integration as a standard evidence-based nursing practice for total joint replacement patients.
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