Åsa Bäärnhielm, Lars Sturesson, Ewa Gustafsson, Stefan Anania

1. Inventing and solving a problem Nursing a patient with a nephrostomy tube Åsa Bäärnhielm, Lars Sturesson, Ewa Gustafsson, Stefan Anania A cooperative study between the Department of Urology, the Medical Imaging Centre and the Accident & Emergency Department at Stockholm South General Hospital Objectives: Urological patients sometimes, for a number of different reasons, need to be given a nephrostomy catheter for a period of time or for life. After receiving the catheter, the patient stays at the hospital for around 24 hours. This is to ensure that the catheter is working and to teach the patient how to manage his or her new way of life, including what to do if the catheter stops working. Source: UCL Institute of Child Health At the start of the project we wanted to find out whether there was a trend for long waiting times for patients with nephrostomy problems. If so, how could we provide the most appropriate information and achieve optimum results in reducing waitig times. We also wanted to examine the routines relating to consultations forthese patients and if necessary amend the guidelines. The Nephrostomy Project has attempted to identify and describe the problems faced by patients when the nephrostomy tube malfunctions. We have also presented proposals for certain amendments to the standard procedures and guidelines. Methods: • To establish whether there was a problem with long waiting times in Accident and Emergency, we studied 75 patient records from 2004-2006. We found that the average wait was between six and seven hours. In other words, there really was a problem. • The initial aim was to reduce waiting time by 50%. However, the principal aim then changed from reducing waiting times to advising most patients not to attend Accident and Emergency but to make appointments directly at the Medical Imaging Centre. • Meetings were held to inform staff involved in managing these patients. and talks have been given on nursing patients with nephrostomy tubes throughout the hospital. An information brochure was produced and distributed to patients and to staff involved, both in and outside the hospital. • The number of patients attending the Medical Imaging Centre was recorded and compared with the number attending Accident and Emergency over the period 2004-2008. • A questionnaire was handed out during the autumn of 2008 to obtain the views of patients on this matter. Results: There was more than a 100 % decrease in the number of patients who presented in Accident and Emergency to have their nephrostomy tubes changed in 2008 compared with 2005. Conclusions: The conclusion is mainly based on the assumption that several kinds of improvements represent a better situation for patients with nephrostomy tubes. We have found that good quality information is vital and enables patients to take action themselves, which also fosters a sense of self-determination. We have also found that information provided to staff involved with these patients reliably improves the nursing of the patient. The main aim, to persuade patients to go to the Medical Imaging Centre directly in order to avoid long waiting times in the Accident and Emergency Department, has been achieved, with the result that there is more space and time for patients with other illnesses. References: • Urologic Nursing, Dec. 1995, Vivian A. Cofield, RN, CURN Percutaneous Nephrostomy Tubes: Nursing Care • Urology ward attenders: auditing a nurse-led service - Joseph Nariculam, Declan G Murphy Cathy Jenner, International Journal of Urological Nursing, Volume 1, Issue 2, Page 71-76, Jul 2007, International Journal of Urological Nursing, Volume 1, Issue 2, Page 71-76, Jul 2007