Musgrove recognised for patient safety

The team’s efforts recently gained recognition by reaching the finals of the International Society for Quality in Healthcare awards.

The urology team at Musgrove Park Hospital in Taunton, Somerset, is celebrating following news that they have reached the Paris finals of a prestigious international award for their work with the new Mediplus suprapubic foley catheter. The team entered the Patient Safety category of the 27th International Conference of the International Society for Quality in Healthcare. There had been 1,038 applications from 35 countries and the Musgrove Park team was further honoured by being asked to provide a formal presentation in front of an international audience. Suprapubic catheterisation is a minor surgical procedure traditionally performed in theatre, either under general or local anaesthesia, using blind or ultrasoundguided percutaneous trocar puncture. In recent years, suprapubic catheterisation has become increasingly used for those requiring long-term catheterisation, for example those patients with intractable incontinence or bladder outflow obstruction and in patients with neurological disorders. Suprapubic catheterisation avoids the complications of long-term urethral catheterisation, such as traumatic hypospadias and ischaemic stricture. Patients report increased satisfaction with suprapubic catheterisation, stating that they are more comfortable, and complain of less burning and reduced rates of urinary leakage when compared to urethral catheterisation (Ischsan and Hunt, 1982; Shapriro et al, 1982; Emberton and Fitzpatrick, 2008).

Suprapubic catheterisation is also advantageous when performing a trial without catheter (TWOC), as it negates the need for re-catheterisation in the event of an unsuccessful TWOC, thereby reducing unnecessary patient anxiety and the risks associated with further, sometimes multiple, urethral catheter insertions. In a Cochrane review of complications in patients catheterised for short periods (<14 days), 12 out of 14 trials demonstrated that bacteriuria was more common after urethral catheterisation (RR2.6; 95% CI 2.12 vs 3.18) (Niel-Weise and van den Broek, 2005). In addition, urethral stricture rates are dramatically reduced when suprapubic catheterisation is used (Horgan et al, 1992) and it is preferred by those who are sexually active. In recent years, the most widely used suprapubic catheter in the UK has been the Lawrence Add-a-Cath (Femcare- Nikomed), a single unit trocar introducer. The patient is required to have a full and palpable bladder prior to insertion. With the patient lying flat, the bladder is palpated and local anaesthetic is infiltrated approximately two to three finger breadths above the pubic symphysis. The bladder is located via aspiration. Once the clinician is assured of the bladder position, a 1cm horizontal incision is made. Using the introducer (trocar and sheath) and a twisting motion, the introducer enters the bladder blindly. The trocar is removed, a foley catheter is passed down the sheath and a balloon inflated. No sutures are required. New technology has allowed the development of utilisation of the Seldinger technique for SPC insertion, a medical procedure that facilitates safe access to blood vessels and other hollow organs such as the bladder via the insertion of a trocar.