Enhancing Postoperative Voiding Trial Adherence With QR Code-Based Video Education: A Quality Improvement Project

INTRODUCTION: Voiding trials are critical in the postoperative recovery protocol following urogynecology, urology, and gynecology surgeries. They are used to assess postoperative bladder function and identify patients who will need catheterization to protect the bladder from overdistention. Oftentimes, these protocols are detailed within electronic order sets that can be confusing to the nursing team who may be unfamiliar with the various protocols. When postoperative voiding trials are not completed properly, patients are at higher risk for suboptimal outcomes, including unnecessary catheterization or urinary retention. Digital health tools, such as Quick Response (QR) codes, present a novel solution for enhancing nursing adherence by providing immediate, on-demand access to voiding trial protocols with video content. OBJECTIVE: The primary aim of this study was to evaluate the effectiveness of QR code-based video education in improving nursing adherence to voiding trial protocols in a postoperative setting. METHODS: A quality improvement project was conducted in a tertiary care hospital’s surgical floor and post-anesthesia care unit. A pre- and post-study design was utilized to analyze 3 months of data, with the first month serving as a control group (pre-intervention) and 2 months later as the post-intervention group. QR codes were generated and placed at strategic locations in the surgical unit, including patient charts and nursing stations. Three different voiding trials were utilized: active, passive, and suprapubic catheter. Scanning the QR code directed users to a short video containing the correct voiding trial protocol, including step-by-step instructions with video demonstrations on how to perform the trial and accurately document the result. Adherence to the voiding trial protocols, measured as a percentage of total voiding trials performed and documented correctly, were recorded through chart review by two independent reviewers. Pre- and post-intervention adherence rates were assessed using a chi-square test. RESULTS: The study enrolled 147 postoperative patients (59 pre-intervention and 88 post-intervention). Adherence to voiding trial protocols improved significantly from 44% (pre-intervention) to 77% (post-intervention) (p<0.001). CONCLUSIONS: Integrating QR code technology into the postoperative workflow significantly improved nursing adherence to voiding trial protocols. This low-cost, easily implementable solution has the potential to streamline protocol adherence in various clinical settings, likely improving patient outcomes and nursing workflow (Table 1).