My name is Amber Fischer and I am one of the

quality leads on my unit 3E3 at the University

Hospital in Edmonton. I have been doing this for

over a year now and thought I would share

what this entails. The role of the quality lead is

to examine what is working and what is not

working on our unit in order to achieve quality

patient care. This is done through: data collec-

tion, chart audits, and patient surveys just to

name a few. There is a team of quality leads that

meet monthly to discuss new initiatives and see

how our units are doing.

Over the last year I have been mainly focusing

on ERAS: Early Recovery After Surgery in re-

gards to our cystectomy patients. So what is

ERAS? “ERAS standardizes care before, during

and after surgery and helps patients get back on

their feet quicker while shortening hospital stays

and reducing surgical complications.” (https://

www.albertahealthservices.ca/scns/page10959.aspx)

For a post op patient these include:

Early Mobilization; out of bed post op day 0

is proven to help reduce complications.

Early oral nutrition; starting ensure post op

day 0 to increase wound healing, increase

energy and decrease patient’s length of stay.

Chewing gum to increase bowel motility

and prevent an ileus.

Avoiding fluid overload by weighing patients

daily, accurately tracking input and output

and avoiding fluid boluses. (More information

on ERAS can be found at www.ahs/eras.ca)

So what do I do?? Once a week I do chart audits

and data collection to ensure the key points of

ERAS are being completed. If they aren’t being

completed I try to figure out why. Is it a lack of

staff participation, education or are patients re-

fusing to participate. Once the audits are com-

plete I use the information to try to come up

with a plan to increase the compliance. On my

unit we initially struggled with input and output

documentation (I know, strange for a urology

unit) so, along with a co-worker we imple-

mented a new documentation sheet so patients

could keep track of their input for us and the

nurse would just transfer the information to the

in and out sheet and it worked. Our initial com-

pliance for documenting oral intake was 31%,

after about six months our compliance was up

to 80%, a huge accomplishment.

Other things I have done include being transpar-

ent with the staff; making sure they knew what

the results of the audits were. I found if they

knew we were only at 47% compliance with

night one mobilization, they were more likely to

try and improve this number. I would include

the manager to ensure the parts of ERAS were

being followed. During our team huddle once a

week I would remind the staff of the importance

of ERAS, and what tools are in place to ensure

we are being compliant. I would also talk to and

re-educate patients about what their part in

ERAS and recovery was.

Continued on page 2

The Day In The Life Of A Quality Lead

I N S I D E T H I S

I S S U E :

UNC/CUA 2020-

Cancelled

2

Scholarship Award

Winner-2019

3-4

Nursing Initiative

Award Winner –2019

5

Phone and Video

Consulting...

5

Welcome to New

Editor

5

Chapter Updates 6

New and Exciting

UNC Happenings

7

PIPELINEPIPELINE May 2020

The Pipeline is published

each fall and spring for

UNC members and their

sponsors and is also

located at www.unc.org.

The Pipeline is looking for

articles for publication

about new initiatives in

urology, latest technology,

clinical research and

evaluation, local chapter

activities, patient and

community resources.

Deadline for next issue:

October 15, 2020

Contact the Editors:

Gina Porter, Gina Harding

pipeline@unc.org

U C N

A Publication of the Urology Nurses of Canada

National Sponsor Ad 9

Coming Events 10

National Sponsors 11

UNC Info 8

P A G E 2

On March 16, 2020, the following letter

was emailed out to the membership, con-

ference registrants, as well as posted on

the UNC website.

After much careful consideration

with the projected impact of

COVID-19 and the health of this

country, and by following the

Health Canada and BC Ministry of

Health's recommendations of no

gatherings larger than 50 persons

along with the cancellation of the

CUA 2020 annual meeting, the

UNC Executive board regrets to

announce the UEC 2020 Meeting

in Victoria is unfortunately can-

celed. This was a difficult decision

to come to, however, for the

safety of our members, confer-

ence attendees, hospitality staff,

and all

“Prior to ERAS the

average length of

stay for

cystectomy patient

was 13 days…”

In general the goal of the quality team was

to ensure that the steps of ERAS were be-

ing followed in order to decrease patient

complications and decrease patient length

of stay and we were able to accomplish

this. Prior to ERAS the average length of

stay for cystectomy patient was 13 days,

now the average length of stay is 10 days

and we have seen a decrease in complica-

tions.

What’s next? Ensuring the quality of care

for our patients, especially in regards to

The Day In The Life Of A Quality Lead-Continued

PIPELINEPIPELINE

UNC/CUA 2020 Conference - Cancelled involved in the conference, this conclusion is

essential for everyone's wellbeing. For those

that have already registered for the confer-

ence, the UNC executive will be having a

teleconference shortly and will contact all

registrants via email with information soon.

If you have already reserved a room, please

cancel your hotel reservation.

The UNC board has received many applica-

tions for the awards program; thank you for

your applications. We will be holding on to

all awards submissions at this time. The

UNC conference planning committee and

executive board thank you for your under-

standing and support during these extraordi-

nary times.

Courtney Ware

Chair, UEC 2020 Victoria

ERAS, will be continuous, we are currently

focusing on increasing the compliance re-

garding early oral nutrition. I also am going

to train the next quality lead. Time to pass

the torch.

I would also like to thank the committee

for granting me the attendance award for

the 2019 UNC/CUA Conference. I look

forward to the conference every year and

getting the award makes it so much easier.

Submitted by: Amber Fisher

U C N

Scholarship Award Winner -2019: Gloria Connolly

P A G E 3 M A Y 2 0 2 0

Thank you to the Urology Nurses of Canada for selecting me

as one of the recipients of the 2019 UNC Scholarship

Awards. The monies awarded will help towards the cost of

completing the Nurse Specialized in Wound, Ostomy and

Continence (NSWOC) program. As a Clinical Nurse Educa-

tor (CNE) in Geriatrics, my focus is on what affects this

population, promoting evidence-informed practice, and as a

Nurse Continence Advisor (NCA), improving continence

care.

Incontinence is not a normal part of ageing; however, many

factors can increase an older adult’s risk of incontinence,

including:

Changes to body systems and organs

Having another illness(es)

Taking multiple medications

Experiencing problems with memory

Difficulty mobilizing and caring for self

Age-related changes to the urinary system can

include:

Bladder muscle and message pathways not communicat-

ing as well

Not being able to hold as much urine

Increase in unnecessary bladder contractions

Weakened bladder contraction

Less physical awareness about bladder filling

Decreased kidney efficiency causing urine production at

night

For women: the urethra closes less tightly, tissue thins

and becomes dry as levels of estrogen drop

For men: the prostate gets bigger

These changes may results in a variety of symptoms,

including:

Rushing to the bathroom because of delayed awareness

of the bladder being full

Voiding more often because the bladder is not com-

pletely emptied

Getting up during the night to void

Women may leak urine, have more urgency, frequency

and increased risk for urinary tract infections (UTIs)

Men may experience difficulty passing urine, voiding in

smaller amounts and dribbling

(Wagg et al. 2017 pages 1316-1321)

(See chart 1 for the diseases and illnesses that increase the risk of

incontinence.)

It is essential to understand what may be adding to the risk of

incontinence and reduce the impact of these factors as much

as possible. Interventions such as assessing medications that

may be worsening incontinence using resources that

focus on this population (e.g. American Geriatrics

Society 2019 updated AGS Beers Criteria®). Con-

necting with other disciplines (e.g. physiotherapy,

occupational therapy) to review how able to best

mobilize and manage toileting for individual patients.

For cognitively impaired patients, changes to the

brain may affect one's ability to recognize that the

bladder is filling or what to do, as is the case with

dementia. (See Chart 2 Functional Incontinence: some

new term - ICS glossary.) Make sure clear signs show

where the toilet is; this can include using pictures of a toilet,

keeping bathroom doors open and using contrasting colours

between the toilet and the floor. (Wagg et al., 2017)

(Palmer, 2016)

In conclusion, many factors can contribute to the increased

risk of urinary incontinence in older adults. It is up to us to

take time to do an in-depth assessment and not assume it is a

part of ageing.

Submitted by: Gloria Connolly RN, BScN, NCA, GNC(C)

(NSWOC Student) Clinical Nurse Educator (CNE) Geriatrics

- NSHA, Halifax, NS

References

2019 American Geriatrics Society Beers Criteria® Up-

date Expert Panel, Fick, D. M., Semla, T. P., Steinman, M.,

Beizer, J., Brandt, N., Dombrowski, R., DuBeau, C.E.,

Pezzullo, L., Epplin, J.J., & Flanagan, N. (2019). American

Geriatrics Society 2019 updated AGS Beers Criteria® for

potentially inappropriate medication use in older adults. Jour-

nal of the American Geriatrics Society, 67(4),674-694.

Continued on page 4

“It is essential to

understand what

may be adding

to the risk of

incontinence…”

Wagg, A., Chen, L.K., Johnson II, T., Kirschner-

Hermanns, R., Kuchel, G., Markland, A., Murphy, K.,

Orme, S., Ostaszkiewicz, J., Szonyi, G. and Wyman, J.

(2017). Incontinence in Frail Older Persons. In P.

Abrams, L. Cardozo, A. Wagg & A. Wein (6th Eds.), In-

continence (1309- 1442).

P A G E 4

References - continued from page 3

International Continence Society (ICS) Glossary terms

retrieved from: https://www.ics.org/glossary

Palmer, M. H. (2016). UI and lower urinary tract symp-

toms in the older adult. In Wound, Ostomy and Continence

Nurses Society Core Curriculum Continence Management.

(pp. 180-195). Philadelphia: Wolters Kluwer

Scholarship Award Winner -2019 Continued

PIPELINEPIPELINE U C N

Table 1 Diseases & Illness that increase Risk of Incontinence

(Palmer, 2016 pg 180- 191) (Wagg et al. 2017 pg 1322-1323)

Diseases & Illness Intervention

Diabetes- High blood sugars will cause more urine to be produced

to try and get rid of extra glucose,

Good to have better control of diabetes

Joint pain- Will make getting to the bathroom harder Treat pain with medications and other things such as

heat

Cough- Maybe because of lung problems such as COPD; this can

cause leakage with coughing (stress incontinence)

Try and reduce coughing with medications

Extra body fluid- Things such as leg swelling (edema) and heart-

pumping problems (congestive heart failure) increase the amount of

fluids the kidneys need to get rid of and cause people to void more

often, especially at night.

Controlling heart failure, reducing sodium, wearing

support stockings, raising legs during the afternoon

will help the body get rid of the fluids during the day-

time.

Constipation- If very bad can make it more difficult to pass urine Treat constipation by eating lots of fruits and vegeta-

bles, increasing fibre and water and taking medications

to soften stool if needed.

Diseases such as stroke and Parkinson’s- Effect a person’s mobil-

ity causing a sense of urgency to try and make it to the bathroom in

time

Regular help to go to the toilet is needed

Dementia- Have more difficulty with locating the toilet and being

able to care for themselves properly after

Regular help is needed

Table 2 Things outside of the urinary system can affect being able to get to the bathroom in time to void commonly known as

Functional Incontinence; some new terms are as follows:

pleased to announce that Gina Harding, our current NS

Provincial Representative, has agreed to take over the edi-

tor’s position starting with the November 2020 issue! Please

join me in welcoming her to the position!!

Submitted by: Gina Porter RN, NCA

It has been my great pleasure to be the editor of the UNC

Pipeline for the past seven years. It is wonderful to see our

members step outside their comfort zone and write their

first article for their very own newsletter but it is now time

to pass the torch along to someone with fresh ideas. I am

Changing of the Guard: New Pipeline Editor for Fall 2020

Nursing Initiative Award Winner -2019

P A G E 5 M A Y 2 0 2 0

ble. For example: if video conferencing from home, un-

plug or mute the phone and ensure children are not mak-

ing a lot of background noise.

When teaching (i.e. pre-op or Kegel exercises, etc.), mail-

ing patient information brochures and or bladder diaries

ahead of time, will enable the patient to follow along with

you more easily.

Ask the patient if they are familiar with certain hospital

approved programs and if they are, would they like to

include their spouse or partner on the conference call.

Keep the calls short and concise; this will help prevent

the patient from becoming overwhelmed. More frequent

follow up calls may be required instead.

Ensure you have given the patient enough time to verbal-

ize his/ her concerns and that you have addressed any

questions they had.

Mail out validated questionnaires pre and post telephone/

video consults to capture the full understanding of the

patient in regard to his teaching/ follow up.

Submitted by: Frankie Bates RN, NCA

During these difficult times of the COVID 19 Pandemic, many

of us as Healthcare professionals need to follow up with our

patients by phone or video consultations. This can certainly

be trying at times and never quite the same as eye to eye

contact but none the less, very effective. Clinicians should

use their professional judgment to make decisions about the

most appropriate consultation method on an individual basis.

Here are a few top tips to help guide professionals.

Most importantly ensure that privacy is maintained at all

times. Ask the patient the questions “Is now a good time

to speak with you?” and “Are you able to talk in private

about your medical condition?”

Introduce yourself and ensure you maintain your profes-

sional attitude. This may be something as simple as wear-

ing your lab coat on a video call or if calling from a home

office not having household clutter visible to the patient.

Explain to the patient that for their health and safety, it is

best they stay away from hospital visits during this time

and assure them, you can cover the same information

with video or phone teaching.

Try to ensure you have the fewest interruptions possi-

Phone and Video Consulting During COVID 19 Pandemic.

Again, I am very thankful to the UNC for their continued

support with the 2019 Nursing Initiative Award. Furthering

education in our membership is a strong sign of dedication to

our profession and concretes the foundation for the future.

Education has always been and will continue to be in the

forefront of my practice. My passion for the UNC is growing

stronger with each opportunity to network with fellow UNC

members and attend education sessions. The 2019 UEC in

Quebec City was again, a testament to meeting my educa-

tional needs. Hearing the new innovative surgical techniques

of live donor transplants and understanding the importance of

time, donor and recipient monitoring of intra-operative and

post-operative care, to understanding the overall procedure

really demonstrates how we continue to raise the standards.

As I continue to volunteer with the UNC, this has given me a

vast number of experiences and I’m eager to share my passion

and new knowledge for urology nursing.

Submitted by: Todd Bradley

Edmonton, AB Chapter

We had to cancel our Urology Daze which was scheduled for

May 1st. We were hoping to have it in the fall but have post-

poned it until next spring as we were hearing about the po-

tential 2nd wave of COVID-19 in the fall. We are hoping to

have the event on April 30th next year but we have not

heard from the hotel yet.

Submitted by: Betty Ann Thibodeau, Chapter contact

P A G E 6

Calgary, AB Chapter

Our chapter had successfully organized a Urology Education

day (Theme: Love your prostate) last year. There is no event

or meeting being planned so far this year due to COVID-19

pandemic restrictions.

Submitted by: Geman Chen, AB Prov. Rep

Chapter Updates

PIPELINEPIPELINE U C N

Annual Election for UNC Executive and Provincial Reps With the cancellation of the UNC/CUA conference for 2020,

due to the COVID 19 pandemic, this has resulted in missed

opportunities for further education for all that were planning

to attend. We are looking into the possibility of partnering

with the CUA to look at further education programs later in

the fall. Once we have confirmed these we will be sure to

keep the membership informed.

The other impact of the cancellation is that we will miss our

Annual General Meeting and election. This has presented the

Halifax, NS Chapter

We have a good number of members, 9 in total here in Hali-

fax and 2 of them being first time registrants to the UNC. So

very exciting!

We were really looking forward to our annual Dine and

Learn that was scheduled to take place May 7, 2020. It was

set to be a good one, especially having had such strong finan-

cial support again this year from multiple pharmaceutical

companies. Unfortunately, with the COVID-19 restrictions

implemented, we have had to reschedule to sometime in the

fall. We already had several nurses reaching out from local

areas to see if/ when the event was going to happen this year

and looking to secure seats. With the enthusiasm and thirst

for knowledge of our members, filling seats is not a prob-

lem. We usually have approximately 75 people in attendance

and spend 4 hours networking and have several guest speak-

ers discussing the most up to date urological topics.

This year we have also done some fundraising events to help

support the ability to send more members to our annual con-

ference and give more people an opportunity to experience

such an exciting and educational event.

Unfortunately things happen, schedules change for the safety

of everyone. So we will have to challenge our excitement for

Niagara Falls in 2021

Our goal as always is education, networking and becoming a

stronger chapter here in Nova Scotia.

Submitted by :Liette Connor RN VP East

Gina Harding RN NS Prov Rep

Saint John, NB Chapter

The Saint John Chapter of the UNC has been meeting

approx 3 times annually. We have 4 members presently. We

are presently working on organizing our annual Dine and

Learn. This year it is scheduled for September 15th. It will be

held at Thandi's Restaurant again as it has been extremely

popular in the past. We plan to have speakers on topics such

as Androgen Deprivation Therapy, Negative Wound pres-

sure and Vacuum devises and Pelvic floor Physiotherapy.

We are currently working on sponsorship. We were disap-

pointed as a chapter that the UEC was cancelled as 2 of our

members had planned to attend. However, we will make our

Dine and Learn something to focus on in our further educa-

tion until the unrest with COVID settles.

Submitted by: Frankie Bates RN, NCA, NB Prov. Rep

Executive with a unique and unprecedented problem; how to

hold the annual election for 2020. Because this is not an oc-

currence covered in the Constitution, the Executive will be

discussing how to proceed at a planned teleconference in

early May. We will keep the membership informed once a

decision has been made. Please feel free to contact any of the

Executive if you have any questions, concerns or suggestions.

Thank you

UNC Executive

P A G E 7

Come check out the

new UNC website!

It is now user friendly

for all your devices!

You can renew your

membership or check

out popular posts from

Urology sites around

the world under the

Publications tab and

“News” section.

Introducing the New UNC Website

New and Exciting UNC Happenings

Clean Intermittent Urethral Catheterization in Adults | Canadian Best

Practice Recommendations for Nurses.

The work began on the Best Practice Rec-

ommendations in the fall of 2017 and in-

volved the collaboration of four Canadian

Nursing organizations to bring it to its final

fruition in April 2020. Initially the EAUN

was approached and granted permission to

cite and include aspects of their best prac-

tice guideline for intermittent catheteriza-

tion, which provided a solid base for the

development of the Canadian document.

Educational grants received from industry

partners: Coloplast, Bard, ConvaTec and

Hollister, with additional support from 3M,

provided the financial support required to

have the document professionally edited

and produced in an electronic format.

The 11 member task force consisted of expert nurse repre-

sentatives from each of the following associations: Nurses

Specialized in Wound, Ostomy & Continence Canada, Cana-

dian Nurse Continence Advisors, Urology Nurses of Canada

Announcing the release of New Best Practice Recommendations and Infection Prevention and Control Canada. The work

was conducted over a two and a half year year period elec-

tronically through teleconferencing, video

chat, zoom, etc. Countless hours of litera-

ture review, chapter development, writing

and editing has resulted in a Canadian docu-

ment created by nurses for nurses.

The purpose of the document is to provide

evidence-based recommendation and guid-

ance for nurses in diverse practice settings

who care for adults requiring intermittent

urethral catheterization. The document is

available for viewing, down loading and/ or

printing on the UNC website under the

Publications tab.

The UNC is proud to have been involved in

the development of these best practice

recommendations and we encourage all of

our members to use and share them with their nursing col-

leagues.

Submitted by: Gina Porter RN, NCA

M A Y 2 0 2 0

P A G E 8

UNC InfoUNC Info

PIPELINEPIPELINE U C N

Victoria: Ali Maclaggan - Ali.maclaggan16@gmail.com

Edmonton: Betty Ann Thibodeau -

bettyann.thibodeau@albertahealthservices.ca

Calgary: GeMan Chen - gmwwee@gmail.com

Kingston: Todd Bradley - bradleyt@kgh.kari.net

Ottawa: Susan Freed - freeds@teksavvy.com

New Brunswick: Gina Porter - gina.porter@horizonnb.ca

Halifax: Gina Harding - Ginaharding@hotmail.com

Newfoundland: Marg Hollett - margarethollett@hotmail.com

UNC Representatives 2019-2020 UNC Executive

UNC Executive

President: Susan Freed

Past President: Gina Porter

Vice-President West: Courtney Ware

Vice-President Central: Emmi Champion

Vice-President East: Liette Connor

Membership: Todd Bradley

Sponsorship: Frances Stewart

Treasurer: Nancy Carson

Secretary: Carolyn Richardson

UNC Provincial Representatives

West: British Columbia: Kari Fisher

Alberta: Linda Brockmann

Alberta: GeMan Chen

Saskatchewan:

Central: Manitoba:

Ontario: Lucy Rebelo

Ontario: Joe Lugarich

Quebec:

East: New Brunswick: Frankie Bates

Nova Scotia: Gina Harding

Newfoundland and Labrador: Marg Hollett

Prince Edward Island: Tara Rose Stewart

1. Contact nurses and allied health in your area

interested in Urologic Nursing.

2. Pick a topic and a speaker (for initial meeting).

3. Book meeting room.

4. Contact local sales rep for potential support of

meeting.

5. Advertise meeting and distribute information

about the UNC.

6. Create local executive e.g. chairperson, secretary,

treasurer.

7. Organize educational meetings/events.

8. Contact UNC provincial representative regarding

local business meetings.

9. Encourage submissions of articles and upcoming

events to the “Pipeline”.

How to form a local UNC Group Local Chapter news info: www.unc.org

P A G E 9 M A Y 2 0 2 0

Coming EventsComing Events

P A G E 1 0 M A Y 2 0 2 0

UNC / CUA Joint Conference 2020

Cancelled

Information for the 2021 conference

Will be posted on the UNC website this fall.

www.unc.org

ICS 2020 Las Vegas

50th Annual Meeting

Las Vegas, USA

November 18th– 24th, 2020 - Note date changed from

August.

www.ics.org/2020

Edmonton Chapter

2020 Urology Daze

May 1, 2020 Cancelled

Tentative date April 30, 2021 for next Urology Daze

Edmonton, AB

http://urologyinterestgroupedmonton.ca

Halifax Chapter

Dine and Learn

May 7, 2020 - Postponed until the fall - date TBA

Contact your Provincial Rep for more info.

Saint John Chapter

2020 Dine and Learn

September 15th, 2020 (COVID 19 restrictions dependant)

Thandi’s Restaurant

Saint John, NB

Society of Urologic Nurses and Associates:

SUNA UroLogic Conference

October 9th -12th, 2020

Hyatt Regency New Orleans

New Orleans, LA, USA

www.suna.org

find SUNA on facebook:

www.facebook.com/UrologicNursing

2020 Annual CANO/ACIO

October 23rd - October 26th, 2020

Victoria Convention Centre

Victoria, British Columbia

www.cano-acio.ca

WHAT DO ALL THESE

ABBREVIATIONS MEAN????

AUA - American Urologic Association

CANO/ACIO - Canadian Association of Nurses in

Oncology

CNCA - Canadian Nurse Continence Advisors Association

CUA - Canadian Urologic Association

ICS - International Continence Society

NCA - Nurse Continence Advisor

PCCN - Prostate Cancer Canada Network

SUNA - Society of Urology Nurses of America

UEC - Urological Excellence Conference

UNC - Urology Nurses of Canada

If your chapter or organization has an upcoming event

that you would like to advertise in the Pipeline, submit

the information with contact email or phone number to

pipeline@unc.org

2020 Gold Corporate Sponsors

2020 Silver Corporate Sponsor

2020 Bronze Corporate Sponsor