OIA2021120902 Response.pdf

15 February 2022

      OIA Reference: OIA2021120902

Andrew McGregor

Email: [FYI request #17708 email]

Tēnā koe Andrew

Official Information Act 1982 (OIA) – Joint 2DHB Response – OIA2021120902

Thank you for your official information request regarding guidelines and procedures for management
and treatment of patients, which was received by Hutt Valley (Hutt Valley DHB) and Capital & Coast
(CCDHB) District Health Boards on 9 December 2021. You requested the following information:

  Please provide Guidelines/Procedures for the management of postoperative Urinary Retention
(POUR).
  Please provide Guidelines/procedure for the management/prevention of persistent Postsurgical
Pain.
  Please provide Guidelines/procedure differentiating subtypes of primary (idiopathic)
constipation.
On 17 January 2022, we notified you that you could expect a response from us on or by 21 February
2022.
Due to our two DHBs sharing information, staff, many services, and a single Chief Executive, you are
receiving a joint Hutt Valley and Capital & Coast DHB (2DHB) response. Please be assured that separate
data sets will apply to each DHB in this joint response.

Our joint 2DHB response to your request is outlined below.

CCDHB Response

  Please provide Guidelines/Procedures for the management of postoperative Urinary Retention
(POUR).

Monitoring for post-operative urinary retention is a routine clinical task carried out for all patients.
There is no single policy for this. It is variable depending on the clinical situation and so the patient is
assessed and treated based on their specific circumstances (see examples in attachments 1, 2 and 3).
For some surgical specialties, many patients will return from theatre with a catheter in-situ. Urinary
output is measured as part of the Early Warning Score (EWS) assessment (Attachment 4) as well as
through fluid balance. The surgical wards/areas have access to bladder scanners, which are used to
identify urinary dysfunction, including retention. All wards/areas follow the Indwelling Urethral

Hutt Valley DHB | Private Bag 31907, Lower Hutt 5010 | 04 566 6999 l   www.huttvalleydhb.org.nz
Capital & Coast DHB | Private Bag 7902, Newtown, Wellington 6342 | 04 385 5999 l www.ccdhb.org.nz

Catheterisation Guideline (Attachment 5) should a patient require catheterisation following a surgical
intervention as a result of retention. This guideline also covers trial removals and removals of catheters.

  Please provide Guidelines/procedure for the management/prevention of persistent
Postsurgical Pain.

There are no specific guidelines or procedures as requested.

Persistent post-surgical pain would be defined as pain that has persisted beyond 3 – 6 months after
surgery.

Management depends on the nature of the surgery and the cause of the pain. The pain service would
always recommend a surgical review to exclude treatable causes.

Following this some pointers as to the management of chronic pain can be found in the chronic pain
pages of the community health pathways “chronic non-cancer related pain” and “medications in chronic
non-cancer related pain”.

There are no guidelines for the prevention of persistent post-surgical pain. Intuitively, good pain
management in the peri-operative period should lessen persistent pain, but this has not been proven.

There are some more specific management options for specific conditions, such as phantom limb pain
and complex regional pain syndromes, but we would need more information to advise on a specific
condition.

  Please provide Guidelines/procedure differentiating subtypes of primary (idiopathic)
constipation.

There is CCDHB guideline/procedure differentiating subtypes of primary (idiopathic) constipation. A
3DHB Health Pathway on constipation can be found here:

https://3d.communityhealthpathways.org/13804.htm

HVDHB Response

  Please provide Guidelines/Procedures for the management of postoperative Urinary Retention
(POUR).

Monitoring for post-operative urinary retention is a routine clinical task carried out for all patients.
There is no single policy for this. It is variable depending on the clinical situation and so the patient is
assessed and treated based on their specific circumstances (see examples in attachments 1, 2 and 3).
For some surgical specialties, many patients will return from theatre with a catheter in-situ. Urinary
output is measured as part of the Early Warning Score (EWS) assessment (Attachment 4) as well as
through fluid balance. The surgical wards/areas have access to bladder scanners, which are used to
identify urinary dysfunction, including retention. All wards/areas follow the Indwelling Urethral
Hutt Valley DHB | Private Bag 31907, Lower Hutt 5010 | 04 566 6999 l   www.huttvalleydhb.org.nz
Capital & Coast DHB | Private Bag 7902, Newtown, Wellington 6342 | 04 385 5999 l www.ccdhb.org.nz