Development, Implementation, and Impact of an Electronic Medical Record Alert System for Implanted Artificial Urinary...

The presence of an artificial urinary sphincter can be overlooked resulting in inadvertent urethral catheterization and cuff erosion. A hard-stop best practice advisory was created in the electronic medical record to alert for the presence of an artificial urinary sphincter. We evaluated its utilization and impact on patient outcomes.

Our advisory fired for men with an artificial urinary sphincter implanted or in place between August 1, 2016, and September 30, 2023. We calculated exposure years (total time in years of implant duration during each time period), which were used to determine incidence rates of explants, erosions, and erosions preceded by catheterization before and after advisory implementation. Rate ratios (adverse event rate/exposure years) were compared before and after advisory using a test of 2 rates based on Poisson distribution. P values < .05 were considered statistically significant.

Two hundred thirteen unique implants were identified in 194 patients. The advisory fired 2425 times for a median of 36 unique patients per month. Twenty-five explants occurred, with 22 (0.6/exposure years) before advisory and 3 (0.1/exposure years) after advisory (P = .01). Nineteen (0.03/exposure years) of the 25 explants were due to cuff erosion, with 17 of 19 (0.04/exposure years) occurring before advisory and 2 of 19 (0.01/exposure years) occurring after advisory (P = .02). Ten (0.03/exposure years) of the 19 erosions were preceded by inadvertent catheterization without implant deactivation, all of which occurred before advisory. No erosions preceded by inadvertent catheterization occurred after advisory.

Our novel advisory has strong implications for patient safety in men with artificial urinary sphincters.