Urinary incontinence (UI) has become a hot topic in LTC due to federal mandates described in the CMS F315 Tag. These guidelines require all clients with continence related problems to be assessed, evaluated and treated to restore optimum bladder function. This provides a window of opportunity for continence nurse specialists to develop continence programs in LTC that are respected and indispensable (Smith, 2000).

Objective A weekly LTC continence clinic was set up by an independent WOC Nurse practitioner to evaluate residents with bladder/bowel control issues. Education of staff at all levels about UI and treatment modalities was part of the comprehensive continence program.

Outcomes Over 57 residents were evaluated over a 11 month period in a 215 bed LTC facility. Over 90% suffered urge UI or OAB (over active bladder); 33% suffered incomplete emptying problems; 12% suffered from chronic urinary tract infection (UTI); 12% incontinence associated dermatitis (IAD); 6% with symptomatic prolaspe. 15 residents had at least moderate reduction in UI episodes (moderate = 50% reduction in UI episodes from baseline; may be wet @ HS); 12 residents became greatly improved (wore underwear & pad for 1 damp episode during the day) while 16 residents became completely continent (no pad usage). 6 residents had variable progress (less UI vs. same as baseline) & 2 residents did not change from baseline. Progress could not be evaluated on 7 residents who had only initial evaluation completed. Surprising was the 51% reduction in pad use by residents. Staff was responsible to implement treatments and monitor response. They developed ownership of the program and acknowledged that inappropriate belief systems were dispelled. Further discussion of the outcomes will be forthcoming.

Reference Smith, DB. (2002). Establishment of Continence Services. In DB Doughty (ED.), Urinary and fecal incontinence: Nursing management, 2nd edition. St. Louis: Mosby, Inc.