Simple Bedside Cystometrogram Use by Advanced Practice Continence Nurses in Long Term Care

Statement of the Problem:  Urinary incontinence (UI) is prevalent in approximately 70% of the long term care (LTC) population. Debate exists over the use of simple bedside cystometrogram (CMG) testing, to establish a confirmed diagnosis and correlated plan of care versus a presumptive diagnosis and empiric treatment.  As CMG testing has been associated with a risk of urinary tract infection, particularly in frailer individuals, the value of its use in the LTC population who often have more complex symptomatology needs further exploration. 

Purpose:  The primary purpose was to describe the APCNs’  UI diagnosis and plan of care pre versus post simple bedside CMG testing for LTC patients with UI.   The secondary purpose was to determine the incidence of post-CMG (simple bedside) urinary tract infection (UTI) rate 1 week following CMG testing.

Methodology:  A descriptive study design utilized pre-CMG and post-CMG test investigator-designed questionnaires.  A convenience sample of APCNs practicing in LTC, who routinely perform bedside CMG testing, were recruited to complete the pre-CMG questionnaire and the post-CMG UTI incidence questionnaire while performing their routine consultation. The post-CMG questionnaire was completed by the researcher through review of APCNs’ records.  

Statistics: Descriptive statistics were utilized.

Results: Simple bedside CMG testing was statistically significant in the decision-making of the APCN related to diagnosis of UI type (p = 0.04) and change in the treatment plan post-CMG from the pre-CMG anticipated treatment (p = 0.008).  UTI incidence at one week post-CMG was zero.

Conclusion: The findings of this pilot study, while not generalizable due to the small sample size, indicate the simple bedside CMG test may impact the APCN’s diagnosis and treatment plan decision-making.  Additionally, the use of simple beside CMG testing was not associated with increased rate of UTI.