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Title: Foundations of a Continence Protocol for Adults in an Acute Care Setting
BACKGROUND: Continence management for adults in acute care experiencing transient or persistent urinary and/or fecal incontinence is essential to prevent incontinence associated dermatitis, lower urinary tract and skin infections and pressure ulcers.
Unfortunately, the overuse of briefs in acute care patients increases functional incontinence, the risk of infection and epidermal damage. This occurs when the occlusive environment traps heat, enzymes and moisture allowing microbes to flourish causing skin to become more vulnerable.
When incontinence is managed with best practice principles / initiatives, this decreases the incidence of care sensitive adverse events (CSAE) such as: pressure ulcers, falls and hospital acquired urinary tract infection (HAUTI), functional incontinence and epidermal damage and infection.
PURPOSE: Develop and implement a continence protocol for adults in acute care in a large community based hospital in western Canada.
METHOD: A multidisciplinary team including CWOCN, ETN (C), NCA, Professional Practice, PT, OT, unit managers and hospital directors, developed an evidence informed continence management protocol. The protocol includes algorithms such as: scheduled toileting, collection devices and 2 piece containment devices. Briefs are not ward stock. Briefs are only an option once everything else has been tried and failed and a CWOCN/ETN (C) referral has been made for assessment for a brief. Staff education about the protocol/algorithm and products were provided for 6 weeks prior to the implementation of the new protocol and products.
OUTCOMES: Scheduled toileting was initiated into patient care plans. Incidence of pressure ulcers has dropped from 62% (2009) to 4% (2015). Care sensitive adverse events for urinary tract infections are decreasing. The reduction of CWOCN/ ETN(C) referrals for incontinence associated dermatitis went from 68 (85%) to 3 (0.03%) in 4 months.