Improving incontinent care in a community hospital

Best practise for managing urinary and fecal incontinence in the acute care setting. Our problem/reason for action in my community acute care facility was related to the rather large patient population with UI. On an average our UI rate was 26% and fecal incontinence 8%. The nursing units involved were 2 medical/surgical units and one 4 bed ICU. The facility also had a large variety and options of products to be used that caused confusion and non-standardization of patient care. The facility predominately used re-useable quilt pads for their incontinent patient and if this was not sufficient adult briefs and diapers in and out of the bed. Due to this type of containment we saw frequent cases of incontinent associated dermatitis (IAD) and frequent linen changing causing strain and stress on patients and staff.

Gap Analysis: not following evidence based practice for UI and fecal incontinence management, non-standardiation of products was detriement to our patient population. The cost of laundering the re-usable underpads was also detriemental. It was predicted at the start that there maybe in increase in cost by using a larger and better absorbing disposable pad.

Solution Approach: began the process for change in practice with reviewing research on best practice for managing UI and fecal incontinence.

Test of change: Trial was done on the 2 medical/surgical unit on different under pads. This project also required a culture change for the nursing staff.

Confirmed State: We have elminated the re-usable pad through out this facility. We have seen a decrease in the number of hospital acquired IAD and pressure injury. We have reduced the number of adult briefs and diapers but this continues to be an ongoing culture change and requires further encouragement and education.