Journey to Continence Management

 Purpose/Objectives:

At our large tertiary Magnet academic medical center in Metropolitan New York City, the specialists on the Wound, Ostomy & Continence Nursing Service noted an increase in the incidence of Incontinence Associated Dermatitis (IAD). Prior to the intervention, clinicians had a limited formulary for urinary/fecal effluent containment—the primary methods of containment were absorbent pads and diapers which have been associated with poor outcomes.  Pre-existing IAD and cell deformation is associated with an increased risk of pressure injury development. For these reasons, the nursing staff in conjunction with WOC Nurse Specialists identified a need for evidence-based containment products—our objective was to develop and implement a process for establishing a continence formulary in a Magnet Model.  

A literature review, gap analysis of the product availability and product fair were completed. Chosen containment products were trialed in Medicine, Surgery, Intensive Care and Rehabilitation areas with positive feedback from nurses. A multimodal approach to education was chosen in order to facilitate adult learning .

Outcomes: As a result of this process, a standard of care for fecal and urinary containment was drafted from the literature, products for male and female fecal and urinary containment were chosen, a trial of the products was performed and a decrease in the incidence of IAD was noted. Nurses verbalized feeling empowered to initiate interventions for fecal and urinary containment as a result of this nurse-driven practice change.