49APPROPRIATENESS OF CONTINENCE CONTAINMENT PRODUCTS IN MANAGING INCONTINENCE IN HOSPITAL: PREVALENCE AND PREDICTORS IN AN ACUTE HOSPITAL POPULATION

Abstract

Introduction: Incontinence is a common geriatric syndrome. Continence containment products (CCP) including all-in-one pads and urinary catheters are used in managing incontinence, both urinary and faecal. Empirical evidence suggests CCPs may be used inappropriately, leading to adverse events including infections, dermatitis, pressure ulcers and functional decline. Little is known about the point prevalence of or risk factors for inappropriate use of CCPs. Methods: Consecutive inpatients (≥18) in a large university hospital were assessed on one day in August 2017. Patients were assessed for their pre-admission and current use of CCP, function based on the Barthel Index (BI) and frailty according to the Clinical Frailty Scale (CFS). Baseline characteristics and the Charlson Co-morbidity Index were also recorded. All-in-one pads were deemed appropriate for patients who scored zero on the bowel section of the BI, indicating faecal incontinence and/or zero on the transfer section indicating major assistance or a hoist to transfer from bed to chair. This was based on hospital policy and NICE guidelines (2015). Distributions using Pearson's Chi Squared test and associations using the Mann-Whitney U test were calculated. Binary logistic regression was used to examine independent variables. Results: In all, 435 inpatients were included, median age 72 ± 23 years and 53% were male. CCP usage was 39.8% of inpatients aged ≥18 and increased to 57% ≥70. All-in-one pads (69% of all CCP) were the most common type used. In all, 62/435 (14%) inpatients used a urinary catheter. There was a 21% increase in all-inone pad usage compared to premorbid levels (27% versus 6%, p < 0.001). Inappropriate use of all-in-one pads was 64% and was significantly more common in patients with established frailty (p = 0.02) and those with functional impairment as judged by the BI, currently on review (p < 0.001) or at baseline (p = 0.001). Age was independently associated with use of any CCP including pads and urinary catheters (p < 0.001). Conclusion: This study highlights the high proportion of hospitalised older adults using CCPs and inappropriate use among inpatients. There was a significant increase in their use after admission. Although older, frail and functionally impaired patients are most at risk of complications of CCP, they are associated with a higher prevalence of inappropriate CCP usage. Concerted efforts are required to tackle this issue.