8 Improving Identification and Assessment of Urinary Incontinence in Older People

Abstract

Introduction Urinary incontinence is very common in the older people and wrongly considered a normal part of aging. The prevalence of UI is 39.1% in people with frailty and 19.4% in those without (Veronese et al. European Geriatric Medicine, 2018, 9(5), 571–578). Despite the high prevalence of urinary incontinence, its detection and management remain suboptimal. A comprehensive multidisciplinary continence assessment is recommended to assess and manage urinary incontinence in older patients (NICE CG171). Methods Plan, Do, Study, Act (PDSA) cycle audit was conducted to identify the practices for identification and assessment of urinary incontinence on a care of elderly ward. Data was collected on a structured proforma containing six standards prospectively. Following the results of first cycle, a strategy was developed and implemented. Results Standards Cycle 1 Cycle 2 Improvement Identification by nursing staff 100% 100% Maintained Identification by medical staff 00% 57% 00-57% Specific Interventions 00% 84% 00%-84% Continence assessment care plan 00% 100% 00%-100% Alert on Handover 55% 100% 55%-100% MDT Discussion 00% 53% 00%-53% Strategy Cycle 1 (35 patients) results were disseminated to the Divisional Safety and Quality Committee, ward teams, educational sessions held for multidisciplinary teams, involved Trust's continence advisor, displayed multidisciplinary teams prompt sheets, trialled new nursing documentation booklet, discussed continence status at daily board round and conducted audit cycle 2 (28 patients) after 4 months. Conclusions PDSA cycle audit with involvement of multidisciplinary teams, presentation to the Divisional Quality and Safety Committee combined with regular educational sessions and prompt about continence status at the daily board round led to better detection and improved management of urinary incontinence. We recommend other clinical teams to follow our strategy to improve the urinary incontinence care in older people without any additional resource. [ABSTRACT FROM AUTHOR]