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Dignified and Dry

John Hunter Hospital
Project Added:
23 May 2012
Last updated:
30 September 2014

Dignified and Dry 

Promoting Urinary Continence in Acute Care

By Hunter New England Local Health District

Abstract

Several prevalence surveys highlighted that on a 32 bed general medical ward 30% of patients at any time had some degree of urinary incontinence.

Staff noted that many nursing hours were spent changing wet beds and clothing and that visitors and members of the multidisciplinary team commented on the malodour of the ward.

The nursing team identified that these factors were indicative of poorly managed urinary incontinence that impacted not only on nursing workload but more importantly on the dignity of patients.

The project used a practice development approach of problem identification, critique against best practice literature, group reflection, implementation and evaluation.

Evidence of current practice was collected through:

  • retrospective file audits
  • analysis of falls incident data
  • observations of practice patient / carer feedback
  • staff focus groups.

Best practice was identified through review of literature and consultation with expert clinicians. Inconsistencies between best and current practice were identified at reflective practice sessions.

Changes were implemented one at a time to ensure they became embedded in practice. Each member of the team was given the lead role in implementing one area of change.

Implementation

Changes implemented included:

  • the development of a urinary continence assessment tool and care plan specific to acute care
  • redesigning and relocating toilet signs more suitable to the elderly patient cohort
  • wayfinding markers on the floor from bedrooms and toilets to assist the confused elderly
  • the trial and implementation of better continence products
  • development and presentation of education to staff
  • availability of patient and carer education brochures on ward
  • reflective practice sessions with staff to highlight ageist and undignified practices.
Photo of ward floor showing red lines directing patients to the toilets

Evaluation

Evaluation showed positive sustained changes in outcomes relating to evidence based clinical practice, patient dignity, patient independence, patient safety and cultural change.

Specific examples of these improvements include:

  • increased toileting of patients by staff rather than product use as the only management strategy
  • 95% increase in patients achieving social continence (no wet bed/clothing)
  • positive feedback from patients and carers on the effectiveness comfort and dignity of products with some requesting purchasing information on discharge
  • reduction in malodour of patient rooms and general ward areas
  • increased ability to toilet independently due to ease of application and removal of new products
  • increased independence for confused patients due to improved toilet signage and floor marking
  • 100% reduction in falls related to incontinence (sustained for past 8 months)
  • 70% of staff attended ward education
  • 95% reduction in number of patients who have protective linen placed on their bed because they are old, even though they are continent (audit results)
  • continence management is seen as a patient issue rather than a workload issue
  • significant reduction in the use of terms such as 'nappy'
  • staff now challenging ageist attitudes and practices of other team members.

Conclusion

  • A rigorous process is required to investigate and understand practice issues and their impact on patients and staff.
  • Effecting changes in practice takes time and culture change takes even longer.
  • By taking ownership and working as a team and in partnership with patients you can make a difference.

Authors

Sudakshina Raychaudhuri, Alison Clinton, Jess Jung, Justin Galvin, Yvonne Reading, Greg Schwager, Michelle Knight, Matthew Lockyer, Melissa Oakman, Lia Heffernan, Jenny Haslam
Hunter New England Local Health District

Contact


Clinical Nurse Consultant Older Person Acute Care, Division of Medicine
Hunter New England Local Health District
Phone: Tel 02 4921 4791

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