Nursing assessment and management of incontinence among medical and surgical adult patients in a tertiary hospital: a best practice implementation project.

Abstract

OBJECTIVES The objectives of this implementation project were to review the nursing assessment and management of adult patients with urinary and fecal incontinence, and to develop local guidelines and ward-based continence assessment tools that can assist nursing staff in assessing and managing incontinence. INTRODUCTION Urinary or fecal incontinence in acute care hospitals is a growing issue that can lead to constipation, depression, breakdown of skin integrity, increased nursing home placement of elderly patients, increased length of hospital stay, and escalated healthcare costs. In many cases, incontinence can be treated and managed effectively; however, it is poorly understood and under-prioritized in many hospital settings. METHODS A pre-post intervention chart audit was conducted and reviewed compliance against 10 best-practice criteria for incontinence assessment and management. Following baseline data analysis, barriers to compliance with the criteria were identified and subsequently addressed using targeted strategies. The project utilized the JBI Practical Application of Clinical Evidence System (PACES) and the Getting Research into Practice (GRiP) tools. RESULTS Education on continence strategies was delivered to nursing staff which resulted in improved compliance for all audit criteria, ranging from 5% to 100%. There were notable improvements in the nursing documentation, and assessment and management of patients with urinary and/or fecal incontinence in the post-intervention analysis. CONCLUSIONS The results demonstrate that nursing education and formalized assessment pathways in an acute setting can improve nursing compliance with the assessment and management of patients with either urinary or fecal incontinence to ensure safe, compassionate and person-centered care.