National Audit of Continence Care

17 March 2014

The National Audit of Continence Care was a successful audit run by the Clinical Effectiveness and Evaluation Department (CEEU) of the Royal College of Physicians (RCP) and commissioned by the Healthcare Quality Improvement Partnership (HQIP). The first report was published in 2005 and subsequent audits in 2006 and 2010. These audits have demonstrated that there is a real and urgent need for improvement in continence care for people with bladder and bowel problems, particularly in those aged 65 and over.continence_survey_web The latest report, published in September 2010, describes in detail the care given to almost 19,000 adults with continence problems in a variety of NHS settings such as hospital wards, hospital outpatient clinics, mental health hospitals, GP surgeries and care homes. It found significant deficits in training, diagnosis, treatment and communication with patients, with older people receiving worse care. Successive audits however showed some improvements in the continence care of older people in hospitals, implying that this national audit also works as an agent for change. New continence care audit – 2011/12 pilot A new shorter version of the continence audit was piloted in 2011/12 with content focussing on areas of most concern: lack of proper assessment, under-treatment, and poor communications with patients.  A new web-based technology was used that provided instant feedback of results, so professionals could rapidly act on findings and re-measure the effect of their actions in a continuous cycle of quality improvement. 85% of pilot participants said they could use this tool to assess and improve the quality of their services, and also to train health care professionals. The new audit included a specific tool for care homes, addressing both the technical difficulties within that setting, and the particular needs of residents. Participating care homes said that this tool could be used on a regular basis to audit care, improve quality and prompt care planning.

Public-friendly continence care audit report – ‘Keeping Control – What you should expect from your NHS bladder and bowel service’ (2011)              The audit steering group joined forces with continence user groups to produce a public-friendly version of the 2010 audit report - users felt it was important to inform others of what they should expect form continence services, as patients often have difficulty accessing the care they need. This has been widely disseminated through libraries, Age UK shops, stakeholders and the Bladder and Bowel Foundation website, and the project team have received requests for over 700 further copies.

The questions were drawn up by a clinical team with support from the Royal College of Physicians (London) and the Royal College of Nursing. The survey resulted in 89 detailed responses, the summary of which is published in this report authored by, amongst others, Dr Danielle Harari at Guys and St Thomas' NHS Foundation Trust. At the same time, the audit educated and informed healthcare providers in better standards of care. Collaborating with continence user groups and charities, it produced a public-friendly report, "Keeping Control - What you should expect from your NHS bladder and bowel services". For clinicians, as part of the ongoing campaign to raise awareness of good continence care, Dr Harari has also made available, a series of audit tools and helpnotes which have been piloted at the RCP. They are designed to be brief and easy to use whilst still being NICE complaint. Colleagues are urged to  download and use them as paper versions with a view to encouraging audit and improved care. The tools are available for download here:

For Care Homes:


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