Enhancing assessment and continence care in a community hospital setting: A quality improvement project.

Enhancing assessment and continence care in a community hospital setting: A quality improvement project.

Introduction:

It was noted that continence was frequently not addressed prior to transfer to a community hospital setting. The project aimed to recognise and offer opportunities for improved continence care.

Method:

Patients were screened for continence problems through comprehensive geriatric assessment on arrival at a community hospital from acute settings.  The first cycle identified whether continence assessment was considered on arrival at our community site.  Subsequent cycles improved adherence to a structured assessment and recording of diagnosis of the continence problems on the discharge summary.

Patient records were reviewed to determine whether continence assessment was performed, treatment had been initiated, and appropriate referrals were made before transfer.

All patients with continence problems were then assessed with a physical examination, bladder diary, symptom profile, medication review, infection screening, constipation assessment, mobility assessment and bladder scan.

Results:

Of 40 randomly selected patients admitted over 12 weeks 26 had continence issues.  22 patients had no documented diagnosis of urinary incontinence prior to admission; eight of these developed new-onset UI during hospitalisation.  Two people were treated prior to transfer. No patients had documentation of continence on the discharge letter from acute setting. 

Eighteen patients had a pre admission continence problems. Of these 6 had been reviewed by the continence team or GP prior to admission.  Two subsequently required medication changes. No patient had a recorded assessment or continence treatment modification prior to transfer to the community hospital.

15% of patients were male. The commonest treatments initiated were for overactive bladder.

Conclusion:

Continence problems were frequently under-recognised and poorly documented, with minimal assessment or management initiated in the acute setting. Recognition frequently lead to changes to management plans and improvements in outcomes.  Patient satisfaction and quality of life measures have been added to the next QI cycle.