4.5 Article

Improving Practice for Urinary Continence Care on Adult Acute Medical and Rehabilitation Wards: A Multi-Site, Co-Created Implementation Study

Journal

HEALTHCARE
Volume 11, Issue 9, Pages -

Publisher

MDPI
DOI: 10.3390/healthcare11091241

Keywords

urinary incontinence; lower urinary tract symptoms; inpatient; patient care planning; professional practice gaps; evidence-based practice; nursing process; hospital; implementation science; quality improvement

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This study implemented a guideline-based intervention to improve inpatient continence care. The results showed an increase in the proportion of symptomatic patients receiving recommended care, and these improvements were sustained.
Many adult inpatients experience urinary continence issues; however, we lack evidence on effective interventions for inpatient continence care. We conducted a before and after implementation study. We implemented our guideline-based intervention using strategies targeting identified barriers and evaluated the impact on urinary continence care provided by inpatient clinicians. Fifteen wards (acute = 3, rehabilitation = 7, acute and rehabilitation = 5) at 12 hospitals (metropolitan = 4, regional = 8) participated. We screened 2298 consecutive adult medical records for evidence of urinary continence symptoms over three 3-month periods: before implementation (T-0: n = 849), after the 6-month implementation period (T-1: n = 740), and after a 6-month maintenance period (T-2: n = 709). The records of symptomatic inpatients were audited for continence assessment, diagnosis, and management plans. All wards contributed data at T-0, and 11/15 wards contributed at T-1 and T-2 (dropouts due to COVID-19). Approximately 26% of stroke, 33% acute medical, and 50% of rehabilitation inpatients were symptomatic. The proportions of symptomatic patients (T-0: n = 283, T-1: n = 241, T-2: n = 256) receiving recommended care were: assessment T-0 = 38%, T-1 = 63%, T-2 = 68%; diagnosis T-0 = 30%, T-1 = 70%, T-2 = 71%; management plan T-0 = 7%, T-1 = 24%, T-2 = 24%. Overall, there were 4-fold increased odds for receiving assessments and management plans and 6-fold greater odds for diagnosis. These improvements were sustained at T-2. This intervention has improved inpatient continence care.

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