Development of a multidisciplinary continuing care continence assessment tool and continence care pathway
Jennifer Peplar, Lisa Wragg
The Centres Promoting Health Independence (CPHI) – Improving Care for Older Persons project identified 10 domains of clinical practice imperative in the holistic care of the older person. The domain of managing and resolving incontinence issues was highlighted as a clinical problem area that can contribute to a patient’s functional decline during hospitalisation. Continence nurse advisors (CNAs) have been aware that urinary and faecal incontinence issues are often poorly identified and managed in the continuing care wards. This paper is an overview of the project undertaken to address this issue. The project had three phases. The first phase consisted of an open chart audit of patient medical records. Undertaken by a CNA, it determined how often incontinence was identified, assessed, diagnosed and appropriately managed by ward staff. Phase 2 developed a multidisciplinary, evidence-based best practice continence assessment and management tool (CAMT), to improve assessment, diagnosis and management of continence problems and facilitate patient-centred care in the continuing care wards. Phase 3 focused on testing the tool. Continence education and mentoring was provided to the ward staff and the tool was evaluated, via a staff survey. This project identified gaps in clinical practice and led to changes in continence assessment, diagnosis and management by ward staff. Phase 3 identified barriers to staff using the new tool. The project fostered mentoring among clinical staff and has provided challenges in sustaining changes in practice.