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. 2023 Apr 26;11(9):1241.
doi: 10.3390/healthcare11091241.

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

Dianne Lesley Marsden  1   2   3 , Kerry Boyle  1   2   4 , Jaclyn Birnie  5 , Amanda Buzio  6 , Joshua Dizon  3 , Judith Dunne  7   8 , Sandra Greensill  9 , Kelvin Hill  10 , Sandra Lever  11   12 , Fiona Minett  13   14 , Sally Ormond  1   15 , Jodi Shipp  7   8 , Jennifer Steel  16 , Amanda Styles  5   17 , John Wiggers  2   3   18 , Dominique Ann-Michele Cadilhac  19 , Jed Duff  2   20   21 ; I-SCAMP Project Team
Affiliations

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

Dianne Lesley Marsden et al. Healthcare (Basel). .

Abstract

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 (T0: n = 849), after the 6-month implementation period (T1: n = 740), and after a 6-month maintenance period (T2: n = 709). The records of symptomatic inpatients were audited for continence assessment, diagnosis, and management plans. All wards contributed data at T0, and 11/15 wards contributed at T1 and T2 (dropouts due to COVID-19). Approximately 26% of stroke, 33% acute medical, and 50% of rehabilitation inpatients were symptomatic. The proportions of symptomatic patients (T0: n = 283, T1: n = 241, T2: n = 256) receiving recommended care were: assessment T0 = 38%, T1 = 63%, T2 = 68%; diagnosis T0 = 30%, T1 = 70%, T2 = 71%; management plan T0 = 7%, T1 = 24%, T2 = 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 T2. This intervention has improved inpatient continence care.

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

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Conflict of interest statement

Authors D.L.M., K.B., J.B., A.B., J.D. (Judith Dunne), F.M., S.O., M.P., J.S. (Jodi Shipp), S.L., J.S. (Jennifer Steel), A.S., and J.W. are employees of NSW Health (New South Wales, Australia). S.G. is an employee of Queensland Health (Queensland Australia). K.H. is an employee of the Stroke Foundation. J.D. (Joshua Dizon) is an employee of the Hunter Medical Research Institute. J.D. (Jed Duff) is an employee of Queensland University of Technology and worked for the University of Newcastle during the study, where he now is a conjoint professor. D.A.-M.C. receives a Senior Research Fellowship from the National Health and Medical Research Council (1154273).

Figures

Figure 1
Figure 1
Proportion (%) of inpatients receiving components of UI/LUTS care and experiencing one or more complications often associated with UI/LUTS across the three study periods.
See this image and copyright information in PMC

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