Authors (including presenting author) :
Lam YY(1), Tang SW(1), Ma KW(1)
Affiliation :
(1) Medicine and Rehabiliation, Tung Wah Eastern Hospital
Introduction :
Incontinence is common in elderly and it is often neglected. It may cause medical complications, embarrassment and withdrawal, and financial burden. Local studies have shown 65% frail elderly admitted to rehabilitation facilities had micturition disorders and one-third of patients from rehabilitation wards were on urinary indwelling catheters. The demand of continence service is in an increasing trend. A designated continence nurse to coordinate continence service in Med & Rehab Department has been launched in 9/2018.
Objectives :
To evaluate the effectiveness of nurse-led continence nurse in TWEH
Methodology :
Data were collected from documents available in continence services. There are;
1. Performance of continence clinic
Service statistic data was collected to review the performance.
2. Promotion of continence care
Number of patients, carers and staff participated in relevant education sessions were retrieved and the comments from recipients were collected for services improvement.
3. Enhancement in patient quality care
A pilot study - Diaper-free Project has been launched in two rehabilitation wards to enhance patient care quality. The usage of diapers and comments from both patients and staff were collected to review the quality of care.
4. Application of evidence-based practice
An evidence-based Nurse-driven Urinary Catheter Removal Protocol has been adopted and the successful rate and complication rate were employed to monitor the effectiveness.
Result & Outcome :
1. Performance of continence clinic
From 9/2018 to 8/2019, there were 123 referrals received, 331 attendances served and 197 diagnostic investigations performed.
2. Promotion on continence care
About 500 patients and carers had participated in individualized education sessions and 17 patients and carers had participated in group education classes. All of them were appreciated with the education materials and contents. They also expressed the increase in confidence in managing continence issues.
65 staff had attended the education classes on continence services and management. All staff gave positive responses.
3. Enhancement in patient quality care
after the program, the percentage of patient using diappers were dropped from 87.5% to 61.82%. And 1336 pieces of diapers were saved within the study period.
Most of patients expressed the confidence in self-managed toileting had increased, both self-image and skin condition had improved.
Staff was well accepted the program and had positive comments on care quality.
4. Application of evidence-based practice
53 patients having urinary catheter were caring under the Nurse-driven Urinary Catheter Removal Protocol. 77.4% of them had their urinary catheters removed successfully and all participants were free of complication, UTI and AROU.
Conclusion:
The redesigned continence service model is effective in different aspects, both patients and carers’ confidence in continence management had increased. In addition, staff members’ awareness on continence care were enhanced.
