Authors (including presenting author) :
WONG TT (1), CHUNG KY (1), LI HY (1), SIU YS (1), CHAN TS (1), PANG HSI (1), LAM HY (2)
Affiliation :
(1) Department of Medicine and Geriatrics, Ruttonjee & Tang Shiu Kin Hospitals (2) Physiotherapy Department, Ruttonjee & Tang Shiu Kin Hospitals
Introduction :
Urinary incontinence is a common problem for elderly in hospitals. According to Northwood et al. (2022), 13.1% of hospitalized elderly patients report incontinence at discharge, due to acute illness, changes in physical or cognitive status, medication side effects, or way of care is provided in the hospital. Hospital-acquired incontinence can lead to serious complications, including pressure injuries, incontinence-associated dermatitis (IAD), urinary tract infections (UTIs), falls, depression, and result to prolonged hospital stays and significant burden on healthcare systems. However, continence care is often neglected in acute care settings. A prevalence study in Hong Kong found that 37.9% of patients in hospitals used diapers, in which near half of them didn’t need diapers before admission (Tsang, Sham & Chan, 2017). Overuse of diapers not only fails to address individual patient needs, but also further contributes to adverse outcome. This highlights the need for proper continence care education to healthcare providers and creating personalized nursing care plans to patients for reducing hospital-acquired incontinence.
Objectives :
1.To maintain the functional level of continence among patients after recovering from acute illness phases. 2.To minimize hospital-acquired complications of incontinence, including IAD, falls, and persistent incontinence. 3.To enhance clinical awareness of continence care and promote personalized management among ward staff.
Methodology :
A nursing working group was established to review current nursing practices and develop a training plan, workflow and communication tool. In October 2024, staff in the female ACE unit attended a workshop on continence care. All patients admitted in November 2024, who had been living at home before admission were recruited into the program. During hospitalization, other than prompt toileting, patients were optimized their functional level with appropriate assistance and walking aids by collaboration with physiotherapist. Specific skincare was provided to patients with diarrhea and incontinence. Patient data were sourced from the Premorbid Assessment Form for Geriatric Elderly, Intake and Output record and Nursing Discharge Summary Form. These records documented continence status and toileting mode before admission, 6-8 hours after admission, and upon discharge. Patients or their carers were interviewed one month after discharge via phone follow-up when change in continence status or mode of toileting was indicated. Staff experience survey was conduct to examine their feedback on the program.
Result & Outcome :
A total of 95 patients from the female ACE unit were recruited. The mean age was 83.20 years, and the mean length of stay was 4.03 days. Among these patients, 40% were screened as cognitive impairment, and over 50% required assistance with walking or were bedridden. There was positive correlation between mobility level and maintenance on mode of toileting (r=.29, p<.01). The results showed that 88.4% of patients were able to maintain or restore their premorbid continence state or toileting mode, whereas only 11.6% experienced a decline in functional continence level upon discharge. However, by phone follow-up one month later after discharge, all of these patients returned to their premorbid continence status. The program also successfully prevented from any complications, in term of developed IAD or experienced falls. Regarding the staff experience survey, over 93% of ward staff agreed that the program increased their knowledge and improved the quality of continence care, while 80% of them believed that personalized interventions were feasible to implement in the ACE unit, though one-third of staff expressed that resource was inadequate to promote continence care.
