222 Incontinence acquired during hospitalisation: targets for improving standards of care

Abstract

Abstract Background Urinary incontinence is common in older adults, frequently underreported and consequently under-treated. Up to 15% of patients with hospital-acquired incontinence will have persistent incontinence afterwards. We performed an audit in a Level 3 hospital examining documentation of continence, pad use and call bell use in order to identify areas where continence care can be improved. Methods Data were gathered on all inpatient at a single timepoint. Biographical data, admission diagnoses, diagnosis of dementia, delirium and urinary incontinence, use of diuretics and urinary incontinence medications, toileting plans, continence care bundles and mobility status were gathered from medical notes, nursing notes and drug charts. Results The dataset comprised 309 patients. 9% were continent pre-admission and now had incontinence or occasional accidents. 72% of these were admitted >15 days. 17% had a diagnosis of dementia and 48% delirium. 31% were on diuretics. 14% were independently mobile. 44% of patients were wearing pads, one in two of whom were continent or had only occasional accidents. 15% of patients had a continence status documented in the medical admission proforma, 29% had a continence care bundle and 36% a toileting plan recorded. Patients whose continence status was documented at admission were more likely to have a toileting plan and continence care bundle than those without a documented continence status. 20% of patients did not have a call-bell in reach. In the population that required assistance to mobilise, 23% did not have a call-bell, 52% of which were incontinent. Conclusion Long duration of admission, diuretics, delirium and dependent mobility were all risk factors for hospital-acquired incontinence. Pads were used indiscriminately, regardless of continence status. A significant proportion of patients had no access to a call-bell, placing those who could not mobilise independently at risk of incontinence. Our study identifies a number of areas for improvement to promote continence throughout a person’s inpatient stay.