Assessment Of Hospital-acquired Incontinence In An Acute Hospital: A Re-audit

Background Urinary incontinence is a common problem in older adults. Hospital-acquired incontinence can result in increased morbidity and increased length of stay. The aim of this audit was to assess hospital-acquired incontinence in older adults in an acute hospital. Methods This audit and re-audit was guided by Royal College of Physicians (RCP) National Audit of Continence Care (NACC) standard. A prospective audit was carried out over a three-day period on general medical and surgical wards at the beginning of continence awareness month. Nursing notes and medical charts on all patients over 65 years old were reviewed for documentation of continence status pre-admission, inpatient continence status, continence wear and reason for continence wear. A re-audit was conducted eight weeks later. Results All patients had a documented continence status. Fifty-nine patients were included in the initial audit. Forty-four were continent preadmission. Of these, twelve had documented incontinence wear as inpatients. Documented rationale for incontinence wear included frequency (n=2) secondary to [urinary tract infection (UTI) (n=1), and not documented (n=1)], mixed continence (n=1), cognition (n=1), mobility (n=7) and not documented (n=1). Sixty-eight patients were included in a re-audit. Forty patients were continent preadmission. Among them, fourteen had documented incontinence wear as an inpatient. Documented rationale for incontinence wear included frequency (n=1) with no documented reason, acutely unwell (n=1), cognition (n=5), mobility (n=3), reassurance (n=2) and not documented (n=2). Conclusion Although continence status was well documented, a significant number of patients who were continent pre-admission were using incontinence wear as inpatients. The rationale for incontinence wear varied significantly. The increase in incontinence wear usage between audits highlights the need for sustained proactive identification of patients at high risk for hospital-acquired incontinence. Future projects should focus on continence promotion strategies in this population, quality improvement and education of appropriate use of incontinence wear to mitigate these risks.