Enhanced toileting program decreases incontinence in long term care

Area of Science:

• Gerontology
• Healthcare Quality Improvement
• Nursing Management

Background:

• Incontinence is a prevalent issue in long-term care settings.
• A 304-bed facility identified rates 39% above state and national averages for incontinence indicators.
• A facility-wide performance improvement project was initiated in response.

Purpose of the Study:

• To reduce incontinence rates in a long-term care facility.
• To implement an individualized toileting schedule for residents with incontinence.
• To improve the assessment and management of bowel and bladder incontinence.

Main Methods:

• Revised assessment documentation for improved continence evaluation and reassessment.
• Documented toileting plans on patient assignment and accountability sheets.
• Adopted toilet-assist devices, conducted hospital-wide in-service training, and revised incontinence policies.

Main Results:

• The rate of incontinence without a toileting plan decreased from 79% to 38%.
• The reduced rate of incontinence remained below the yearly mean after implementation.
• The revised assessment tool facilitated accurate, individualized care planning.

Conclusions:

• New assessment processes enabled accurate, individualized continence planning.
• The initiative is easily replicable in most long-term care facilities.
• This project highlights the success of targeted quality improvement in managing incontinence.