Implementing a Urinary Incontinence Screening, Treatment, and Referral Process for Women Veterans: A Quality...

Background: Women veterans are underdiagnosed with urinary incontinence (UI), negatively affecting management and treatment. Objective: The objective of this quality improvement project was to implement an evidence-based UI screening tool with a treatment/referral pathway in a primary care clinic for women veterans. Methods: The Urinary Incontinence Severity Index (ISI) screening tool and treatment/referral pathway for targeted treatment were implemented into all women veterans' care who were under the direct care of the primary family nurse practitioner of the clinic. Evaluation measures included the comparison of UI International Classification of Diseases, Tenth Revision (ICD-10) codes before and during implementation, documentation of treatment/referrals, and provider satisfaction. Results: UI ICD-10 code usage went from 13 instances in the 2 months prior to the new screening protocol to 50 women (N = 157) identified with UI in the 2 months of ISI usage. The number of referrals placed tracked closely with the referral pathway. The provider reports satisfaction and plans to continue using the UI screening pathway. Conclusions/Implications for Nursing: The use of the UI screening tool and treatment/referral pathway promotes increased diagnosis of UI, leading to increased treatment and referrals. To promote early diagnosis and intervention for UI, the ISI screening tool and referral pathway should be expanded to all female primary care.