Closing the loop in an audit of urinary incontinence

Urinary incontinence (UI) fulfils the criteria for an indicator condition of quality of care. A records review audit in 1992 indicated that the minimum standards for history taking, physical examination and investigation of UI were not being met, so this was repeated in 1993 after full discussion with staff. 40% of the 368 patients studied met the definition of UI. In Assessment and Rehabilitation wards 57% met the standard for history (60% in the previous audit), 24% for examination (50% previously), and 86% for investigation (100% previously). As previously results were worse on Continuing Care wards, where minimum standards were being met in only 17% for history, 14% for examination and 47% for investigation. However, management planning had improved with care plans for 71% of incontinent patients in Assessment and Rehabilitation wards and 97% in Continuing Care wards. Our repeat audit has highlighted the difficulties inherent in encouraging health professionals to alter practice to correct apparent deficiencies.