1. Establish a culture that promotes continence, rather than just checking and changing incontinence products. This includes establishing teams of incontinence specialists, setting incident-reduction goals, raising awareness of a plan, periodically ensuring guideline compliance, benchmarking and establishing a staff competency program.
2. Develop a formal bowel and bladder programme. One of the best ways to decrease the incidence of incontinence in long-term care residents is having a clear bowel and bladder program that is in compliance with current clinical guidelines (e.g. NICE). Often suppliers of incontinence pads can supply such a programme.
3. Promote continence with broad staff education and training. Low incontinence incidents and positive survey results may lull many providers into a false sense of security, sometimes surveyors may overlook how the home is promoting continence and you might continue the same process that has contributed to higher incidents of falls, nosocomial infection or depression. Proper staff education and support on perineal care is essential to help eliminate skin breakdown or redness before it can occur as well.
4. Properly assess and identify vulnerable areas. Proper assessments include identifying the type of incontinence, and often the cause. The assessment should lead to the proper care plan and also the type of incontinence product and care that will best support the highest possible level of continence for each individual. A structured program can help identify and treat some very simple underlying causes of incontinence, such as medications, poor dexterity or mobility, anatomical defects or lack of appropriate staff.
5. Keep your eyes and ears open. It might seem simplistic, but many homes link cost with effectiveness when often a more expensive treatment or product will be more effective and reduce overall costs through such areas as reduced treatment of skincare issues or laundry bills. There are undoubtedly many treatments available for incontinence, but the best treatment is simply to pay vigilance and attention to each individual clients situation.
6. Be mindful of the total cost of incontinence. Incontinence pads represent only a fraction of care costs. Consider other metrics such as change rates, cost of laundry, nursing time, medications or ointments, falls and cost of skin injuries.
7. Understand that it’s more than just a physical problem. Preserving the dignity of the resident is paramount. Staff can help residents emotionally by making them feel confident, and by providing quality support products that reduce the incidence of embarrassing leakage.
8. Provide easily identifiable products. Make it as easy as possible for staff to identify the proper supplies, including undergarments and topical treatments, e.g. through using products where the packaging means that names can be read from across the room and also colour-coded packs and products. Staff can are often be overworked, so different products can be quickly identified can help when staff are busy.
Some Mistakes to avoid are:
- Using outdated continence management policies or guidelines.
- Assuming a good survey and few incontinence incidents mean you are managing the problem well.
- Skipping an initial assessment of vulnerable areas of the body.