Research And Best Practice
SJLC is committed to evidenced-based practice at the bedside. Here is a sample of research:
TIMELY ASSESSMENT OF CONTINENCE- STUDY PURPOSE AND RATIONALE
Collaborative Research Project between St. Joseph’s Lifecare, St. Joseph’s Health Centre Guelph and McMaster University
Urinary incontinence (UI) is a common concern for older adults. It is often a complex and multi-faceted problem affecting both emotional and physical well-being, particularly in individuals with frailty and/or dependent for care.
Many people assume that UI is a normal part of aging and thus may be unaware that effective prevention and treatment strategies for UI exist. Whether a person is still living at home, temporarily in the hospital, or residing in a long-term care home, UI can significantly add to the burden of care. Indeed, the development of UI may be the "tipping point” that prompts the caregiver(s) to initiate institutional placement for their loved one.
Older adults aged 65 years and older represent 14.6% of the Ontario population. However, they account for 43% to 73% of total hospital days across each of the Local Health Integration Networks (LHINs) in Ontario1. Hospitalization itself can sometimes further compromise the health of already frail older adults. For example, one third of frail older adults will lose some independent function as a result of hospital practices and half of these patients will be unable to ever recover the function they lost2,3,4,5. Hospital-induced UI is a good illustration of this loss of function that is sometimes not recovered. Poor continence care additionally is a risk factor for falls and is directly linked to pressure ulcers, catheterization and catheter-related urinary tract infections which subsequently contribute to increased costs, longer lengths of stay as well as higher morbidity and mortality6.
Healthcare organizations are getting better at ensuring that protocols and metrics are in place to more effectively manage and track some of these hospital-induced risks. Protocols and metrics to circumvent and/or ameliorate hospital-induced UI are not yet commonly found although the HNHB LHIN (2011) specifically identified hospital acquired UI in their list of senior friendly quality indicators for hospitals5.
A 2011 Ontario LHINs report1 recommended that care/protocols should be delivered in a manner that optimizes function, preserves independence, and ensures continuity for seniors within the health care system and in the community. They further recommended that transitions in care should be supported through inter-organizational collaboration with community and post-acute services.
As a multi-sectorial organization, St. Joseph’s Health System (SJHS) has identified urinary incontinence as a potential opportunity for improvement across the continuum of care. A Urinary Continence Task Force was created to review the literature, assess current practice, and make recommendations to address gaps across the continuum of care within the System.The overarching goals of the Urinary Continence Care Task Force are to:
- Promote routine systematic assessments of urinary continence in older adults across the continuum of care
- Promote the implementation of best practices related to continence care
- Prevent functional decline related to urinary incontinence
After reviewing the relevant literature and consulting with clinical continence experts, the Urinary Continence Task Force developed a four phased plan as follows:
Phase 1: Assessment of Current Practice in the St. Joseph’s family of organizations from the perspective of health care professionals and clients/patients to establish baseline data
Phase 2: Development of evidence-informed strategies to address gaps identified through Phase 1 assessment including a standardized urinary continence screening tool to be used across the continuum of care.
Phase 3: Pilot test of a standardized protocol for urinary continence screening including the pilot test of a urinary continence screening tool, appropriate care planning, and accompanying education
Phase 4: Conduct an evaluation of the screening tool and implementation methodology from the perspective of key stakeholders. Develop recommendations to ensure routine urinary continence screening and associated care planning. An integral component of Phase 4 would be to establish and promote evidence-informed strategies, expectations, quality indicators, and education related to the prevention of UI in this ‘at-risk’ patient population across the continuum of care.
- Institute for Clinical Evaluative Sciences (2010). Aging in Ontario: An ICES Chart Book of Health Services Use by Older Adults. Toronto: Institute for Clinical Evaluative Sciences.
- Creditor MC. Hazards of hospitalization of the elderly. Ann Intern Med 1993;118:219-23.
- Inouye SK, Wagner DR, Acampora D, et al. A controlled trial of a nursing-centred intervention in hospitalized elderly medical patients. J AM Ger Soc 1993;41:1353-60.
- Sager, MA, Franke T, Inouye SK, et al. Functional outcomes of acute medical illness and hospitalization in older persons. Arch Intern Med 1996;156:645-652.
- A Summary of Senior Friendly Care in Hamilton Niagara Haldimand Brant (HNHB)Local Health Integration Network (LHIN) Hospitals. 2011-06-10.
- Rothfeld, et al. A program to limit catheter use in an acute care hospital. Am J Infect Control 2010;38(7):578-571