Improving Continence Care in Complex Continuing Care and Rehabilitation Program

1
Improving Continence Care in Complex Continuing
Care and Rehabilitation Program
Chatham-Kent Health Alliance Team Nancy
Snobelen, Program Director Mary Lue Butler, RPN
Lynda Debuck, Clinical Manager, CCC/Medicine
Denise Dodman, Nurse Clinician Dave Green,
Clinical Manager, CCC/ Rehab Eva Lizotte,
Program Manager, Chatham-Kent Sarnia-Lambton
CCAC Janet Newham, WOC Nurse Specialist Jean
Lyttle, RPN Tina Ripley, RPN Sheila
Campbell-VanBoxtel, RN Main Contact Nancy
Snobelen nsnobelen_at_ckha.on.ca
Together we make a difference
Results
How they were implemented
The Changes Implemented
Pre-post test scores 5-15 improvement in
knowledge
Confidence/attitude 20 improvement

• Awareness Education
• Knowledge, attitudes beliefs surveys
  Jan/05Sept/05
• Education session with materials held
  off-site/catered
• based on KAB results
• content based on IC5 Education subgroup
• pre post knowledge and confidence tests
• Internal Leadership Groups Presentations and
  reports
• Executive Leadership
• Nursing Grand Rounds
• Standing Agenda items
• Staff poster boards
• Nursing Physician expert commitment plans
• Patient and Family Satisfaction Surveys

Aim of Project Beginning December 2004 and ending
July 2005, all CCC patients at CKHA, will have a
continence assessment documented 100 of the time
they are hospitalized. The assessment will be
used to develop an individual plan of care to
improve or maintain their urinary continence
while promoting their quality of life and
independence
Awareness Education Improve knowledge,
attitudes and beliefs regarding Urinary
incontinence for all staff levels, e.g., Board
and Executive Leadership, Nursing groups,
CCC/Rehab staff, Non-nursing groups,Community.

• Next Steps
• One-on-one training and real-time audits by unit
  champions
• Pocket Reference Card
• Circulate KAB pre post results
• High Tea Patient and family session to raise
  awareness and increase knowledge
• Increased compliance to completion of assessment
• Assessment results utilized to plan treatment
  through Intervention algorithms
• Team trained on Intervention algorithms
• Verbal recorded updates regarding compliance and
  Best Practice at shift report
• Third education session for new nurses education
  sessions for non-nursing clinical staff
• Community forum
• Internal spread of knowledge
• Status report to Executive Leadership
• Modify electronic documentation and treatment
  Kardex

• Background
• CCC Quality indicators signaled increased
  catheter use, and UTIs
• Incontinence often diminishes independent living
  situations
• Lack of use of protocols and systematic
  approaches to care
• Previous positive experience with Rapid
  cycle/Breakthrough series approach
• Opportunity for improved Quality of life for CCC
  patients
• Opportunity for improved resource utilization
  through time and supplies

Triage Assessment Develop a systematic approach
for documenting Urinary incontinence triage,
assessment and treatment planning.

• Triage and Assessment
• Developed Triage assessment tools,
  policy/processes, algorithm electronic
  documentation
• Executive Leadership approved purchase of 3
  bladder scanners
• On-unit reference binder for all units
• Retrospective Chart audits ? Real-time
  audits/teaching
• Champions and more champions
• Barriers
• Triage Ax viewed as added work in a already
  busy day
• Did not reference policy/process for accuracy
• Shifting our UI culture not a high priority
• Shifting long-ingrained societal culture pads
  just in case

Individualized Intervention Planning Develop an
individual plan of care to improve or maintain
urinary continence, promote quality of life and
independence.

• Individualized Intervention Planning
• Prompted Voiding Trial
• Catheter product offering and best practice size
  change alerts across continuum to CCAC
• Briefs best practice size and function education
• Hydration and constipation best practices
• Fluid intake monitoring
• Decaffeinated beverages Fluids cart
• Barriers Patient, family and staff
  preferences/beliefs