Application of the AHCPR Urinary Incontinence (UI) Guideline in Nursing Homes in the Three Months Following Onset of UI

2.50
Hdl Handle:
http://hdl.handle.net/10755/163728
Category:
Abstract
Type:
Presentation
Title:
Application of the AHCPR Urinary Incontinence (UI) Guideline in Nursing Homes in the Three Months Following Onset of UI
Author(s):
Watson, Nancy
Author Details:
Nancy Watson, MS/MSc, University of Rochester, School of Nursing, Rochester, New York, USA, email: nancy_watson@urmc.rochester.ed
Abstract:
Purpose. The purpose of this study was to determine the use of the AHCPR Guideline for Urinary Incontinence (UI) in nursing homes and to study the current status of UI evaluation and management. Research Question. Over the last decade a number of federal initiatives have attempted to improve care in nursing homes including UI care. Initiatives have included the Federal Interpretative Guidelines (1990), the Minimum Data Set (MDS) and related Resident Assessment Protocols (RAPs)(1990), as well as the guidelines on UI by AHCPR (1992; 1996) and the American Medical Directors Association (1996). Each initiative has been aimed at transforming UI care to use evidence as the basis for UI practice. However, data supporting their impact on UI care is lacking. Methods. This study was conducted in 52 nursing homes (7,458 beds). First, cases of new onset UI and new admissions with UI were identified. Casefinding was done by interviewing certified nursing assistants prospectively across time to detect and verify changes in UI status. Casefinding methods were thoroughly tested and validity and reliability were high. Criteria for cases warranting/allowing a thorough UI evaluation and development of a UI management strategy were -- UI had to last at least 4 weeks (i.e., not transient), have a frequency of UI of at least 2/week (i.e., to need clinical attention), were medically stable, were not terminal or comatose, and remained in the nursing home for at least 12 weeks (i.e., to permit a clinically appropriate evaluation and trial of an initial UI management strategy). Guideline application was evaluated using chart abstraction/scoring. Results/Conclusions. New cases of UI (i.e., incidence) occurred at a rate of 2 cases per 100 beds every 12 wks among already admitted residents and in 14% of new admissions. One hundred and thirty-four standards from the AHCPR Guideline were identified and found to have face and criterion-related validity. Application of the guidelines was low. Of the 201 residents studied, only 35% had all potential reversible causes of UI present at onset treated, 57% had a basic physical examination (abdominal, check for edema, neuro check if needed), 29% had a rectal exam, 56% had a urinalysis, 7% who were able had a post-void residual (PVR), and 38% of new admissions and 2% of existing residents with new UI had evidence that their medical provider knew about their UI. Primarily due to lack of work-up (e.g., PVR) and unknown UI symptoms, none met the qualifying criteria for recommended UI treatments based on UI type. UI outcomes at 12 wks showed limited effectiveness in UI care provided -- only 6% were cured of their UI -- eight of them were cured due to reversible causes (UTI, mobility, medication change), four due to a toileting plan, and one due to urethral dilation. Implications. UI care in nursing homes is not evidence-based. Development of new ways -- other than mandates and guidelines -- to ensure better UI care on a national basis (e.g., UI NP consultants to nursing homes) need to be explored.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2001
Conference Name:
ENRS 13th Annual Scientific Sessions
Conference Host:
Eastern Nursing Research Society
Conference Location:
Atlantic City, New Jersey, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleApplication of the AHCPR Urinary Incontinence (UI) Guideline in Nursing Homes in the Three Months Following Onset of UIen_GB
dc.contributor.authorWatson, Nancyen_US
dc.author.detailsNancy Watson, MS/MSc, University of Rochester, School of Nursing, Rochester, New York, USA, email: nancy_watson@urmc.rochester.eden_US
dc.identifier.urihttp://hdl.handle.net/10755/163728-
dc.description.abstractPurpose. The purpose of this study was to determine the use of the AHCPR Guideline for Urinary Incontinence (UI) in nursing homes and to study the current status of UI evaluation and management. Research Question. Over the last decade a number of federal initiatives have attempted to improve care in nursing homes including UI care. Initiatives have included the Federal Interpretative Guidelines (1990), the Minimum Data Set (MDS) and related Resident Assessment Protocols (RAPs)(1990), as well as the guidelines on UI by AHCPR (1992; 1996) and the American Medical Directors Association (1996). Each initiative has been aimed at transforming UI care to use evidence as the basis for UI practice. However, data supporting their impact on UI care is lacking. Methods. This study was conducted in 52 nursing homes (7,458 beds). First, cases of new onset UI and new admissions with UI were identified. Casefinding was done by interviewing certified nursing assistants prospectively across time to detect and verify changes in UI status. Casefinding methods were thoroughly tested and validity and reliability were high. Criteria for cases warranting/allowing a thorough UI evaluation and development of a UI management strategy were -- UI had to last at least 4 weeks (i.e., not transient), have a frequency of UI of at least 2/week (i.e., to need clinical attention), were medically stable, were not terminal or comatose, and remained in the nursing home for at least 12 weeks (i.e., to permit a clinically appropriate evaluation and trial of an initial UI management strategy). Guideline application was evaluated using chart abstraction/scoring. Results/Conclusions. New cases of UI (i.e., incidence) occurred at a rate of 2 cases per 100 beds every 12 wks among already admitted residents and in 14% of new admissions. One hundred and thirty-four standards from the AHCPR Guideline were identified and found to have face and criterion-related validity. Application of the guidelines was low. Of the 201 residents studied, only 35% had all potential reversible causes of UI present at onset treated, 57% had a basic physical examination (abdominal, check for edema, neuro check if needed), 29% had a rectal exam, 56% had a urinalysis, 7% who were able had a post-void residual (PVR), and 38% of new admissions and 2% of existing residents with new UI had evidence that their medical provider knew about their UI. Primarily due to lack of work-up (e.g., PVR) and unknown UI symptoms, none met the qualifying criteria for recommended UI treatments based on UI type. UI outcomes at 12 wks showed limited effectiveness in UI care provided -- only 6% were cured of their UI -- eight of them were cured due to reversible causes (UTI, mobility, medication change), four due to a toileting plan, and one due to urethral dilation. Implications. UI care in nursing homes is not evidence-based. Development of new ways -- other than mandates and guidelines -- to ensure better UI care on a national basis (e.g., UI NP consultants to nursing homes) need to be explored.en_GB
dc.date.available2011-10-27T11:12:47Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T11:12:47Z-
dc.conference.date2001en_US
dc.conference.nameENRS 13th Annual Scientific Sessionsen_US
dc.conference.hostEastern Nursing Research Societyen_US
dc.conference.locationAtlantic City, New Jersey, USAen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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