Documented history-Bladder Our Site: <65 95% % (52% 2006)

Impact of symptoms on Quality of Life measured Our Site: <65 50% % (12% in 2006) – need to ask about impact of incontinence on daily life (question on proforma) and patient’s attitude (may be passive through ignorance)

Summary of results (comparison 2010vs 2006) Was frequency of FI documented? Our Site: Documented % (100% in 2006) <65 100%

Is there documented evidence of a bowel history? Our Site: % (80% 2006) <65 100%

Does patient have documented treatment plan? Does patient have documented treatment plan? Our Site: % (73% 2006) <65 100%

Documented evidence of full discussion with patient of causes and treatments of FI? Our Site: % (60% 2006) <65 92%

What works in our service? Community and inter-speciality liaison A comprehensive service Integrated service provision Assessment led service Multidisciplinary teamwork Link Nurses Continence nurse ward rounds Teaching and training

What works in our service? Agreed pathways urogynaecology urology colorectal Agreed referral criteria (in keeping with NICE) OPAL team (older persons Liaison) screens all in- patients age 70+ in acute medicine POPS team (proactive older person undergoing surgery) screens all in-patients undergoing surgery

What works well in our service? Clinical Governance Improved documentation by regular audits 2monthly MDT integrated pelvic floor continence service meeting 2monthly CNS forum meeting-which includes the community services and the contruted universities

What works well in our service? Patient involvement guidelines Information leaflets patient user group meetings

Barriers Institution providing insufficient time for link nurses training days ●wards short of staff (nurses/doctors state this as reason for not completing assessment) Patient’s acceptance Patient’s perception

Areas for improvement - FI GSTFT in upper quartile for 65+ and <65 (nominated centre of excellence at NACC launch) BUT Stool charts Clear documentation of causes in 65+ Sharing of treatment plans with patients / carers Quality of life Patient own goals for treatment (65+) Patient information (e.g. contact for Bladder and Bowel Foundation)

Elderly care - winners of UK integrated continence Team of the Year