1. Continence

2. Aims of the session… To bring you up-to-date with current best practice in continence assessment management To give you practical advise and information you can go back and use today in your clinical area To reinforce recommendations coming from the RCHT Continence Action Group

3. The Impact of Incontinence 14 million people in the UK are affected by some sort of bladder problem It's estimated that 6.5m people in the UK have some kind of bowel control problem

4. Women are more likely to be affected by bladder control problems than men Incontinence in most prevalent in the elderly Urinary incontinence can be treated successful in a great many cases

5. ‘The Dignity Challenge’ High quality services that respect people’s dignity should: 1.Support people with the same respect you would want for yourself or a member of your family 2.Treat each person as an individual by offering a personalised service 3.Enable people to maintain the maximum possible level of independence, choice and control 4.Listen and support people to express their needs and wants 5.Respect people’s right to privacy 6.Ensure people feel able to complain without fear of retribution 7.Have a zero tolerance of all forms of abuse 8.Engage with family members and carers as care partners 9.Assist people to maintain confidence and a positive self- esteem 10.Act to alleviate people’s loneliness and isolation http://www.scie.org.uk/publications/guides/guide15/standupfordignity/dignitychallenge/index.asp

6. 2: Treat each person as an individual by offering a personalised service Assessment is fundamental to know the individual and their needs One size does not fit all!!

7. 5: Respect people’s right to privacy Clean toilets Well signposted doors that close Assess toilet needs give choice ‘Toilet’ should be the default first option Response promptly ‘Pro-active’ toileting

8. The Patient Association: The Care Challenge C – communicate with compassion A – assist with toileting, ensuring dignity R – relieve pain effectively E – encourage adequate nutrition

11. 9: Assist people to maintain confidence and a positive self esteem Confidence is based in knowledge and understanding Confidence grows when solutions are found and hope emerges

12. Reversible Factors of Incontinence. The Continence Risk Assessment An evidence based screening tool that enquires into seven reversible factors which commonly cause incontinence Developed to simply guide best practice in the initial assessment of new incontinence symptoms

13. Let’s try and name the seven reversible factors? ?

14. “7 Reversible Factors” Fluid intake Urinary tract infections Functional causes Medications and drugs Atrophic vaginitis / urethritis Uncontrolled / undiagnosed diabetes Constipation

15. Fluid Intake

16. Urinary Tract Infections

17. Functional causes

18. Atrophic vaginitis

19. Medication and drugs

20. Uncontrolled / undiagnosed diabetes

21. Constipation

22. ‘Pre- Connect’, stays connected for 14 days (not 7) New fixation device

23. Transferring classroom learning back to the clinical area… What can you take back into practice from what we have shared today?

24. What I hope to have covered… o ‘Pad and Pant’ plans o Bottle Holders o CAUTI – Catheter Associated Urinary Tract Infections o Catheters o ?Over used in RHCT o Promote ‘flip-flow’ valves o Remove ASAP o DATIX o Future ‘Talking Tool Kit’ on continence management

25. Documentation CHA 2930 - Urinary Incontinence Assessment and Management Care Plan CHA 2931 - Faecal Incontinence Assessment and Management Care Plan both are used in conjunction with the Incontinence Screening Tool (now in Risk Assessment Pack) CHA 2725 Catheter insertion record and care plan