Authors (including presenting author) :
Ho YH(1),Tsang HS(1),Lau CC(1),Hai MK(1),Tse LS(1),Tang CW(1),Lo ML(1),Leung SF(1), Chi CY(1),Wong YY(1),Ho YY Andrew(1),Chan NH(2),Chan CH(1)
Affiliation :
(1) Department of Medicine and Geriatrics, Tuen Mun Hospital (2) Department of Medicine and Geriatrics, Pok Oi Hospital and Tin Shui Wai Hospital New Territories West Cluster, Hospital Authority, Hong Kong SAR
Keyword 1: :
Functional incontinence
Keyword 2: :
Hospital - acquired incontinence
Keyword 3: :
Diaper reduction
Keyword 4: :
Structured continence care
Keyword 5: :
Foster patient-centered care
Keyword 6: :
Improve quality of life
Introduction :
Hospitalized elderly patients often suffer from functional incontinence due to physical or cognitive impairment. They became diaper user even they were continent. An oversea study showed that hospital-acquired incontinence affected 10.4-16.1% of elderly patients (Campell et al, 2013). A local study reporting that the overall diaper usage rate during admission was 37.9%. (Tsang et al, 2017). Yet, patient’ independence, dignity, and comfort might be deprived. To address this issue, a diaper reduction program: WeeCare was initiated in Tuen Mun Hospital (TMH) Medicine & Geriatrics (M&G) wards, aiming to reduce unnecessary diaper use through structured continence care and patient education.
Objectives :
1) To identify patients with functional incontinence and implement a structured continence care program. 2) To enhance a patient-centered care culture, preserve patients’ dignity and autonomy. 3) To prevent complications of diaper use such as incontinence-associated dermatitis (IAD) and pressure injuries.
Methodology :
A 6-week clinical quality improvement pilot was conducted in two M&G wards at TMH from October to December, 2024. Eligible patients included those were continent before admission but placed on diapers who could express voiding needs. Patients with urinary catheters or clinical instability were excluded. Interventions included prompted voiding, encouraging mobility and hydration, skin integrity monitoring, and providing education to patients and caregivers. Educational pamphlet was distributed to patients and relatives for reinforcing continence strategies and self-empowerment. Supporting staff assisted with toileting according to schedule and provided positive feedback. Diaper would be weaned off if patient stayed dry for three consecutive days; otherwise, they exited the program.
Result & Outcome :
The pilot demonstrated promising outcomes. Compared to baseline data, in C10 (female acute medical ward), 22 patient was recruited and diaper reduction rate improved from 13% to 23%. In R7C (male rehabilitation ward), 26 patients participated with diaper reduction rate increased from 8% to 58%. Patient’ feedback indicated improved comfort and dignity, while the incidence of IAD decreased. These findings suggest WeeCare program is beneficial for diminishing the risk of acquired functional incontinence and lowering diaper use. Hospital-wide promotion is recommended to foster patient-centered care and enhance staff understanding of patient continence needs.
