Authors: (including presenting author): :
Tsang YT (1), Chan NF (1), Li WL (1), Wong SWA (1), Chung YY (1), Wong CL (2), Law YK (2), Chan WT (2), Tsang WY (2), Wong MS (2), Lee SC (2), Leung LM (3)
Affiliation: :
(1) Continence Care Services, Nursing Services Division, Kowloon East Cluster
(2) Department of Medicine and Geriatrics, United Christian Hospital
(3) Nursing Services Division, United Christian Hospital
Keyword 1: :
Continence ward rounds
Keyword 2: :
LUTS screening
Keyword 3: :
TWOC management
Keyword 4: :
Diaper prevention
Keyword 5: :
Elimination care
Keyword 6: :
Patient dignity
Introduction: :
Suboptimal elimination management risks urinary tract infections (UTIs), incontinence-associated dermatitis (IAD), while compromising patient dignity and prolonged hospital stays. The “Helping SMALL with BIG elimination” project by KEC Continence Team, in collaboration with United Christian Hospital (UCH) ward 2DM and Haven of Hope Hospital (HHH) ward 7H, introduced structured ward rounds to transform elimination care from reactive to proactive, people-centred management.
Objectives: :
To minimize UTIs, IAD, and reliance on catheters or diapers through proactive identification and collaborative management for a dignified discharge.
Methodology: :
From August to October 2025, continence nurses conducted structured rounds in UCH ward 2DM (acute medical/overflow) and HHH ward 7H (rehabilitation/palliative). Using standardized tools- International Prostate Symptom Score, Incontinence Questionnaire-Urinary Incontinence Short Form, Wexner score - nurses screened for hidden Lower Urinary Tract Symptoms (LUTS) and constipation. Trial Without Catheter (TWOC) planning was also initiated for failed TWOC or unattended catheters. Comprehensive assessments, including evaluation of elimination habits, skin integrity, bladder scanning, digital rectal examinations, and diagnostic reviews, were performed to formulate personalized plans to address LUTS or TWOC plan.
Result & Outcome: :
Across 30 ward rounds, 36 patients (mean age 76.8) were screened, including four cases with concurrent LUTS and constipation. Findings revealed significant gaps: 58.3% (N=21) had unaddressed LUTS and 16.7% (N=6) experienced under-reported constipation. Consequently, integrating ward rounds with UCH ward 2DM’s ongoing nurse-led-diaper-prevention policy successfully limited transient diaper-assisted elimination to only 6.9% of total patients encountered (N=67) to reduce IAD/UTI risks. Furthermore, 36.1% (N=13) were catheter-dependent, one-third initially lacked TWOC plans. Implementation of personalized catheter management by continence nurses achieved a 53% TWOC success rate. This outcome demonstrates the efficacy of proactive service gap identification. Collaboration between the KEC team and wards ensures timely referrals for LUTS, constipation, and TWOC. This synergy enables expert intervention and safeguarding dignity. Expanding this model through standardized TWOC protocols and reduced diaper dependency will promote patient holistic recovery.
