More to incontinence management than meets the eye - Feature Article - Toni Moodie discusses management strategies and goals - Interview

Nursing Homes, March, 2002 by Toni Moodie

Managing incontinence is an ongoing challenge for long-term care facilities, both in terms of quality of care and expense. Some costs are directly attributable to the use of garments and other absorbent products for incontinent residents, but other costs are not so apparent. Managing Editor Linda Ziun sought the expert advice of Toni Moodie, RN, BSN, an experienced nurse who spent 7 years as a director of nursing. She now serves as a director of account management for SCA Incontinence Care.

Zinn: What are the most common mistakes you see nursing homes make in managing their incontinence programs?

Moodie: Organizations often don't realize the importance of an incontinence manager or focus person to oversee the total program. When implementing a new incontinence program or reviewing an existing one, facilities need to be certain there is one person who oversees ongoing issues and does problem solving along the way. In other words, that person needs to oversee ordering, supplying units, ensuring proper sizing of incontinence products (and resizing, if necessary) and proper assessment of residents, educating staff (both existing and new), reviewing the budget and bringing issues to administration as needed.

Another common shortcoming I see is in the assessment of clinical goals--both in making sure they are being set and that they are being achieved. Using assessment tools and using the appropriate product for each resident is essential to individualized, high-quality care.

Finally, too often the roles and importance of CNAs/hands-on caregivers are underestimated in the decision-making process for incontinence programs. They are the ones who are familiar with the residents and responsible for product usage, and they should be aware of the issues involved.

Zinn: What are the options for solving these problems?

Moodie: Up front, prior to setting up an incontinence program, you need to designate an incontinence program manager who has education regarding all aspects of the program and implementation plans. This person could be anyone in the facility the administration chooses, as long as there is a method in place for the incontinence manager to review his/her findings with administration to solve problems.

When instituting the program, this manager should use assessment guides to evaluate individual residents for clinical goals, such as toileting programs, and review the criteria for the use of briefs vs pads/pants vs pull-up type products, to ensure the highest quality care, maintain residents' dignity and keep them at their highest levels of functioning and mobility.

Another important point is that the caregivers should be involved early on, to help decide on key elements of the incontinence program. They know the residents and what the staffing issues are. Involving them up front ensures good information and helps when new elements of the program are introduced to the whole staff, because they know they had a hand in the decision making.

Zinn: What are the most common questions nursing homes ask your support staff regarding managing incontinence, and what do you tell them?

Moodie: They want to know what will make managing incontinence easier for their staff and request the tools available for training and retraining, such as sizing kits and instructional videos.

They also want to know if there are any products for keeping residents dry. Many products are, in fact, available for helping people stay dry, such as a daylight pad for stress incontinence, an incontinence pouch for men who dribble urine because of prostrate problems, a pad/pant system for residents who are on bowel/bladder training and pull-ups for people with Alzheimer's.

Our clients also want to know what kind of clinical support we offer. In our company, each account is assigned an account manager. Our account managers are businesspeople with a clinical background. They work with the incontinence manager and the staff to ensure quality clinical outcomes; at the same time, they work with administration to conduct business reviews and ensure cost containment.

Another frequent question is how we initiate a new incontinence program. In our organization, the account manager and the district sales rep and distributor work in partnership to make sure all aspects of the program--from working with staff to getting product into the building--are efficient and effective.

Zinn: In addition to potential for resident discomfort, why is improper sizing a problem?

Moodie: Improper sizing leads to waste of products. It is typical in nursing homes for a high percentage of residents who should be wearing medium briefs to be wearing large briefs. This is a costly mistake, amounting to as much as $150 to 180 per resident per year, depending on the type and grade of products used. A hidden cost associated with improper sizing is the potential for skin problems, which then equates to dollars in staff time and use of extra skin care products to alleviate them.

Inappropriate sizing also can lead to leakage onto linens, which increases the need for staff time to keep the resident dry and increases laundry costs because of more frequent bed changes. Often CNAs resort to padding the beds with cloth or disposable underpads, which are costly to launder or purchase. This can contribute to skin breakdown because of wrinkling and extra layers under the residents' bodies, and can nullify the pressure-relief features of specialty beds and mattresses. Leakage also causes odors on residents' clothes. These are serious quality-of-care, dignity and customer-satisfaction issues.