Funded by the Agency for Healthcare Research and Quality (RO1 HS08491).
Use of the Agency for Health Care Policy and Research Urinary Incontinence Guideline in Nursing Homes
Article first published online: 20 NOV 2003
Journal of the American Geriatrics Society
Volume 51, Issue 12, pages 1779–1786, December 2003
How to Cite
Watson, N. M., Brink, C. A., Zimmer, J. G. and Mayer, R. D. (2003), Use of the Agency for Health Care Policy and Research Urinary Incontinence Guideline in Nursing Homes. Journal of the American Geriatrics Society, 51: 1779–1786. doi: 10.1046/j.1532-5415.2003.51564.x
- Issue published online: 20 NOV 2003
- Article first published online: 20 NOV 2003
- urinary incontinence;
- nursing homes;
- guideline implementation
The objective of this study was to assess the use of the Agency for Health Care Policy and Research (now called the Agency for Healthcare Research and Quality) Urinary Incontinence (UI) Guideline (1996) in nursing homes (NHs) using retrospective chart review and nursing assistant screening interviews. The study was conducted in a nonrandom sample of 52 NHs in upstate New York. Two hundred residents developing new UI or newly admitted with UI on the dayshift and who met criteria for evaluation and treatment/management were evaluated in the 12 weeks after onset of or admission with UI. Fifteen percent of newly admitted residents needed evaluation. Of residents already in NHs, 2.3 per 100 beds developed new UI over the 12 weeks. Aspects of UI evaluation rarely done were rectal examination (15%), digital examination of prostate (15%), and pelvic examination (2%). Sixty-eight percent had a culture/sensitivity, 56% a urinalysis, and 6% a postvoid residual. Eighty-one percent had a reversible cause at the time of onset, but only 34% had all addressed. Few (2%) needed urologist evaluation. Treatment was rare (3%), but management using toileting and absorbent products were common. Only 6% achieved resolution of UI. These results suggest that assessment and treatment of UI is manageable (a total of 4.2 new cases per 100 beds per 12 weeks) but quality is not adequate. On average, only 20% of the standards applicable were met, due primarily to lack of awareness of new UI and lack of familiarity with the guideline. Thus, improvements are needed. Recommendations for guideline revision are made.