Pathways for continence care: background and audit

An Integrated Care Pathway Appraisal Tool: A ‘Badge of Quality’

Integrated care pathways (ICPs) are being introduced as a tool to improve the quality of health care. Their local development usually involves some consensus-based approach which engages clinical staff in discussions about how to improve services. Whilst this has definite advantages, it also means that ICPs which are developed for ostensibly the same group of patients with a specific disease or condition will vary in content and quality. Many articles have been written expounding the benefits of using ICPs, but recently there have been a number of evaluations of ICPs which report little or no significant improvement in the quality of health care as a result of their introduction. Why is there this divergence of views about the value of ICPs? Could it be connected with the variability in quality of the ICPs being introduced? What is missing from many of the evaluations of ICPs undertaken so far is a consideration of how good those ICPs really are.

This article describes an appraisal instrument for ICPs — the integrated care pathway appraisal tool (ICPAT) — which has been developed within the West Midlands region of the UK and which can provide a framework for assessing the quality of ICPs.

Addressing incontinence for people with dementia living at home: a documentary analysis of local English community nursing service continence policies and clinical guidance

AIM AND OBJECTIVES

To establish whether the problems and issues experienced by people with dementia living at home and their carers were addressed in the clinical guidance for continence management for community nursing services in England.

BACKGROUND

Internationally, the numbers of people with dementia are rising. Managing incontinence is a significant issue as the presence of incontinence is one of the triggers for people with dementia to move their residence to a care home. People with dementia living at home and their family carers report difficulties in accessing knowledgeable professionals and acceptable continence products.

DESIGN

A review by documentary analysis of clinical policies and guidance from a sample of community nursing services in all Strategic Health Authority regions of England.

METHODS

A sample of clinical policy and guidance documents for continence assessment and management from up to four community nursing services in each of the ten Strategic Health Authority regions in England was sought. Documentary analysis was undertaken on the relevance of the documents identified for people with dementia living at home.

FINDINGS

Ninety-eight documents from 38 local community nursing services spread across ten Strategic Health Authority areas were obtained and analysed. Only in the documents of three services were nurses offered detailed guidance about the management of incontinence for people with dementia at home. In the documentation of only one service were people with dementia identified as a special case which warranted the provision of additional continence products.

CONCLUSION

Clinical guidance on continence assessment and management for community nurses in many parts of England does not address the specific needs of people with dementia living at home or their carers.

RELEVANCE FOR CLINICAL PRACTICE

Nurses working in community settings and those providing clinical leadership in continence care should review their clinical guidance and policies to ensure relevance for people with dementia living at home and their family carers.

Risk assessment and management tools for constipation

Constipation is a distressing condition that can happen to anyone, but is of particular concern in the elderly and less mobile, people with neurological impairments, and those in institutional care. The causes of constipation are multifactorial, and can be influenced by physical, psychological, physiological, emotional and environmental factors. This article discusses definitions, symptoms and types of constipation, and provides guidance on risk factors and assessment using the Norgine Risk Assessment Tool for Constipation.

Constipation and palliative care - where are we now?

Constipation is an unpleasant and distressing symptom that many palliative care patients may experience, often having a profound effect on their quality of life. The many management options available reflect the multifactorial nature of constipation. The article explores the complexity of constipation in palliative care and highlights the challenge of managing opioid-induced constipation. Advances in the pharmacological and non-pharmacological management of constipation are reviewed and discussed in the light of relevant research. Further discussion includes definitions, incidence and causes of constipation in palliative care.

Pathways for continence care: an audit to assess how they are used

This is a follow-up article to three articles that were published between 2000 and 2001 in the British Journal of Nursing about the development of template pathways for continence care (Bayliss et al, 2000a,b, 2001). It reports on what has happened since the development of these templates. One hundred and forty-four healthcare professionals working in the field of continence care were asked to complete a questionnaire about whether the pathways are being used and what changes have been made to them. The audit found nearly half of the respondents are currently using the pathways and find them an effective method of assessing incontinence and providing equitable quality of care for patients. Many respondents have made changes to the pathways, making them easier to use and adapting them to local practice and the availability of local resources. This was what was anticipated, although the authors noted that variance tracking, which should be the driver for change, had not significantly influenced local pathways. Of those healthcare professionals not using pathways, all said they were still interested in using them, which is particularly encouraging as pathways are promoted in 'Guidelines for Continence Care' (Department of Health, 2000). To provide support to these individuals and encourage the efforts of those already using the pathways, a support group is to be established following a further conference on pathways for continence care later this year. It will be the role of this group to facilitate information sharing on pathway development. As a first step in the dissemination of information, a pack is being produced comprising consolidated versions of the changes to the pathways used in practice all over the country.