aA

Overview

Updated on December 02, 2015

Issue

Urinary incontinence (UI) is a significant health and quality of life issue for many seniors.1 As well, those who suffer from urinary incontinence are susceptible to rashes, urinary tract infections, and pressure sores.2 Examining 932 long-term care homes in Canada in 2011-2012 showed that nearly 1 in 5 (19%) of long-term care resident’s bladder incontinence worsened over a 90-day period.3

The causes of incontinence can vary considerably, and yet urinary continence can be improved in certain circumstances. The Long-Term Care Homes Act, 2007, requires all homes in Ontario to have a continence care and bowel management program to promote continence and to ensure that residents are clean, dry and comfortable.4  To help implement these programs effectively, best practices in long-term care homes aim to promote and improve urinary continence by addressing the root causes of the problem at the individual and long-term care home level.

Call to Action

Ontario is the first jurisdiction in Canada that publicly reports quality indicators for long-term care homes. Measuring and monitoring efforts is essential in quality improvement. The tools and information provided in this resource focus on the process of quality improvement for long-term care homes however, the ultimate goal is to provide residents with the best possible care.

  1. Ramage-Morin P, Gilmour H. Urinary incontinence and loneliness in Canadian seniors

    Ottawa: Statistics Canada, 2013.

    Available from: http://www.statcan.gc.ca/pub/82-003-x/2013010/article/11872-eng.htm

  2. Shaban A, Drake MJ, Hashim H. The medical management of urinary incontinence

    Autonomic Neuroscience: Basic and Clinical 2010; 152: 4-10.

  3. Canadian Institute for Health Information. When a Nursing Home Is Home: How Do Canadian Nursing Homes Measure Up on Quality?

    Ottawa, ON: CIHI; 2013.

    Available from: https://secure.cihi.ca/free_products/CCRS_QualityinLongTermCare_EN.pdf

  4. Government of Ontario. Ontario Regulation 79/10.

    Long-Term Care Homes Act, 2007. 2010 Mar 10

    Available from: http://www.e-laws.gov.on.ca/html/source/regs/english/2010/elaws_src_regs_r10079_e.htm

Best Practices

Updated on December 02, 2015

“Insanity is doing things the way we’ve always done them and expecting different results”
Albert Einstein

Evidence-informed best practices are based on quality evidence and should be implemented into practice to optimize outcomes.8 Listed below you will find best practices graded according to the type of evidence. To view a description of the types of evidence, click here.

To help you move from best evidence to best practice, click on the + button next to each best practice to find details on how to implement, as well as change ideas to test using a PDSA approach. 

Change ideas are specific and practical changes informed by experience and research that focus on improving specific aspects of a system, process or behaviour. To learn more about change ideas see the QI: Getting Started tab.

  1. Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients' care.

    Lancet. 2003 Oct 11;362(9391):1225-30.
    Available from: http://www.ncbi.nlm.nih.gov/pubmed/14568747

Measurement

Updated on December 02, 2015

“Some is not a number, soon is not a time.”
Don Berwick,former CEO and President of IHI, December 2004, at launch of the 100,000 Lives Campaign

How will we know if a change is an improvement? Measurement is one of the critical steps in a quality improvement (QI) initiative that assesses the impact of your tests of change. Quality indicators are used to measure how well something is performing. There are three types of quality indicators used to measure your QI efforts: outcome (indicators that capture clinical outcomes and or system performance), process (indicators that track the processes that measure whether the system is working as planned), and balancing indicators (indicators that ensure that changing one part of the system does not cause new problems in other parts of the system).

Type of Indicator Indicator of Quality Improvement How to Calculate:

numerator
__________

denominator
Targets/ Benchmarks How is This Indicator Used?
Outcome Percentage of residents with worsening bladder control during a 90-day period Residents with a greater value for bladder incontinence on their target assessment than on their prior assessment
Residents with valid assessments whose bladder continence could worsen (did not have maximum score on prior assessment)
Targets: As low as possible (set by individual homes)

Provincial benchmarks:
12%
Quality improvement

QIP indicator

Publicly reported by HQO


Run Charts

Collected measures can be presented graphically by plugging the monthly results into run chart.

Tools & Resources

Updated on December 02, 2015

Tools

Continence Tools

QI Tools


For a more comprehensive list of tools and resources, visit the following links on our HQO website:

 

Resources

Continence Resources
QI Resources