Continence

The importance of proper assessment and management of continence was highlighted in the Department of Health report, Good Practice in Continence Services (2000). In addition, the National Service Framework for Older People (2001) set the requirement that service providers should establish integrated continence services for older people by April 2004.

The National Audit of Continence Care for Older People (NACCOP) is the largest audit of continence care to be conducted in the UK, and the first national audit of practice outside the secondary care environment.

Recent evidence, however, suggests that there has been only limited action towards this and that provision of services remains extremely variable.

Why is this procedure being audited?

Urinary incontinence afflicts some 24% of older people, and 30-60% of people in long-term care settings. Faecal incontinence occurs in approximately 1-4% of community dwelling adults and up to 25% of people in institutional care. Both cause much individual distress, particularly to the sufferer but also to the carers.

Who is carrying out the audit?

The Royal College of Physicians has been developing measures for defining the quality of care in managing urinary and faecal incontinence for many years.

The audit is endorsed by Professor Ian Philp, National Director of Older People's Services at the Department of Health.

What is the end product?

The first two rounds of National Audit revealed a slow start to service redesign and delivery of integrated continence care and provided evidence that integrated care delivered better quality care for patients. The next round of the audit is due to start in November 2009.

The next audit will cover the services available to and the care received by all adults in England, Wales Northern Ireland and the Channel Islands

The aims of the audit are to:

• Improve care for people with continence problems as highlighted in Good Practice in Continence Services (DoH, 2000)
• Demonstrate variation in standards of care relating to the management of continence problems in older people across different healthcare settings
• Enable healthcare settings (in primary care, secondary care (including mental health care) and care homes) to compare the quality of their continence care to evidence based criteria
• Monitor the National Service Framework for Older People milestone for establishing integrated continence services (April 2004)
• Monitor the implementation of NICE guidelines on urinary incontinence in women (CG40), faecal incontinence (CG49)
• Provide a baseline assessment with respect to the NICE guidelines on the management of lower urinary tract symptoms in men (February 2010)

The audit tool has been derived from expert opinion and evidence-based quality standards from national guidelines (National Service Framework for Older People, Good Practice in Continence Services and NICE guidelines). Previous use has demonstrated it to be robust and reliable in the different care settings. The tool is web based and consists of:

Organisational audit: structure, manpower, training and education available for care.
Data collection will commence in November 2009.

Case mix and clinical for bladder and bowel problems: the case mix captures the characteristics of the patients, and the process assesses the quality of care experienced by a patient with urinary and/or faecal incontinence.
Data collection will commence in January 2010.

The Royal College of Physicians