PROMOTION OF URINARY CONTINENCE: NURSE DRIVEN EVIDENCE-BASED GUIDELINE FOR URINARY INCONTINENCE AMONG STROKE SURVIVORS

Urinary incontinence among stroke survivors in inpatient rehabilitation facilities is a significant healthcare challenge. Despite efforts by nurses to treat and manage urinary incontinence (UI) among stroke survivors, it remains a troublesome post-stroke sequela. One possible reason is that nurses may not be addressing the specific UI needs of the stroke survivor. The purpose of this quality improvement project was to improve continence among stroke survivors by developing and implementing an evidence-based guideline. The Integrated Promoting Action on Research Implementation in Health Services framework was used to guide implementation and evaluation of the project. The Promotion of Urinary Continence (PUC) guideline was developed using accredited guidelines and expert opinion on the promotion of urinary continence. The PUC guideline was implemented following education to unit nursing staff and information to other key stakeholders (physicians, administrators, other clinicians). Patients with functional independence measures bladder scores (FIMBS) of ≤ 4 upon admission were compared before and after PUC guideline implementation. Each patient’s FIMBS change was calculated comparing admission and discharge score change. The results indicated a 31% increase in the post-PUC patients’ mean scores of FIMBS when compared with prePUC patients’ mean FIMBS. The post-PUC mean FIMBS was significantly increased from the pre-PUC mean FIMBS, t(2.32) = 81, p = .023. Therefore, the PUC guideline interventions resulted in 31% increase in the continence rate among stroke survivors over the three-month period of the project. The project also created awareness of the iv prevalence and incidence of UI among stroke survivors and appropriate measures to manage it. Biannual staff in-service education and integration of the PUC guideline into online charting will lead to sustainability of the project’s benefit to stroke survivor function.