University of Colorado School of Medicine
A small group, preceptor-mediated, Power-Point guided workshop was designed on the evaluation and management of geriatric incontinence and urinary catheters for the inpatient physician. It is based on the philosophy that the hospital physician must be able to integrate the unique interaction between the physiology of the aging body and the inter-current illness in the context of the hospital system delivery of care. The module is designed to guide students through a practical process for evaluating and acting on risk factors for incontinence as a risk for placement of unnecessary urinary catheters or as a contributor to hazards of hospitalization, including falls and pressure ulcers in the elderly patient. A central emphasis of this module is that knowledge about the general topic of incontinence is insufficient if this is not interpreted in the context of the system of hospital care delivery including how the physician’s actions can increase or decrease the probability that a patient will have incontinence or a urinary catheter placed. The module explores barriers to continence in the hospital and exposes provider knowledge deficits about incontinence and institutional communication silos which contribute to unnecessary catheter use. The emphasis is on systems-based practice improvement rather than solely individual practitioner knowledge. It was developed for the Hospitalist Training Track internal medicine residents at the University of Colorado Hospital rotating on the Hospitalist Acute Care for the Elderly service, and is designed for small groups of 1-8 students. Content level is appropriate for 3rd and 4th year medical students and internal medicine/family practice housestaff. The entire module requires approximately 1 hour including a 5-10 minute follow-up review of the housestaff findings after the workshop.
1) To understand appropriate and inappropriate indications, risks and alternatives for indwelling urinary catheters 2) To understand the role of the physician and how this interacts with the role of nursing in the care of incontinence in the elderly hospitalized patient 3) To review the types and mechanisms of incontinence and how they relate to physiologic and functional changes with aging 4) To critically examine how hospital systems interact with the at-risk geriatric patient in regards to incontinence and indwelling catheters 5) To facilitate the learners exploration of how hospital systems could be redesigned to reduce the harms associated with incontinence and urinary catheters
Instructor Qualifications and Responsibilities The preceptor should be familiar with the hospital system and with the geriatric syndrome of incontinence. Familiarity with one of the many fine reviews of the subject is recommended. Two are suggested at the end of the manual. Small group facilitation skills are needed. Required Resources The preceptor should familiarize him/herself with the answer to three institution specific questions prior to facilitating this module. A hospital charge nurse can provide resources and answers to these questions in less than 15 minutes. 1) Where is assessment of incontinence recorded in the nursing portion of the medical record? 2) Where is the presence of an indwelling urinary catheter recorded in the nursing portion of the medical record? 3) What hospital protocols and triggers for implementation are in place for the patient who has incontinence during hospitalization. Do these occur automatically or do they require a physician order (i.e. scheduled toileting)? The module can be facilitated by a power-point projector and a board on which to write down the learners’ input. This is optional for the facilitator who is well versed in the material. Learners will need access to 6-10 elderly inpatients to assess use of indwelling urinary catheters and barriers to/problems with continence during hospitalization.