National audit of continence care for older people: management of faecal incontinence.
BACKGROUND
Faecal incontinence in older people is associated with considerable morbidity but is amenable to successful management. Quality standards in this area were previously subject to a pilot audit in primary, secondary care and care homes to allow providers to compare the care delivered by their service to others and to monitor the development of integrated continence services as set out in the National Service Framework for Older People. This study reports the results of the national audit.


RESULTS
Data were returned by 141 primary care sites, 159 secondary care trusts (involving 198 hospitals) and 29 care homes. Data on the care of 3,059 patients/residents with bowel problems were analysed. Fifty-eight per cent of Primary Care Trusts (PCTs), 48% of hospitals and 74% of care homes reported that integrated continence services existed in their areas. Whilst basic provision of care appeared to be in place, the audit identified deficiencies in the organisation of services and in the assessment and management of faecal incontinence.


CONCLUSIONS
The results of this audit indicate that the requirement for integrated continence services contained within the National Service Framework for Older People has not yet been met. Basic assessment and care by the professionals directly looking after older persons is often lacking. There is an urgent need to re-establish the fundamentals of continence care into the daily practice of medical and nursing staff, and undoubtedly, action needs to be taken with regard to the establishment of truly integrated, quality services in this neglected area of practice.
Potter
Jonathan
J
Clinical Effectiveness and Evaluation Unit, Royal College of Physicians, London, UK.
Peel
Penny
P
Mian
Sarah
S
Lowe
Derek
D
Irwin
Penny
P
Pearson
Michael
M
Wagg
Adrian
A
D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D005242:Fecal Incontinence / Q000453:epidemiology / Q000628:therapy*; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000592:standards; D006301:Health Services Needs and Demand / Q000592:standards; D006299:Health Services for the Aged / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D006707:Homes for the Aged / Q000592:standards; D006739:Hospital Administration / Q000592:standards; D006801:Humans; D008485:Medical Audit / Q000706:statistics & numerical data; D009313:National Health Programs / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D009735:Nursing Homes / Q000592:standards; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards; D015397:Program Evaluation; D011787:Quality of Health Care / Q000592:standards* / Q000706:statistics & numerical data; D013222:State Medicine / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D006113:United Kingdom / Q000453:epidemiology