Knowledge Translation in continence care: clinical audit as an instrument of change Adrian Wagg Professor of Healthy Ageing Division of Geriatric Medicine

Moving evidence into practice: “Good practice in continence services” National Service Framework for Older People NICE guidelines Urinary incontinence in women Faecal incontinence Lower urinary tract symptoms in men (May 2010) International Consultation on Incontinence

Clinical Audit National Audit of Continence Care for Older People –Structure (organisational factors) –Process (care for older people with UI and FI –2005 and 2006 –Web based – excellent data quality –First National Audit to reach out from acute hospitals Primary care Acute care hospitals Care homes Mental health care (2006)

Results

Change management –Series of national workshops –Presentations from local participants –Action plans –Policy “pick and mix” on web

Did change result? Between the 2004 audit and 2006, in acute hospitals –Many of the organisational measures improved

Did change result? However, care indicators did not consistently improve

Organisational “quality” does relate to care r= 0.44 p<0.001 Age Ageing Nov;38(6):730-3.

In the interim There has been a consistent approach to implementation of the national guidelines for incontinence with in E&W, from many different sources. The RCN particularly has concentrated efforts in care homes, using digital stories as a reflective tool

National Audit revisited The National Audit of Continence Care was re- run in late 2009, early 2010.

Snapshot of temporal change

Conclusion Clinical audit can be used as a vehicle for positive change Awareness and knowledge increase with use of audit Clinical audit can probably drive change