Choosing and using disposable body-worn continence pads

Disposable, body-worn pads are the product most commonly chosen to contain and absorb urine and faeces (Pomfret, 2000). The cost to the NHS of supplying continence pads has been estimated at £80 million per annum (Euromonitor, 1999) and is a huge financial burden on local services.

In the UK, disposable absorbent pads are usually supplied by NHS community continence services or hospital supplies departments. These products are free of charge, but choice can be restricted in order to conform to local and national contracts. To try to overcome these disparities, the continence benchmark (Modernisation Agency, 2003) includes a factor relating to patient access to continence supplies and to the Department of Health's formalised key principles for the supply of products (DoH, 2000). These require that pads are issued only after an initial assessment; a full range of products is available; supply of products is governed by clinical need, and that patients' needs are reviewed on a regular basis.

Competence in using a medical device - Nurses need to have a good understanding of products in order to assist a patient in making a choice (Nurse Prescribing Bulletin, 1999).

Disposable body-worn pads are listed as medical devices (Medicine and Healthcare product Regulatory Agency (MHRA), 2000; 2001), and practitioners must be able to demonstrate their competence when using them. Competence is a core requirement of professional conduct (Nursing and Midwifery Council ((NMC)), 2002).

The benchmark for continence and bladder and bowel care (Modernisation Agency, 2003) states that the patient must receive clear instruction about the correct use, fitting, storage and disposal of the product and that this must be supported by written information.

Patient dignity
The benchmark for continence and bladder and bowel care (Modernisation Agency, 2003) stipulates that practitioners must respect patient dignity. Additionally, the NMC Code (NMC, 2002) emphasises the importance of respecting the patient as an individual. Choosing an inappropriate disposable body worn-pad, and fitting and using it inappropriately, will have an impact on patient dignity and demonstrate a lack of respect for the individual (Box 1).

Guidelines on patient use of disposable body-worn pads
Offering patients body-worn pads prematurely can lead to their being unwilling to give them up and start a programme of treatment (DoH, 2000). Unfortunately, absorbent body-worn products are often used as an alternative to an individual toileting programme (Pomfret, 2000). Manufacturers and local continence services have pathways to help inform practitioners about how to use products. These are valuable tools that can assist with clinical decision-making if they are based on the best available evidence.

Assessment
No product should be supplied without a continence assessment (DoH), 2000). The key factors in effectively containing episodes of incontinence are the quality of the assessment and the analysis of the information collected. The criteria used for selecting the most appropriate aid will depend on the nature of the patient's problem. Several factors need to be considered:

- Patient preference;

- Level of disability;

- Physical and cognitive function;

- Type and severity of incontinence;

- Gender;

- Skin integrity;

- Availability of care;

- Products used in the past.

Selecting the correct type, size and absorbency of a product is essential if it is to maintain comfort and security. In turn this can improve a patient's quality of life, protect dignity, encourage independence and even promote continence.

Types of pads available
Disposable pads fall into two broad categories:

- A two-piece system - a pad that is shaped to fit a patient's body (with or without an adhesive strip), and is worn inside close-fitting underwear or underwear that has been designed specifically to hold a pad;

- An all-in-one product - one that does not require additional underwear to be worn; that is, a 'nappy' style or a pull-up pant.

All-in-one disposable body-worn pads - Traditionally, these pads were adult size nappies, but, today, pads are available that are less bulky or that have been specially designed to assist with fitting, and made in materials that aid comfort and skin integrity.

All-in-one pant-style products (pull-ups) can be used to promote continence, as the wearer is able to manipulate the product in the same way as normal underwear. This has the added benefit of promoting independence. They are expensive, so practitioners must be sure that they have made the correct choice of product.

Assessment is important when an all-in-one pad is being considered, because if the design resembles that of a child's nappy, this can have an effect on independence, continence promotion, self-esteem, and dignity. Ideally, these pads should be used only when a two-piece system has proved inappropriate. However, for a select group of patients, dignity can be enhanced by an all-in-one product if incontinence is well contained; in fact, continence may be promoted if an appropriate product is used (Box 2).

Conclusion
Choosing and using disposable, body worn incontinence pads is not simply a basic nursing activity. Pads are listed as medical devices, therefore they must be used correctly in order to achieve high quality care and maintain a patient's physical and psychosocial well-being.

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