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Nursing Times Awards 2010

Continence Promotion and Care Award

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WINNER: Beyond boundaries to promote quality, innovation and productivity in continence services, Jo Howells, Jo Cooke and Kerry Zgrzywa, Wolverhampton City PCT. Award sponsored by Coloplast


Wolverhampton City Primary Care Trust’s community continence service exists to promote independence among service users, improve their quality of life and dignity and reduce the reliance on continence products as a first-line solution.

The service was redesigned to offer more timely support in the management of the physical and social consequences of continence problems, with a strong emphasis on promoting continence rather than managing incontinence. This required a reconfiguration of the workforce to increase skills across the wider team and release senior staff capacity.

Healthcare assistants (HCAs), after completing training and mentorship, undertake tasks traditionally delivered by nurses. They also support continence advisors in their clinical duties. A number of tools were developed to support education, nursing practice and workforce development, and to aid the reassessment of patients, and these are transferable to other services.

The process

Redesigning the continence service involved reviewing the skills across the workforce against service demands. This highlighted the fact that nurses spent considerable time undertaking tasks that, while necessary, impeded the timeliness, quality and productivity of the service. It also revealed that a significant proportion of patients receiving containment products were only reviewed if concerns were raised, which meant some would receive products even if new treatments became available that would promote their continence.

This initiative has enabled patients to be reassessed regularly. It involved the appointment of HCAs; the development of a competency framework to aid their practice and a reassessment tool to support standardised care; pilot and review of documentation; allocation of suitable mentors; regular clinical supervision; robust audit of practice; and appropriate governance arrangements which ensure HCAs are accountable to their allocated nursing staff.

Advice to other organisations

Anyone planning a similar initiative is advised to:

  • Review demand versus capacity to determine the number of HCAs required;
  • Develop a robust job description and person specification;
  • Keep staff involved in decision-making and engage them to support mentorship and clinical supervision;
  • Ensure staff are aware of legal and ethical implications of delegation;
  • Use standardised training packages and reassessment tools specific to the field;
  • Undertake appropriate audits to monitor outcomes.

Benefits of the initiative

The project has bought a number of benefits to the continence service and across Wolverhampton City PCT services. Its holistic approach to care promotes independence and reduces reliance on products. Patients receive dedicated, personalised training and a rapid response to any deterioration in symptoms. Their care is delivered closer to home, reducing hospital bed days.

Integrated working between HCA and nurses enables us to undertake planned reviews of existing patients to ensure they are offered any new treatments and standardised care based on an integrated care pathway. The initiative has also increased both job satisfaction and motivation among nurses and HCAs; overcome traditional boundaries of care; increased staff skills; released nurses’ time to undertake clinical work; increased productivity; and reduced waiting times for patients. It has demonstrated that products are not necessarily the only option for patients with continence problems and in some cases are not required. Products are now distributed responsibly based on clinical need that is assessed regularly, reducing or eliminating rationing.

Financial implications

The initiative required investment for the recruitment of the appropriate skill mix to release registered nurses and redistribute work. This led to savings through:

  • Increased productivity;
  • Appropriate use of containment products;
  • Reducing admissions and hospital bed days.

Freeing up nurses’ time also gave them the potential to undertake new therapeutic interventions, which could have cost implications incurred for continence promotion.

Future plans

The project was undertaken with the continence team and now the infrastructure is in place we plan to roll it out across Wolverhampton community services. As a result of its success the directorate is reviewing the potential for HCAs to support in the transfer of skills elsewhere to promote productivity; improve patients’ experience; and meet service demands.


For more information on this initiative please contact Jo Cooke:

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