Let us know your thoughts

Following a Delphi consensus method, the overall objective of this project is to establish peer-consensus about the best practice principles when selecting continence products to achieve optimal care whilst reducing the risk of harm.

These consensus statements were developed at a recent UK meeting of an expert steering group of healthcare professionals working in continence (in December 2020).

They are intended to be a starting point for defining best practice principles when selecting continence products to achieve optimal care whilst reducing the risk of harm.

Your anonymous responses will be a source of data for the development of a potential consensus publication in this area of care.

1. Please review each statement and indicate your level of agreement with it (tick one box only per statement).
2. Please only complete this questionnaire once.
3. Completion should take approximately 10 minutes.

Date of preparation: January 2021. Project initiated and funded by Essity. Statements prepared by expert steering group listed above. Work facilitated by an independent third party (Triducive).

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* 1. Initials
Please confirm your initials (not mandatory). The initials are collected to avoid any duplication of responses and if a second round of Delphi is needed to address areas where consensus is not reached, it then allows us to go back to specific individuals if the steering group has revised statements. All completed questionnaires will be collected and analysed by a third party and identifiable details will not be shared with anyone.

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* 2. Please select your job role

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* 3. Work institution

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* 4. Region of work

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* 5. Dignity, autonomy and QoL of continence patients

  Strongly Agree Tend to Agree Tend to Disagree Strongly Disagree
The choice of continence pad is limited according to local policy and budget decisions
Patients and carer representatives should always be involved when pad procurement decisions are being made
Patients and carers should always be involved when choosing the pad that is best for them
The choice of continence pad should be made according to an assessed clinical need rather than budget criteria alone
Ongoing patient assessment is fundamental to optimal continence care – including initial assessment and annual review
The use of continence pads should always be based on individual clinical need rather than pads per day target
PROMS (Patient Reported Outcome Measures) and PREMS (Patient-Reported Experience Measures) are vital to consider when making decisions regarding patients continence pad selection
Validated quality of life tools can aid the clinician to appreciate the burden of disease, support continence assessment and measure improvements in outcomes
Continence care should be designed around individual patient needs rather than care provision based on budgetary or pads-per-day decisions

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* 6. Falls as a result of incontinence

  Strongly Agree Tend to Agree Tend to Disagree Strongly Disagree
Individual continence assessment must be mandated in any falls or frailty pathway in line with a comprehensive assessment in patients of any age
Every patient who has contact with a healthcare professional should be asked “Do you have problems with your bladder or bowel?” (as part of a risk assessment)
Independent toileting is safer, and the risk of falls is reduced when patients use a product specifically designed to be easily removed and replaced
Improving individual assessment may reduce the risk of falls and the associated direct and indirect costs associated with incontinence
The patient’s dexterity and gait position should always be assessed when considering suitability of a chosen continence pad
Patient’s dexterity and gait position has an impact on the choice of a continence pad and significantly impacts on a patient’s outcome
One continence pad/product style will not suit all patient needs universally
A&E admissions for falls and fractures in patients with continence problems are related to poorly fitted or inappropriately prescribed two-piece products
Continence product design can positively impact on the risk of falls
The dynamics (functional steps) of how patients achieve functional continence should inform the choice of pad design offered
Men should be offered male-designed products for dignity, mental health and ergonomic reasons
2-piece pads can affect a patient’s gait, which may increase the risk of falls

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* 7. Improved skin health

  Strongly Agree Tend to Agree Tend to Disagree Strongly Disagree
Proprietary wash creams that do not need to be washed off, keep the skin cleansed, protected and cared for, and contribute to a reduced incidence of incontinence associated dermatitis (or MASD)
Data that captures moisture associated skin damage (and whether it is continence acquired) would help improve choice of management options and outcomes
Improved skin health for patients using pads is an important outcome that should be measured
Soap and water are the worst contributors to skin health because soap has alkalinity that impacts the skin mantle which can deteriorate skin integrity
The consequences of using soap and water leading to potential moisture damage is known to have an impact on length of stay (LOS) cost in hospitals due to potential skin irritation
The use of soap and water is a false economy due to indirect costs that may arise. This is due to alkalinity and possible irritation of the perineal tissues leading to additional morbidity and treatment costs

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* 8. Improved education & self-management

  Strongly Agree Tend to Agree Tend to Disagree Strongly Disagree
Patients remaining in soiled (faecally) pads is unacceptable, must be avoided and could be considered a safe-guarding concern
Products that support patients to maintain their ‘normal’ activities should be aimed for. Patient Related Outcome Measures (PROMS) are central to this
Patients should be offered self-management options (e.g. voucher schemes)
Patients need to be educated on the characteristics and use of pads to aid self-management
Patients are not always provided the right pad for their individual need
All HCPs have to be educated about the physical, social and psychological risks associated with incontinence
All HCPs have to be educated about the trigger questions (red flags) for referral
It should be mandatory that bladder & bowel care should be included in all medical education
The minimum standard of HCP education is recognising that incontinence is treatable and is not inevitable

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* 9. Reduced staff and carers pressure

  Strongly Agree Tend to Agree Tend to Disagree Strongly Disagree
The burden of incontinence impacts the carer not just the patient and this is an indirect cost (which is not measured)
The burden of incontinence impacting the carer may (indirectly) increase pressure to the NHS
The choice of continence product design can impact NHS staff and carers in relation to: efficiency, backbend injuries, and time spent changing a pad
The product design (ergonomics) should be considered as this can reduce requirements for lifting and frequency of back-bends
In care homes, it takes less time to toilet individual patients based on their individual need rather than change their pads
The carer patient relationship is improved when patients are kept dry and clean

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* 10. Mental health, early-stage dementia & end of life support

  Strongly Agree Tend to Agree Tend to Disagree Strongly Disagree
Mental health factors should be acknowledged in assessing the individual needs of patients
The mental health of a patient determines what management options may be selected. The degree of cognitive impairment associated will also affect choices
Incontinence can impact a patient’s mental health e.g. depression, isolation, relationship breakdown
There are indirect costs to the NHS associated with mental health issues contributed to incontinence

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* 11. The role of guidelines

  Strongly Agree Tend to Agree Tend to Disagree Strongly Disagree
Awareness should be increased about the guidelines that exist for the management and treatment of incontinence
Incontinence must be routinely measured as a national quality indicator
Guidelines need to be updated to include mental health issues and product suitability based on individual needs
Guidelines should be representative of all devolved nations

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