Stop the Arm Sweep: Saving Precious Minutes in the Clinical Workflow of Incontinence Management

Nurses are often working in settings with high patient-to-nurse ratios, with many medical-surgical nurses managing 5 to 7 patients at a time.¹ These ratios greatly affect nurses, who are responsible for providing high-quality care even in the most challenging circumstances. The traditional method of checking for incontinence events involves a multi-step process that can be time-consuming for the care team and can create situations that negatively impact patient dignity. Typically, a member of the care team will conduct an “arm sweep” to check patients for an incontinence event during rounds. If the patient is found to be “wet,” the caregiver must leave to gather the necessary supplies before returning to perform routine continence care. If the patient is found to be “dry,” then the caregiver has just sacrificed precious minutes and potentially breached a patient’s privacy unnecessarily, making the patient feel uncomfortable.

The demand on a caregiver’s time for routine incontinence care can be significant; studies show that as many as 47% of patients in the hospital setting are incontinent.² Hospitals rely on the care team to assess patients regularly; however, increasing workloads and unpredictable patient needs may make adhering to an hourly rounding schedule difficult or even impossible. When overloaded caregivers are moving from room to room caring for multiple high-acuity patients, an hourly incontinence check may not be feasible or sufficient. Unless a patient requests assistance, the care team may be unaware an incontinence event has occurred and are thus unable to address it in a timely and efficient manner. In addition to the obvious impact on patient dignity and experience, the duration of exposure to moisture is also an important factor associated with skin damage. A recent study demonstrated that healthy skin is compromised within 15 minutes of exposure to an incontinence event.³ This means that even with routine rounding undisrupted by other events, patients are often reaching an exposure time to incontinence that is compromising their skin integrity unless they self-report, which is rare.

A SMARTER SOLUTION

A smarter solution to check patients for incontinence events is available. The WatchCare Incontinence Management System by Hillrom uses sensor technology installed under the surface of a hospital bed, and these sensors communicate wirelessly with an incontinence smartpad. The smartpad has all the necessary functionality of a breathable, high-absorbency, moisture-wicking underpad, but with the added benefit of embedded moisture-detecting technology. Once the smartpad detects the presence of an incontinence event, the bed alerts the care team through discrete visual lights at the foot of the bed and audible alarms through the nurse call system (Figure 1). These alerts make caregivers aware that an incontinence event has occurred and allows them to address it through prioritized care. This solution empowers hospitals to not only protect patients’ skin and optimize caregiver effectiveness, but also to improve the overall patient experience with discreet and dignified patient-centered care.

Most hospital nurses would agree that more alerts do not equal better alerts. To avoid alarm fatigue and ensure that alerts contain relevant clinical insights, hospital data and devices must work together. By bringing together data from numerous sources — including smartbeds with incontinence detection technology — hospitals can ensure that important patient information is available to busy nursing staff members. When alerts are customized to work in conjunction with the nurse call system, alarm middleware, and mobile communications devices, caregivers can prioritize their work accordingly and intervene quickly (Figure 2).

A smart incontinence detection system, with alerts that are actionable and properly integrated into workflows, can lead to higher care team effectiveness. For example, the WatchCare System was shown to reduce the time nurses spent checking patients’ incontinence status; when nurses received a notification of an incontinence event, efficiency was increased because they were able to gather the appropriate supplies before going to the patient’s room.⁴ Such efforts help safeguard patients and improve outcomes, and significantly decrease the alarm burden while increasing nurse and patient satisfaction.⁵

During the COVID-19 pandemic, a medical facility in Springfield, MA, used the WatchCare System to help monitor patients who were in isolation.⁶ A nurse at the facility noted, “As soon as I saw the light, I could gather the supplies I needed for other tasks, such as taking vitals and grabbing linens. It helped me prioritize my actions and manage my time in patient rooms.”

The nurse educator at the facility also noted that staff members quickly grasped how the system worked — a key benefit given how frequently new nurses came to the unit. In a survey of the unit’s nurses and patient care technicians, nearly 90% of respondents indicated that the WatchCare System improved their ability to do their jobs.

Unit nurses also reported that the system provided psychological and emotional benefits to highly stressed patients who often felt scared and alone. A study in the critical care environment⁶ found the system “provided a voice for patients where they would not have one otherwise.” For example, 2 patients at a facility were unable to voice the need for a bedpan due to aphasia but received timely care due to the WatchCare system notifying the care team that they needed help in a discrete but efficient manner.⁶ An RN who utilized the system on the night shift noted that, “Now I don’t have to wake up patients to check their pads.”

By serving as the patient’s “voice” that calls for help, the system sends a message that the facility is committed to keeping them healthy and comfortable. This technology can help the care team provide more dignified care. As a patient care technician noted, “With WatchCare, I didn’t have to violate patients’ space by turning them on their sides to see if their underpads were wet. Instead, I could come into their rooms and chat awhile before changing the pads. This is a more compassionate way to provide care.”

In addition, implementing patient-centric technologies could help raise a facilities’ Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, which typically improve when patients feel that hospitals are meeting their basic needs for care and comfort.

CONCLUSION

The burden of incontinence in hospitalized patients is significant. Consequences range from inefficient clinical workflows to patient dissatisfaction and an increase in hospital-acquired pressure injuries. That is why the WatchCare Incontinence Management System by Hillrom is a key innovation for the med-surg space. It enables a caregiver to be prepared for incontinence care before entering the patient room and avoiding the lengthy back-and-forth to linen carts or supply areas, thus helping to minimize patients’ exposure time. Utilization of this technology enables care teams to address incontinence in a timely manner, preventing loss of skin integrity. It was found that average incontinence event exposure time with the system dropped 83.4% from the standard of care prior to system implementation.⁶ Access to patient information in real time through the WatchCare Incontinence Management System by Hillrom can help caregivers advance connected care and provide better patient outcomes.

Innovative Moisture Management was made possible through the support of Hillrom (https://www.hillrom.com). The opinions and statements of the clinicians are specific to the respective authors and not necessarily those of Hillrom, Wound Management & Prevention, or HMP Global. This article was not subject to the Wound Management & Prevention peer-review process.

1. The three Bs of med-surg nursing. Lippincott Solutions, September 4, 2014. Accessed January 30, 2020. http://lippincottsolutions.lww.com/blog.entry.html/2014/09/03/the_three_bs_of_med--cEOD.html

2. Gray M, Giuliano KK. Incontinence-associated dermatitis, characteristics and relationship to pressure injury: a multisite epidemiologic analysis J Wound Ostomy Continence Nurs. 2018;45(1):63–67. doi: 10.1097/WON.0000000000000390

3. Phipps L, Gray M, Call E. Time of onset to changes in skin condition during exposure to synthetic urine: a prospective study. J Wound Ostomy Continence Nurs. 2019;46(4):315–320. doi: 10.1097/WON.0000000000000549

4. Mayer, B, Shih, C. Use of an incontinence management system to improve nurse efficiency. Poster presented at: American College of Wound Healing and Tissue Repair Conference; October 11-12, 2019; Chicago.

5. Brill E. 10 Ways to improve your alarm management practices. Becker’s Health IT & CIO Alert. November 28, 2017. https://www.beckershospitalreview.com/healthcare-information-technology/10-way-to-improve-your-alarm-management-practices.html

6. Kennedy R, Slaughter C, Raygoza H, Brooks P. Evaluation of an incontinence management system in the critical care environment: a case series. Poster presented at: NPUAP Annual Conference; March 1, 2019; St. Louis.