Implementing an incontinence management protocol in long-term care. Clinical outcomes and costs.

This article describes clinical outcomes and costs of implementing an incontinence management protocol based on the recommendations contained in the Agency for Health Care Quality and Research clinical practice guidelines on incontinence and pressure ulcer prevention. Following implementation of the protocol, 63 nursing home residents were followed for 6 months and assessed for the presence of wetness or pressure ulcers. Facility costs for incontinence management were accumulated. Fifty-four percent of the residents (34 of 63) received treatments for incontinence and 60% (20 of 34) became dry. Pressure ulcer rates decreased from 16 participants developing 26 pressure ulcers to 3 participants developing 5 ulcers. Facility cost of incontinence management for 6 months was $86,436 with 46% attributed to direct labor costs. Toileting was the most expensive component, costing $36,755. Total daily cost of incontinence management was $573 ($9.09 +/- 10.52 per resident). Implementation of the incontinence protocol resulted in improved "dryness" of the participants and reduced pressure ulcer incidence.