Saving method

Acquisition and use of an absorbent device according to patients’ needs. Implementation and application of local protocol. Selection of diaper based on ISO 15621 international standard, training on and routine use of a practical decision-support matrix.

Purpose

Significant and rapid improvement of the quality of life of patients and nurses, and provision of medical care at lower total costs.

Background

Incontinence (disorder of retention of stool and urine) is one of the most common and serious nursing tasks and expenditure item in inpatient institutes. Key issues in the modern nursing aspects of incontinence care include functional efficiency meaning appropriate fitting (less leakage) and maximum patient independence (less nursing hours needed). If the cost structure of inpatient care of incontinence is analysed, cost of diaper is negligible compared to the total costs of hospital care of incontinence. Two-thirds of total cost includes “overhead costs” related to non-avoided leakage events. (laundry, extra diaper change, extra waste, iatrogenic skin problems, etc.) Interestingly, waste disposal costs of used diaper is alone higher than the direct purchase price (but when the used diaper re derived from an infectious department, it is classified as hazardous waste that extremely increases the associated expenditures).

The method

Development of the appropriate method and provision of high quality care at lower total costs result in a cost-saving solution and high quality medical care:

According to this scheme, complete cost assessment and analysis are required prior to starting implementation to ensure that there will be lessons to learn based on the results. Thus, local implementation of the fully cost-focused medical care can be developed based on the principles of ISO 15621 standard supporting optimisation of the nursing process. In addition to direct costs, well-being of the affected patients and nursing personnel is also assessed. The assessment is performed by questionnaire interviews. This method provides objective and continuous feedback allowing optimization of an effective, local and specific incontinence care process in the following three areas:

Implementation of the method starts with assessment of qualitative (patients’ need/hit rate of the applied diaper type) and quantitative (waste, etc.) measures of the current condition followed by education of nursing staff on the principle and practice of customised incontinence care. The education is followed by a practical training and implementation of the device selection based on patients’ needs in the daily routine. By re-assessing qualitative and quantitative measures of incontinence care, the institute will get the following results – projected to one patient day.

Clinical studies shows that the system based on “choice of care" logic is the most cost-efficient. Common use of the principles of ISO 15621 and the appropriate modern incontinence medical devices reduce the total cost of care for one patient by around one-fourth while improves the quality of care by at least one-third.

It should be noted that, although ISO 15621 standard is an option representing a change of era utilising the residual hygienic/self-care capabilities of patients in healthcare, the best standard gives nothing in practice without the need for professional improvement and hard work. Professional dedication of staff is the basis, particularly when a new system has to be tried and learned.