Care home continence promotion care bundle: improving quality of care and safety

NHS Lanarkshire Health and Social Care Partnerships

  • Led by NHS Lanarkshire Health Board, in partnership with NHS National Procurement and with wide health and social care stakeholder involvement.
  • Aimed to improve continence among care home residents and reduce containment product usage in two care homes in NHS Lanarkshire.
  • Developed and tested a continence care bundle that includes continence promotion measures, and supported care home staff to implement it.
  • Project ran from March 2016 to August 2017.

Incontinence is common in care home residents with prevalence ranging from 30% to 80%, and is associated with risks such as falls, infection and skin damage. In care homes incontinence is primarily managed with absorbency pads, which contain rather than promote and improve continence. National continence guidance suggests interventions such as toilet assistance, optimal fluids, nutrition and medication can promote continence rehabilitation, and reduce the use of absorbency products in the elderly by <50%.

This project developed and implemented a continence promotion care bundle (CPCB), consisting of five interventions to improve care, within two care homes in NHS Lanarkshire. The primary aim was reducing the use of high absorbency products by 25% in 12 months, and the secondary aim was reducing the safety risks associated with incontinence.

A phased approach was used to implement the CPCB in four clinical areas within the care homes, and data was collected over a ten-month period (September 2016 – June 2017).  59 care home residents were involved in the project. Those requiring end of life care were excluded.  


The project demonstrated the following successes:

  • a reduction in episodes of incontinence and in pad use, and less distress in residents and families
  • a 30% reduction in skin damage
  • a 40% - 65% reduction in falls
  • a 50% reduction in urinary tract infections (UTI)
  • a 40% reduction in unplanned hospital admission for falls/UTI
  • improved record keeping and ability to have more time with residents.   

Economic analysis showed the potential for savings of £250,000 over nine months. The intervention would be transferable to other care homes, however further testing and refining of the data capture measures would be beneficial.

  • Winner of a GO Awards Scotland 2017/18 for excellence in ‘GO Procurement Innovation / Initiative Award – Central Government, Health and Social Care’ category at Marriott Hotel, Glasgow, on 26 October 2017.

Contact details

  • For further information about the project, please email Alice Macleod, Senior Nurse, National Procurement, Procurement, Commissioning and Facilities, NHS National Services Scotland.
  • Or Jean Donaldson, Associate Nurse Director, NHS Lanarkshire.

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