Poor continence care in overwhelmed emergency departments is leading to avoidable harm

Summary

In this anonymous blog, a continence nurse highlights the difficulties in delivering toileting support to patients in overwhelmed emergency departments. They explain the challenges staff face, how these impact patient outcomes and experience, and why this needs to be urgently addressed. 

Content

After reading a number of recent articles about the challenges of delivering safe care in overwhelmed emergency departments and corridor settings, I wanted to highlight another increasingly difficult issue.

As a continence nurse, I provide toileting support for patients and guidance for staff to help maintain good care and outcomes. With emergency departments increasingly overwhelmed and patients being cared for in corridors, it is critical that we look at the impact on continence care and risk of harm.

What are the challenges?

• Not enough toilet facilities.
• Not enough staff to accompany patients who need assistance to the toilet.
• Lack of private, dignified spaces.
• A reliance on incontinence pads but no capacity to regularly change pads or manage this well.

What can this mean for patients?

• An increase in moisture-associated skin damage, especially among those who are incontinent or rely on staff for support with toileting needs.
• Skin damage that often begins in the emergency department continues to worsen once patients are transferred to wards.
• Delays in accessing the toilet.
• No access washing facilities until they are admitted to a ward, sometimes many hours after coming to the emergency department. 
• Patients are often being cleaned and changed behind a screen in a corridor which contributes to both physical harm and emotional distress.

What can be done?

Although there are measures that can be taken to help reduce harm in these increasingly overwhelmed environments, they always come with other considerations.

• Increasing toilet facilities can help support good continence care where these are lacking.
• Bed pads like Ultrasorb can help where there isn’t capacity to change personal pads regularly and in private. Although bed pads can hold a lot of fluid and keep the moisture away from the skin for longer, they are not ideal as they encourage incontinence.
• Looking at staffing allocation could help but the reality is that these teams are extremely stretched and, in the emergency department, blood tests and urgent investigations need to come first. Too often there is no time left for continence care.
• Using the appropriate products such as moisturising wipes and the right barrier cream can also help improve outcomes and speed things up for time-poor staff teams.

This situation undermines patient dignity and wellbeing and places added strain on staff and hospital resources due to the preventable nature of much of the resulting skin damage.

I have been part of several multidisciplinary solutions—such as revisiting staffing allocations and exploring alternative toileting support options—and have escalated these concerns through the appropriate channels.

Despite these efforts, the challenge remains very real, and the daily struggle for staff to maintain basic standards of continence care continues.

I hope this issue can be given the urgent attention it deserves.

Share your insights

Have you experienced some of the challenges around toileting support in emergency departments, either as a patient, relative or a member of staff?

Could you share your insights and experience to help others understand the safety issues?

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