Page 189 - Hospital Authority Convention 2018

Parallel Sessions

PS11.3 Evidence Based Nursing 14:30 Room 221

To Identify the Incident of Urinary Incontinence in Pregnant Women among Eight Hospital Authority Birthing
Hospitals
Chan CN
Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong HOSPITAL AUTHORITY CONVENTION 2018

Urinary incontinence is a common problem which can affect up to 10 - 46% of women. This problem has been reported in
34% of women at three months postpartum, but the peak incidence is during pregnancy. A study had shown that 78.3% of
local Chinese women did not aware stress incontinence was a disease entity, or were not willing to seek medical advice. In
order to view the prevalence of local Chinese obstetric women with urinary problem(s) or incontinence during pregnancy, a
one-week survey in December 2017 was conducted. Those pregnant women attended the first antenatal visit or Group B
Streptococcus Screening in eight birthing hospitals of Hospital Authority during the study period were recruited. The two
Chinese short-form questionnaires, Urogenital Distress Inventory-6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7)
were used as they are reliable and validated to assess the impact of the urinary incontinence in Chinese women.
Of 951 anonymous pregnant women completed the UDI-6 and IIQ-7, mean maternal age was 32.1±4.6 years old, gestational
age was 22.8±11.5 weeks and parity was 0.7±0.8. The mean scores of UDI-6 and IIQ-7 were 38.17±9.70 and 11.1±17.01
respectively. 395 (41.6%) women indicated to have moderate to great bothered by the symptoms in UDI-6. Statistical
calculation was performed to compare the parity with the symptoms in UDI-6 scores, significant differences were found in
urine leakage related to physical activity, coughing or sneezing (p<0.001), but no significant difference in other symptoms
in UDI-6 with parity. Results also showed significant differences when increased with gestation age as frequent urination
(p<0.001), urine leakage related to feeling of urgency (p=0.008), urine leakage related to physical activity, coughing or
sneezing (p<0.001), and pain or discomfort in the lower abdominal or genital area (p=0.032). Regarding the age group, a
significant difference was only found in frequent urination (p=0.005) when increased of maternal age, but no significant
difference in other symptoms in UDI-6.

When comparing the IIQ-7 scores with the parity, 61.3% (19/31) of women whose parity=1 stated that urine leakage had
affected their ability to do household chores (P=0.29). There was no other difference found in other items in IIQ-7 with
maternal age and gestation.

The survey concluded that local Chinese pregnant women with urinary problem(s) or incontinence were very common. The
importance of early recognition and increase of awareness on the prevention of urinary incontinence should be iterated
during antenatal period.

PS11.4 Evidence Based Nursing 14:30 Room 221

Developing a Clinical Practice Guideline in Preventing Diaper Dermatitis in Paediatric Patients
Chan MY
Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong
Introduction
Diaper dermatitis (DD) is a common problem in paediatric patients, which not only causes pain in children and anxiety
in parents, but may also have an impact on medical cost due to the increased length of stay and alteration in treatment
regimen. There is no evidence based intervention(s) for the prevention and management of paediatric patients with DD and
no standardised guideline/protocol among individual units and paediatric departments in Hospital Authority hospitals. Tuesday, 8 May 2018

Objectives
To develop a clinical practice guideline with the best evidence in prevention of DD in paediatric patients for knowledge
enhancement and change in practice among nurses and patient care assistants (PCAs).
Methodology
A systematic review of prevention of DD was performed using Johns Hopkins Nursing Evidence Based Practice model.
English articles regardless of the year of publication were searched from electronic databases (e.g. OVID Multifile, CINAHL
and EMBASE) using search terms including “sore buttocks”, “diaper dermatitis”, “nappy dermatitis”, “nappy/diaper rash” and
“incontinence associated dermatitis”. Reference lists of the retrieved articles were also searched. Two independent reviewers
assessed the studies for relevancy and level of quality by using appraisal tools from Johns Hopkins Nursing. A panel of
experts translated the evidence into practice.

Results
A total of 42 studies were identified and summarised into an “ABCDE approach” clinical practice guideline – A: Assessment
and Airing, B: Barrier protection, C: Cleansing, D: Diapering, and E: Education. Training kits were established to enhance
knowledge of nurses and PCAs in prevention of DD. Cue cards for the change in practice and education pamphlet for patient
and parents were developed.
Conclusions
The evidence based practice model is effective in appraising and utilising evidence into practice. A further pre-and post-test
study shall be conducted to evaluate the effectiveness of the clinical practice guideline in the knowledge and behaviour of
nurses and PCAs.
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