Incontinence audit data: linking pad use and gel use

Eleven hundred pads a month and nine kilograms of gel powder. Put those two numbers next to each other on a spreadsheet and you have something more useful than either on its own, because in a stable unit they should move together. When they stop moving together, something has changed, and it is usually not the thing the monthly report blames.

Most continence audits count pads because pads are easy to count and expensive to buy. Gel is treated as a consumable that appears in the stores figures and nowhere else. That is a missed opportunity, because the ratio between the two is one of the cheapest indicators of continence care quality you can build.

Build the ratio, not the totals

Two figures: pads per occupied bed-day, and grams of gel per occupied bed-day. Then the ratio between them. In a unit where most residents are continent with assistance, you might see 1.8 pads and 14 g of gel per bed-day. In a unit with a high dependency case mix, 3.4 pads and 26 g.

The absolute numbers tell you about case mix. The ratio tells you about practice. A change in the ratio without a change in case mix is a signal worth chasing.

Track it monthly for six months before you draw any conclusion. Conti pads and gel both move with the seasons, with staff turnover and with the arrival of a single high-need resident, and a one-month blip is noise.

Three patterns and what they mean

Pads down, gel up. Usually a shift towards prompted toileting, which is good news. The gel rises because more urine is going into containers rather than into pads. Check the ratio rather than the totals, and expect a settling period of four to six weeks.

Pads up, gel down. This is the pattern that should trigger a review. It often means residents are being left in pads rather than assisted to a container, and the reason is usually staffing at a particular time of day rather than a clinical decision.

Both up together. Case mix has changed, or a UTI is circulating, or the pad product has changed and is leaking. That last one catches people out, because a leaking pad increases both pad use and container use, and the two numbers rise in step.

The case that did not add up

A 56-bed home changed pad supplier in February to save 9% on the unit price. By April, gel use was up 34% and pad use was up 12%. The continence lead assumed a urinary tract infection outbreak and sent three samples, all clear.

The actual cause was the pad’s shape: the new product was 15 mm narrower, which was fine for mobile residents and inadequate for anyone being turned in bed. Night staff were changing pads twice as often and, because they were already in the room, were also emptying containers they would previously have left until morning.

The 9% saving was worth about four hundred pounds a month. The extra gel and the extra pads were worth eleven hundred. Nobody had joined the two data sets up until the audit did it for them.

Two contextual figures make the ratio interpretable: the number of assisted toileting episodes per day, and the number of containment products issued per resident per week. Without those, a rise in gel use could be better care or worse care, and you cannot tell which.

• Assisted toileting episodes, counted on two sample days a month.
• Pads issued per resident per week, from the stores record.
• Grams of gel issued per occupied bed-day, from the same record.
• Containment product changes recorded on the care chart, if your system captures them.

Four numbers, one spreadsheet, ten minutes a month. It is not a research project.

Where the numbers should change your buying

If gel use is high and pad use is low, the unit is doing the right thing and the gel spend is a sign of good practice, not waste. If both are high, look at the pad before you look at the powder. If gel use is low and pad use is high, check whether containers are being used at all, because a pad-only routine is more expensive and less comfortable.

The dosing guide gives the grams per volume you need to convert container counts into a gel figure, which is the step most audits skip.

Pull last month’s pad issue and gel issue this week and divide each by your occupied bed-days. Whatever the ratio is, write it down, and compare it with the same figure in three months. That is how you find the next supplier change before it costs you.