Abstract General Information

Title

AN AUDIT OF STRUCTURED ENURESIS SERVICES IN CAVAN AND MONAGHAN, IRELAND

Introduction and objective

To audit the treatment success of a community-based public health nurse (PHN) provided enuresis clinic since the amalgamation of services in the counties of Cavan and Monaghan in the Republic of Ireland. Success was based on the International Children's Continence Society's definitions of the "Percentage of Reduction in wet nights" and compared to targets set by ERIC (Education and Resources for Improving Childhood Continence), defined as Initial Success (14 consecutive dry nights) achieved by 50% of patients. Presented at IPA 2017.

Method

A retrospective review of new patients attending the fortnightly combined Cavan/Monaghan Enuresis Clinic from October 2014 to April 2017. The existing defined referral pathways are via PHNs, General Practitioners, or Paediatricians. Clinical data are recorded prospectively on a dedicated electronic Health Care Record, EEF (Electonic Enuresis File). Statistical analysis was performed using IBM SPSS 23.0.

Results

79 New patients were identified, 2 were excluded due to failure to attend, and 77 were included for analysis. Male-to-female ratio was 1.7:1. The median (range) of age at the first visit was 8.1 (6.5-13.8) years. 55/77 (71.4%) represented patients with monosymptomatic enuresis. Overall 48/77 (62.3%) achieved initial success with a median (IQR) time to initial success of 23 (12-34) weeks from first visit. 33/77 (42.9%) achieved initial success by 16 weeks of treatment. 17/77 (22.1%) achieved complete success (>99% reduction in wet nights) at 16 weeks. Median (IQR) of Dry-Index (number of dry nights/number of nights observed) by 16 weeks was 0.54 (0.85-0.13) with a median (IQR) of "Percentage of Reduction in Wet Nights" of 80.5% (39-97). 46/77 (59.7%) initiated an enuresis alarm. Initiating an enuresis alarm was significantly associated with the achievement of initial success, p=0.04. The number of clinical contacts in the first six months significantly differed between those that achieved initial success and those that didn't, p=0.02.

Conclusion

Success rates at 16 weeks, 42.9%, fell short of the ERIC target of 50%. increased intensity of interaction at the onset of treatment, and further streamlining the referral process and treatment implementations may improve this.