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Real-World Incontinence Advice

Tips Gleaned from
Learning Session 4 of our Collaborative

Discussions among participants at our January 2016 meetings generated a wealth of ideas and best practices related to incontinence. Try some of these peer-tested techniques at your facility!

  • Admission continence assessment for first 72 hours to determine natural patterns.
  • Offer frequent toileting assistance, either routine or according to individualized needs of resident.
  • Night shift toileting is individualized so as to not awaken people who don’t need to get up during the night and offer assistance at the appropriate time for those who do need it.
  • No longer allow any incontinence (soaker) pads in beds.
  • Recognize that you may face initial resistance to this culture change from both staff and families, but after implementation in other facilities they have liked the change.
  • Ensure that quarterly assessments of frequency and extent of incontinence are just a thorough as admission assessments.
  • Establish benchmarks and set incident reduction goals. You might want to start with just a few residents at a time rather than house-wide.

Bowel & Bladder Incontinence Assessment Process Elements

  • B&B record (from CNA Flow sheet, Point Click Care, etc.)
  • Observe patterns for 72 hours
  • Medical History
  • Resident &/or Family interview re: preferences & history
  • Bladder scan
  • Measure mobility & cognitive ability
  • Skin check
  • Medication Review
  • Product utilization records

MDS Accuracy Audits

  • Ensure that you are correctly capturing cognitive ability, mobility dependence, and other resident data for exclusions from the low-risk denominator for the incontinence QM
  • Use the QM data specifications to track back through the resident level QM report in QIES/CASPER to the individuals who trigger for the QM to their individual MDS assessments.

Resident mobility & continence therapy

  • Ensure you are offering restorative and occupational therapy (part B) appropriately to help with mobility and continence challenges
  • Ensure you are addressing medical issues that may put pressure on the resident’s ability to maintain continence, e.g. Lasix or other diuretic therapy, physical assessment by a urologist if needed, evaluation of other related issues that could help.

Work processes questions

  • How do you communicate assessment results so that all staff are aware of the individual resident’s care plan for toileting?
  • How do you ensure staff are following the toileting plan?
  • Is everyone on a check and change every 2 hours schedule or have you developed a work flow that allows for individualized toileting plans?
  • How do you ensure enough hands are on deck to answer call lights and provide toileting assistance during peak times, e.g. after meals? Would additions of administrative, nursing, or volunteer staff to answer call lights or provide pro-active 4 P’s rounding during a peak time help free up nurse assistants for toileting?
  • At admission do you automatically issue depends to everyone? Or, could you ask family to bring in underwear during the 72 hour assessment period to help with establishing patterns at the highest level of continence practicable? After the assessment period pads might be offered if needed instead of briefs, as appropriate.
  • Do CNAs believe that their job is to assist residents to maintain their continence or to clean up after residents experience incontinence? Do staff feel that promoting continence is important, or that incontinence is inevitable? What could be helpful to shift the culture? How do direct supervisors support CNAs in providing individualized toileting assistance for those residents who would benefit from that? Try completing a time study to compare the time involved in peri-care after incontinence to time involved in assistance with toileting proactively when anticipating the resident’s needs.