Prior to an assessment:
1. A urinalysis must be completed and any detected abnormalities treated first.
2. A resident is not to begin their assessment until it can be determined they are not constipated.
When assessing:
1. Ensure at least 1200ml fluid input/day, if not, repeat day, unless it is deemed, after much encouragement, that the resident cannot drink this as part of their usual routine.
2. When a resident requests to be toileted, they are not to be prevented, include these effective toileting times in their assessment.
3. Note the amount of incontinent episodes per day, assessing the resident hourly for four days.
4. Assess and note any patterns of behaviour, or conditions which regularly occur either prior or after incontinent episodes or when incontinent, place this information in the remarks column.
· ie incontinence related to recently given medications, restlessness of a resident prior episodes of incontinence, what the resident was doing when found incontinent.
5. Ensure fluid intake and other information is accurately completed.
6. Ensure the graph is accurately completed using the number of times voided as the base-line which includes both incontinent and voluntary voiding times.
7. Write exact determined toileting times for staff to follow when completing the evaluation section of the chart.
8. When voiding times have been determined, toileting should occur prior to these times, ie.1/2 an hour before incontinent episode noted.
9. Evaluate the type of incontinence.
10.If a resident is totally incontinent, hence unable to effectively use a continence management routine, ensure a continence aid is used during the day if the resident wishes and include this information in the evaluation section of the chart.
11.When evaluated times appear to be repeatedly ineffective, a re-evaluation should begin to determine the most effective routine, otherwise, if only one time is affected a determined ‘better’ toileting time should be documented and begun.
12.Ensure all information is transferred onto Nursing care Plans.
Notes:
1. Do not take a resident to the toilet after an incontinent episode as this encourages poor bladder tone, unless the resident specifically requests this after explanations have been given why this is not recommended.
2. If a resident does not have an adequate input, they cannot effectively empty their bladder and this also encourages poor bladder tone.
3. A ‘kylie’ is to be used on all residents who are incontinent overnight or other continence management aids as the resident may request.
4. DO NOT WAKE a resident who is asleep, to use a commode or pan at an evaluated time. If they are regularly asleep at their determined effective toileting time, ensure a ‘kylie’ or continence management aid is used prior their sleeping.
5. Overnight, usual pressure area care must be provided for residents who require it, if it occurs at a toileting time and the resident is definitely awake, a pan or commode may be offered, but used only if the resident wishes this.
6. A residents wishes come first with all toileting activities but a resident is not to be allowed to remain wet and must be thoroughly washed and dried after any episodes of incontinence.