1. Dealing with Urinary Incontinence Using Prompted Voiding – An Overview Heather Woodbeck, Best Practice Coordinator - Long Term Care NW. ONT. December 2007

2. Objectives zUnderstand functional incontinence. zUnderstand factors that contribute to functional incontinence zUnderstand prompted voiding as an intervention for incontinence

3. What is Incontinence? Defined by the International Continence Society as: “a condition where involuntary loss of urine is a social or hygienic problem” (ICS, 1987)

4. Why is Incontinence Important? zOne of the most common reasons for admission to LTC. zNegatively affects a person’s dignity. zCauses embarrassment, depression and social isolation. zComplications cause falls, urinary tract infections, skin and wound problems.

5. Myths and Truths zIncontinence is a normal aging process. zLittle can be done for incontinent residents. zToileting residents every 2 hours prevents incontinence. zRestricting fluids reduces incontinence. zPrompted voiding is an effective method to use with incontinent patients.

6. Functional Incontinence patient either has decreased mental ability (e.g. Alzheimer’s disease) or decreased physical ability (e.g. arthritis) and is unable to make it to the bathroom in time

7. Incontinence Management zAssess problem. zDevelop a care plan. zAddress contributing factors. zImplement individualized toileting plan. zEvaluate effectiveness. zRevise as needed.

8. Assessment: Voiding Record zTime and amount of : - Fluid intake - Urine voided - Incontinence -Done for 3 or more days

9. Assessment: Functional Ability zAccess to bathroom zAmbulation (needs assistance) zWheelchair zTransfer aids zAdaptive clothing/environment

10. Assessment - Cognitive Capacity Requirements for Continence aware of urge to void able to get to the bathroom able to suppress the urge until resident reaches the bathroom able to void when resident gets there

11. Approaches to Incontinence zPrompted voiding zHabit retraining zFluid management zPelvic floor muscle rehabilitation zLifestyle modifications, and zUrge inhibition techniques (The Canadian Continence Foundation, 1998).

12. Prompted Voiding zChanges caregiver’s response to urine loss rather than resident’s response. zCaregiver prevents undesired urine loss from occurring before the resident would be incontinent.

13. Prompted Voiding – Target Group zUseful with residents who have physical or mental impairments or little ability to determine how best to meet their needs. zIndividual voiding patterns rather than routine toileting (e.g. q2H) can promote the highest level of success.

14. Prompted Voiding Intervention Three main interventions: zMonitoring - Ask the resident at regular intervals if he/she needs to use the toilet. zPrompting - Remind the resident to use the toilet and try not to void between prompted voiding sessions. zPraising - Give positive feedback to resident to reinforce dryness and appropriate toileting

15. Before Prompted Voiding z1.Determine the resident’s pattern of incontinence using a 3-day voiding record. z2.Address constipation and fecal impaction. z2.Encourage fluid intake of 1500 ml/day. z3.Minimize caffeinated and alcoholic beverages. z4.Initiate an individualized prompted voiding schedule based on the resident’s toileting needs, and as indicated by the 3-day voiding record. z5. Carefully record and monitor resident’s response.

16. Trial Run zCollect baseline information about your resident for at least 3 days. zReview data. Assess responsiveness of your resident to prompted voiding. zStart slowly, with only one or two residents at one time. zTry out the intervention for one week with your resident, carefully track results, then reassess effectiveness. zDiscontinue, if client is not responding.

17. Monitoring Effectiveness - Measures zDecreased # of incontinent episodes per day and increased the # of continent voids. zResident will be continent during waking hours zBladder irrigation will be discontinued zFull continence will be achieved zResident will have an individualized toileting plan

18. Conclusion zPrompted voiding can work in long term care BUT you need to start slowly with residents whom you think will be successful at achieving continence. zBuild on your successes, however large or small.

19. References zAnna and Harry Borun Center for Gerontological Research. 2004. Incontinence Management Training Module. http://borun.medsch.ucla.eduhttp://borun.medsch.ucla.edu zLyons, SS & Pringle Specht, JK. 2000. Prompted Voiding Protocol for Individuals with Urinary Incontinence. Journal of Gerontological Nursing. 26(6). June. pp. 5-13. zOuslander, JG. et al. 1995. Predictors of Successful Prompted Voiding among Incontinent Nursing Home Residents. Journal of the American Medical Association. 273(17), May 3, pp. 1366-1370. zRaiwat, C. & Phillips, D. 2001. A regional approach to continence management. Canadian Nurse. 97(4): 16-20. zRegistered Nurses Association of Ontario (RNAO). 2007. Continence/Constipation Workshop for RNs in Long Term Care. http://www.rnao.org/Page.asp?PageID=924&ContentID=813. http://www.rnao.org/Page.asp?PageID=924&ContentID=813 zRegistered Nurses Association of Ontario (RNAO). 2005. Promoting Continence Using Prompted Voiding. RNAO. Toronto. http://www.rnao.org/Page.asp?PageID=924&ContentID=813. http://www.rnao.org/Page.asp?PageID=924&ContentID=813

20. Part of this presentation were adapted from the IC 3: Improving Continence Care Collaborative and IC 5 Projects Acknowledgements