Transcript Urinary Incontinence

Dealing with Urinary
Incontinence Using Prompted
Voiding – An Overview
Heather Woodbeck,
Best Practice Coordinator - Long Term Care NW. ONT.
December 2007
Objectives
Understand functional incontinence.
Understand factors that contribute to
functional incontinence
Understand prompted voiding as an
intervention for incontinence
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)
Why is Incontinence Important?
One of the most common reasons for
admission to LTC.
Negatively affects a person’s dignity.
Causes embarrassment, depression and
social isolation.
Complications cause falls, urinary tract
infections, skin and wound problems.
Myths and Truths
 Incontinence is a normal aging process.
 Little can be done for incontinent residents.
 Toileting residents every 2 hours prevents
incontinence.
 Restricting fluids reduces incontinence.
 Prompted voiding is an effective method to
use with incontinent patients.
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
Incontinence Management
Assess problem.
Develop a care plan.
Address contributing factors.
Implement individualized toileting plan.
Evaluate effectiveness.
Revise as needed.
Assessment: Voiding Record
Time and amount of :
- Fluid intake
- Urine voided
- Incontinence
- Done for 3 or more
days
Assessment: Functional Ability
Access to bathroom
Ambulation (needs
assistance)
Wheelchair
Transfer aids
Adaptive
clothing/environment
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
Approaches to Incontinence
Prompted voiding
Habit retraining
Fluid management
Pelvic floor muscle rehabilitation
Lifestyle modifications, and
Urge inhibition techniques
(The Canadian Continence Foundation, 1998).
Prompted Voiding
Changes caregiver’s
response to urine loss
rather than resident’s
response.
Caregiver prevents
undesired urine loss from
occurring before the
resident would be
incontinent.
Prompted Voiding – Target Group
Useful with residents who have physical
or mental impairments or little ability to
determine how best to meet their needs.
Individual voiding patterns rather than
routine toileting (e.g. q2H) can promote
the highest level of success.
Prompted Voiding Intervention
Three main interventions:
Monitoring - Ask the resident at regular
intervals if he/she needs to use the toilet.
Prompting - Remind the resident to use the
toilet and try not to void between prompted
voiding sessions.
Praising - Give positive feedback to resident to
reinforce dryness and appropriate toileting
Before Prompted Voiding
 1. Determine the resident’s pattern of incontinence
using a 3-day voiding record.
 2. Address constipation and fecal impaction.
 2.
Encourage fluid intake of 1500 ml/day.
 3.
Minimize caffeinated and alcoholic beverages.
 4. Initiate an individualized prompted voiding schedule
based on the resident’s toileting needs, and as indicated
by the 3-day voiding record.
 5.
Carefully record and monitor resident’s response.
Trial Run
Collect baseline information about your resident
for at least 3 days.
Review data. Assess responsiveness of your
resident to prompted voiding.
Start slowly, with only one or two residents at
one time.
Try out the intervention for one week with your
resident, carefully track results, then reassess
effectiveness.
Discontinue, if client is not responding.
Monitoring Effectiveness Measures
Decreased # of incontinent episodes per
day and increased the # of continent voids.
Resident will be continent during waking
hours
Bladder irrigation will be discontinued
Full continence will be achieved
Resident will have an individualized toileting
plan
Conclusion
Prompted voiding can work in long term
care BUT you need to start slowly with
residents whom you think will be
successful at achieving continence.
Build on your successes, however large or
small.
References
 Anna and Harry Borun Center for Gerontological Research. 2004.
Incontinence Management Training Module. http://borun.medsch.ucla.edu
 Lyons, SS & Pringle Specht, JK. 2000. Prompted Voiding Protocol for
Individuals with Urinary Incontinence. Journal of Gerontological Nursing.
26(6). June. pp. 5-13.
 Ouslander, 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.
 Raiwat, C. & Phillips, D. 2001. A regional approach to continence
management. Canadian Nurse. 97(4): 16-20.
 Registered 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.
 Registered Nurses Association of Ontario (RNAO). 2005. Promoting
Continence Using Prompted Voiding. RNAO. Toronto.
http://www.rnao.org/Page.asp?PageID=924&ContentID=813.
Acknowledgements
Part of this presentation were adapted from the IC 3:
Improving Continence Care Collaborative and IC 5 Projects