Dealing with Urinary Incontinence Using Prompted Voiding – An Overview Heather Woodbeck, Best Practice Coordinator - L

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

2. Objectives • Understand functional incontinence. • Understand factors that contribute to functional incontinence • Understand 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? • 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.

5. 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.

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 • Assess problem. • Develop a care plan. • Address contributing factors. • Implement individualized toileting plan. • Evaluate effectiveness. • Revise as needed.

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

9. Assessment: Functional Ability • Access to bathroom • Ambulation (needs assistance) • Wheelchair • Transfer aids • Adaptive 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 • Prompted voiding • Habit retraining • Fluid management • Pelvic floor muscle rehabilitation • Lifestyle modifications, and • Urge inhibition techniques (The Canadian Continence Foundation, 1998).

12. 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.

13. 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.

14. 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

15. 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.

16. 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.

17. 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

18. 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.

19. 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.

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