Establishing a voiding pattern Whether a resident is incontinent upon admission or becomes incontinent later, it is important to perform an initial continence assessment on everyone at risk, and then develop a plan of care. It is also essential to regularly monitor, review and revise the plan of care to best manage urinary incontinence and restore as much normal bladder function as possible.

Voiding diary A voiding diary is a key tool for gathering information about the resident’s usual urinary pattern. The diary serves many purposes, including assessment of diurnal (daytime) and nocturnal (nighttime) voiding and incontinence patterns. A diary may be generalized or detailed to include behavioral or environmental factors that affect incontinence. Discussing the voiding diary with the resident, family and caregivers is also very important. This discussion allows all parties to be involved in the proposed bladder management program.

Completing a voiding diary Assess the resident every hour for three days (72 hours). When not with the resident, have resident/ family assess and document:

• Time and nature of incontinent episodes and all voids.

• Ask resident whether he or she felt the urge to void.

• Identify activity during incontinent episodes.

• Volume of fluid intake. • Type and amount of food intake. • Any burning sensation, pain or cognitive status.

• Any support required for toileting. • If completing a bowel diary, conduct for 7 days and follow steps listed above.

Interpretation of a voiding diary Review the resident’s pattern of incontinence. Is there a pattern such as always wet at lunch time? Or during an activity? If so, a good strategy would be to toilet the resident before lunch or before the activity. Also, consider the timing of medications. A resident who receives a dose of diuretics may need to be taken to the toilet within an hour of that dose. Be sure to look for triggers such as coffee, caffeine, carbonated drinks, chocolate or citrus juices; even non-caffeinated coffee can be a bladder irritant for some residents.

Once the diary has been interpreted it is time to choose the appropriate adult disposable incontinence management product. Consideration of the residents comfort, dignity and quality of life is crucial when selecting a product.

Tips for product selection Disposable incontinence products must:

• Provide comfort and security • Help protect the skin • Provide odor control

Product selection should be based on: • Degree of incontinence • Gender • Fit (proper sizing to the person) • Ease of use

Prognosis and education Poor standards of continence care continue to be reported and national audits have cited inadequate professional education as a major contributory factor. Caregivers report receiving no education about caring for patients with incontinence. As a result, incontinence is often viewed as a normal part of aging, which is not the case.15

Ensuring that your healthcare personnel are properly trained is critical to improving outcomes as well

1. What is incontinence? National Association for Continence website. Available at: Accessed September 28, 2010. 2. Wagg et al, 2009; Williams et al, 2005. 3. Diagnosis and comparative effectiveness of treatments for urinary incontinence in adult women. Agency for Healthcare Research and Quality (AHRQ) website. Available at: products/169/497/Urinary%20Incontinence%20Protocol%2081%204%2010%20(2).pdf. Accessed September 28, 2010. 4. Hu TW, Wagner TH, Bentkover JD, Leblanc K, Zhou SZ, Hunt T. Costs of urinary incontinence and overactive bladder in the United States: A comparative study. Urology 63(3):461– 5. 2004. 5. Subak LL, Brubaker L, Chai TC, Creasman JM, Diokno AC, Goode PS, et al. High costs of urinary incontinence among women electing surgery to treat stress incontinence. Obstet Gynecol 111(4):899–907. 2008. 6. Xu X, Menees SB, Zochowski MK, Fenner DE. Economic cost of fecal incontinence. Dis Colon Rectum 55(5):586–98. 2012. 7. Landefeld CS, Bowers BJ, Feld AD, Hartmann KE, Hoffman E, Ingber MJ, et al. National Institutes of Health state-of-the-science conference statement: Prevention of fecal and urinary incontinence in adults. Ann Intern Med 148(6):449–58. 2008. 8. Ko Y, Lin SJ, Salmon JW, Bron MS. The impact of urinary incontinence on quality of life of the elderly. Am J Manag Care 11(4 Suppl):S103–11. 2005. 9. de Vries HF, Northington GM, Bogner HR. Urinary incontinence (UI) and new psychological distress among community dwelling older adults. Arch Gerontol Geriatr 55(1):49–54. 2012. 10. Dugan E, Cohen SJ, Bland DR, Preisser JS, Davis CC, Suggs PK, McGann P. The association of depressive symptoms and urinary incontinence among older adults. J Am Geriatr Soc 48(4):413–6. 2000. 11. Dunlop DD, Manheim LM, Sohn M-W, Liu X, Chang RW. Incidence of functional limitation in older adults: The impact of gender, race, and chronic conditions. Arch Phys Med Rehabil 83(7):964–71. 2002. 12. Oliver D, Healey F, Haines TP. Preventing falls and fall-related injuries in hospitals. Clin Geriatr Med 26(4):645–92. 2010. 31. Chiarelli PE, Mackenzie LA, Osmotherly PG. Urinary incontinence is associated with an increase in falls: A systematic review. Aust J Physiother 55(2):89–95. 2009. 32. Parsons JK, Mougey J, Lambert L, Wilt TJ, Fink HA, Garzotto M, et al. Lower urinary tract symptoms increase the risk of falls in older men. BJU Int 104(1):63–8. 2009. 13. Gotoh M, Matsukawa Y, Yoshikawa Y, Funahashi Y, Kato M, Hattori R. Impact of urinary incontinence on the psychological burden of family caregivers. Neurourol Urodyn 28(6):492–6. 2009. 34. Collins JW, Wolf L, Bell J, Evanoff B. An evaluation of a ‘‘best practices’’ muscu- loskeletal injury prevention program in nursing homes. Inj Prev 10(4):206–11. 2004. 35. Durrant J, Snape J. Urinary incontinence in nursing homes for older people. Age Ageing 32(1):12–8. 2003. 14. Dobbs D, Meng H, Hyer K, Volicer L. The influence of hospice use on nursing home and hospital use in assisted living among dual-eligible enrollees. J Am Med Dir Assoc 13(2):189.e9–189.e13. 2012 , Morrison A, Levy R. Fraction of nursing home admissions attributable to urinary incontinence. Value Health 9(4):272–4. 2006. 38. Friedman SM, Steinwachs DM, Rathouz PJ, Burton LC, Mukamel DB. Characteristics predicting nursing home admission in the program of all-inclusive care for elderly people. Gerontologist 45(2):157–66. 2005. 39. Isaacs B, Gunn J, McKechan A, McMillan I, Neville Y. The concept of pre-death. Lancet 1(7709):1115–8. 1971. 15. Lomas, 2009.

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as promoting resident dignity, comfort and quality of life. Encouraging your staff to participate in a Continence Management Program is a great way to strengthen their knowledge about incontinence. Tools and education contained in a Continence Management Program are also crucial for your residents and their family members.

Visit to learn more about a comprehensive, easy-to implement Incontinence Solutions Program. From online education to product sizing tools, we go beyond briefs to help you provide the best care and improve outcomes.

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