Kathy,
Seems to me there were a number of discussions just recently back and forth
on B&B training. If this isn't enough, let me know. It's hard to keep
track of all this stuff when you're working full time and have a family,
along with all the other facility responsibilities MDS nurses get stuck
with!
This was from Holly McGran on 11/12:
>>We first start with a 3 day pattern assessment -what that is - is a q1hour
check and a q2hour toilet check - the staff check for incontinence on the q
1hour check - and ask the resident if they are wet or dry (during waking
hours) -trying to determine awareness and also try to increase the
resident's awareness and then we toilet q2hours and document if the resident
was continent in recepticle or not - we measure output- if they were aware
of the urge to void - we also ask - was their any leaking on the way to BR,
incontinence with urge to void on the way to the BR, pain or strain with
voiding, more than 8 seconds to start urination. Then with this 3-days of
data -we are able to pick up patterns - what time do they go, when do they
not go - when are they wet when are they dry - based on that we come up with
a individualized toileting schedule -if that is an appropriate intervention
for the type of incontinence the resident has. We have most of our incont.
residents on a toileting schedule.
Holly QI in CT<<
This was from Carolyn Ortell:
>>There is a good book on this subject Managing and Treating Urinary
Incontinence by Diane Kaschak Newman published 2002 by Health Professions
Press
I purchased the book after hearing a presentation by a facility who followed
this program and had great success establishing a program<<
This was from Debbie Ohl:
>>Every incontinent person should be evaluated for a toilet program, we all
do
this. It is not automatic that every incontinent person be on a toilet
program. Cooperation is the first criteria. Also consider that some people
can and will self manage. As in a women who is self directed, oriented and
aware with a stress or urge or combination of those two. The key is to look
at the QI and ask why are they incontinent ( is it reversible? Are there
things that can be done to minimize occurrence?: like meds, exercise or
certain procedures requiring a urologist consultant. Can the person self
manage? if not why not? how and what type of facility intervention would be
of benefit? And if a toilet program is indicated when and how often?: during
waking hours only? 24/7? every 2 hours or a different schedule. If not
document the rationale and move on.<<
Debbie Ohl RN, NHA
LTC Consultant & Educator, Ohl & Associates
613 Compton Road, Cincinnati, Ohio 45231
Phone / Fax 513-522-6041
[EMAIL PROTECTED] www.greatcareplans.com<<
This was from an earlier one by Debbie Ohl, who does a good deal of
consulting and seems to have a form ready made for just about everything!:
>>Bladder Tracking is indicated to identify whether there is or is not a
pattern to voiding. If there is no pattern to the voiding AND the resident
is cooperative a habit training program is indicated (those are your check
and change q2h or on rising, after meals, etc.) if there is a pattern it
allows you to set up a more individualized schedule. enter scheduled voiding
program in the form of a prompted program in which you remind the resident
to go and get feedback from him or a scheduled program in which the staff
takes to toilet. In both instances the resident has to be able/willing to
cooperate. I might also suggest for goal measurability if you are trying to
improve bladder status that you use MDS terminology;occ., freq, usually,
etc. Also remember that another reason for a toilet program to promote sense
of normalcy and dignity. Hope this is helpful for you.
Indications for Facility Related to Urinary Incontinence
1.Was the cause of the incontinence clearly identified? If incontinence was
frequent, was it possible to lessen occurrence? If so, what steps were
taken to minimize occurrence?
2 Did the Incontinence RAP trigger? Were guidelines reviewed? Were
responses analyzed?
3 Was care planning initiated, know to staff, followed?
4 Did care plan actively address plan to minimize occurrence or does it
reflect acceptance of incontinence as status quo? If so, was this the most
appropriate judgment? Does the RAP analysis back up your planning and
decision making?
5 Were outcomes evaluated and modifications to plan initiated as needed?
Think about clinical avoidability and enhancement of status to the greatest
degree possible.<<
Debbie Ohl RN, NHA
LTC Consultant & Educator, Ohl & Associates
----- Original Message -----
From: "Vogt, Kathy" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Friday, November 14, 2003 10:09 AM
This is the third time I think I have posted this. If you do not have a
response, will one of you just let me know that it did get out to everyone.
I think our facility is doing poorly in regards to bladder training and
toileting programs. Can you let me know how your facility does it in order
to take credit for it on the MDS?
Thanks
Kathy Vogt, RN
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/----------------------------------------------------------
The Case Mix Discussion Group is a free service of the
American Association of Nurse Assessment Coordinators
"Committed to the Assessment Professional"
Be sure to visit the AANAC website. Accurate answers to your
questions posted to NAC News and FAQs.
For more info visit us at http://www.aanac.org
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