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TO: "We created a policy which says basically if ST memory loss
is triggered and transfer ability is a 3 or 4 then program is not going to be
appropriate- we rap to the fact /reason I.e.; diagnosis etc."
The new CMS draft UI protocol, is VERY BIG on through assessment. You
might want to think a bit more about your current policy, particularly in
light of the protocol. Memory is not necessarily a deterrent to toileting
nor is mobility dependence. A primary key to whether to attempt a
toilet program is whether or not the person is cooperative. Remember the
CFR regulation intent is that you reverse it if possible, minimize the degree of
occurrence, and maintain dignity. The very best tool to use for a bladder
assessment is the UI RAP. It addresses all the pertinent issues to be
considered. Put that with a few days of bladder tracking and you will know which
direction to head in!
Highlights of UI Protocol
- Evaluation of the incontinence requires appropriate
classification by history, examination, and testing.
- Residents who are likely to benefit form behavioral therapy
for urinary incontinence can be easily identified.
Residents who show a response to a simple, non-invasive
assessment consisting of 3-day trial of prompted voiding have [potential to
show long term benefit in control of their incontinence.
- At a minimum the comprehensive assessment should include an
evaluation of the residents:
- Prior history of urinary incontinence, including previous
treatment or management.
- Physical exam to identify prolapsed uterus or other pelvic
organs, prostrate enlargement, urinary retention, use of catheter, abdominal
or urologic surgery, atrophic vaginitiis.
- Individual risk factors: dementia, impaired cognition,
impaired mobility, visual problems, CHF, Stroke, Diabetes, Parkinson�s and
neurologic disorders
- Cognitive status and behaviors that may affect continence
status.
- Functional impairments that can impede ability to maintain
continence.
- Significant alteration or impairment in patterns of fluid
intake and hydration status including presence of constipation and
impaction.
- Medications that may affect continence, including those with
anticholinergic properties
- VOIDING PATTERNS
CLASSIFICATION OF THE TYPE OF URINARY
INCONTINENCE
- RESULTS OF POST VOID RESIDUAL(S) FOR RESIDENTS AT RISK FOR
URINARY RETENTION OR ULTRASOUND.
- Presence or absence of UTI�s, persistent or recurrent, urine
culture if symptomatic
- Environmental factors and assistive devices such as grab bars
raised toilets, bed rails, restraints, etc.
- Type and frequency of physical assistance needed to access
toilet.
----- Original Message -----
Sent: Tuesday, January 06, 2004 9:21
PM
Subject: Re: bladder assessment
In our facility we attempted to make our bladder and bowel assessment as
easy as possible to evaluate ability to start a toilet program.
We incorporated the MDS since we already had to do the assessment, so not
to repeat same questions.
We created a policy which says basically if ST memory loss is triggered
and transfer ability is a 3 or 4 then program is not going to be appropriate-
we rap to the fact /reason ie; diagnosis etc. I don't have the exact policy
with me right now, I am at home, however if you would like to e-mail me at [EMAIL PROTECTED] and leave your
fax number I can fax a copy to give you some ideas. Jennifer Volkman RN MDS
Coordinator
[EMAIL PROTECTED] wrote:
I've worked for a
facility where we did a cognitive assessment before we did a
bowel/bladder incontinence assessment. Our policy stated if the
cog. score was 18 or less the resident was cognitively unable to
participate in a bowel/bladder assessment and therefore any
tolieting program. It makes sense not to put someone through
something they can't understand and possibly triggering anxiety
symptoms or behavior disturbances. The policy has been through
two state surveys and passed without any problems. Just
something to think about before you do a lot of work or stress the
resident for nothing.
In a message dated 1/6/2004 1:39:17 PM Eastern Standard Time,
[EMAIL PROTECTED] writes:
In order to not reinvent the wheel, would anyone out
there be willing to
share a bowel / bladder incontinence
assessment that has worked for them?
Susann Irwin, RN
MDS
Coordinator
Garner, NC
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As
always-Jen
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