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 incontinenceUnderstand 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 bathroomAmbulation (needs

assistance)WheelchairTransfer aidsAdaptive

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 managementPelvic 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 RunCollect 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 hoursBladder irrigation will be discontinuedFull continence will be achievedResident 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.

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

Acknowledgements