Giving care to incontinent patients has a number of challenges, particularly since many patients are elderly, and many others present with co-morbidities. Difficulty in communicating, moving the patient, and even understanding what the patient might need are just a few of the hurdles that need to be cleared in order to do the job well.
Dealing with incontinence goes beyond physical treatment. Just as important as biological considerations are psychological ones – there are concerns about humility and embarrassment that can not only make patients reluctant to seek care but that can also make staff uncomfortable.
Even if you have a good plan on how to approach incontinence with your patients, you may want some guidance on how to educate your staff to provide the best level of care possible. The information below has been gathered from the American Medical Directors Association (AMDA). You should read the entire article here, as it gives detailed instructions on how to best approach incontinence care with your staff.
Step 1 Does the patient have a history of Urinary Incontinence (UI)?
Obtain information about the patient’s past and present urinary function. Review all medication changes in the 30 to 90 days before UI is noted, to rule out medication changes as contributing factors.
Step 2 Does the patient show signs and symptoms of UI?
UI is identified by direct observation (i.e., by observing an incontinence episode or finding the patient wet).
Step 3 Identify factors affecting the patient’s Urinary Incontinence
With the interdisciplinary team, assess for risk factors that may affect the patient’s potentially modifiable causes of UI so that interventions may be targeted to those factors. Consider the input of the consultant pharmacist in the review of medication effects on continence status.
Step 4 Perform a physical examination and an additional work-up as indicated
Step 5 Summarize relevant information about the patient’s UI and make sure all team members have access to it.
Step 6 Identify individual treatment goals and develop a plan of care
The overall goal should be to improve function and quality of life and decrease episodes of UI.
Step 7 Address transient causes of, and modifiable risk factors for, UI
As appropriate, treat transient causes of UI and address modifiable risk factors—both those related to urinary tract function and those that affect urinary function by impairing an individual’s overall function, mobility, level of consciousness, and so on. For example, manage delirium, treat urethritis, provide an easily accessible toilet, and offer frequent reminders to toilet and assistance with toileting if necessary.
Step 8 Provide a toileting program as appropriate
If the patient remains incontinent after transient causes of UI have been treated, consider initiating a toileting program for appropriate patients—that is, a plan whereby staff members at scheduled times each day either take the patient to the toilet, give the patient a urinal, or remind the patient to go to the toilet.
Step 9 Consider additional or alternate interventions as appropriate
Patients who remain incontinent after a toileting intervention ought to be considered for other interventions depending on the type of UI they are thought to have:
- Bladder rehabilitation or bladder retraining
- Pelvic floor muscle rehabilitation
- Physiological quieting
- Electrical stimulation
Step 10 Evaluate the effectiveness of interventions thus far, and implement additional approaches as indicated
Step 11 Consider catheterization
If other interventions are not feasible or have not adequately addressed the patient’s UI, consider bladder catheterization. Catheterization may be intermittent or indwelling.
Step 12 Monitor the course and consequences of UI and its treatment
Specifically, monitor patients for:
- Effectiveness of interventions, using an objective measure of the severity of UI such as systematic recordings or a bladder diary
- Response to any medications initiated to try to control continence
- The appropriateness of changing to a less obtrusive or lower-risk intervention
- Patient satisfaction with treatment
- Side effects or complications of treatment
Step 13 Here is an opportunity to assess the successes of your team and gauge where improvements in team action can take place.
Caring for incontinent patients can be difficult, but with the right steps in place and proper staff education, it can become a seamless step in the overall care of your patients.