Continence Care and Bowel Management
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The best practice guideline (BPG) A Proactive Approach to Bladder and Bowel Management in Adults, Fourth Edition replaces the RNAO BPGs Promoting Continence Using Prompted Voiding and Prevention of Constipation in the Older Adult Population, both of which were last updated in 2011. This BPG provides evidence-based recommendations for effective strategies to support adults (aged 18 years and older) who live with urinary incontinence, fecal incontinence and/or constipation that will improve quality of care and lead to positive health outcomes.
The BPG includes good practice statements on conducing a focused initial assessment and recommendation areas that address the following: toileting strategies, physical activity, adequate intake of fibre and/or fluids, interprofessional approach and bowel protocol.
This BPG can be used by nurses, members of the interprofessional team and caregivers across the continuum of care and in all domains of practice such as administration, clinical, education, policy and research. The evidence-based recommendations in this BPG are applicable to all practice settings where persons who live with urinary incontinence, fecal incontinence and/or constipation are accessing services (e.g., acute care, long-term care, primary and community care, and rehabilitation settings).
Registered Nurses’ Association of Ontario (RNAO). A proactive approach to bladder and bowel management in adults. 4th ed. Toronto (ON): RNAO; 2020. -
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A tool to assist with comparing your organization’s current practice with evidence-based RNAO best practice recommendations.
Registered Nurses Association of Ontario (2022). Gap Analysis- A Proactive Approach to Bladder and Bowel Management. Toronto. ON
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This document contains sample program objectives, policy, procedures and staff training materials and tools that meet the minimum requirements of the LTCHA and regulation. It was developed by Advantage Ontario. Obtained with permission.
Ontario Association of Non-Profit Homes and Services for Seniors. (December 2010). Continence Care and Bowel Management Program - Policy, Procedures and Training Package. Woodbridge, ON, Canada: Author. Retrieved from http://www.oanhss.org/MediaCentre2/LTCHomesActCentralseeSiteNavigation/LTCHA_Resources.aspx.
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This document contains sample program objectives, policy, procedures and staff training materials and tools that meet the minimum requirements of the LTCHA and regulation. It was developed by Advantage Ontario. Obtained with permission.
Ontario Association of Non-Profit Homes and Services for Seniors. (January 2011). Nutrition and Hydration Program - Policy, Procedures and Training Package. Woodbridge, ON, Canada: Author. Retrieved from http://www.oanhss.org/MediaCentre2/LTCHomesActCentralseeSiteNavigation/LTCHA_Resources.aspx.
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Ontario Regulation 246/22 was made under the Fixing Long-Term Care Act (FLTCA), 2021 and proclaimed into force to regulate Ontario's long-term care home sector April 11, 2022. Government of Ontario (2022) Ontario Regulation 246/22. Toronto (ON).
Retrieved from https://www.ontario.ca/laws/regulation/r22246#BK65
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This presentation reviews strategies of sizing and distribution for improving continence product usage. Developed by Deb Jenkins, APN, Improving Continence Care Collaborative Co-lead, SHRTN Community of Practice. December 2011.
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A well illustrated presentation on improving continence care developed by the IC-5 project.
Developed during IC5 and Women’s College Hospital – no references and no name on who developed the presentation
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Appendix H from the RNAO A Proactive Approach to Bladder and Bowel Management in Adults — Fourth Edition is a systematic approach to dealing with constipation and fecal incontinence.
Registered Nurses’ Association of Ontario (RNAO). A proactive approach to bladder and bowel management in adults. 4th ed. Toronto (ON): RNAO; 2020. (p. 132).
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Appendix G from the RNAO A Proactive Approach to Bladder and Bowel Management in Adults — Fourth Edition shows how the best practice guideline recommendations can be applied in the clinical setting.
Registered Nurses’ Association of Ontario (RNAO). A proactive approach to bladder and bowel management in adults. 4th ed. Toronto (ON): RNAO; 2020. (p.131).
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A game using the 'Jeopardy' format with the questions based on the RNAO Best Practices on Continence and Constipation.
Reference: Registered Nurses Association of Ontario. 2014. Best Practice Jeopardy. Toronto, ON.
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This archived webinar and Power Point presentation provides an excellent overview of bladder and bowel continence issues. It has a strong assessment section and gives many helpful suggestions. While it is focused on multiple sclerosis, it is applicable to the broader population.
Reference: Multiple Sclerosis Society of Canada. 2017. Bladder and Bowel Continence: Meet Your Friend the Pelvic Floor Muscle! Retrieved from https://vimeo.com/202074102
© 2016 brainXchange.
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This leaflet on bladder and bowel incontinence is written is simple language. It provides practical solutions to dealing with incontinence. It is aimed at family’s supporting a relative with dementia, but is suitable for staff in long term care homes.
Reference:
The Canadian Continence Foundation. No date. Bladder and Bowel Problems in People Living with Dementia. Accessed Mar. 18, 2018. http://www.canadiancontinence.ca/pdfs/Dementia-English.pdf
Copyright © 2018 The Canadian Continence Foundation
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This bladder and bowel care plan, developed by CorHealth is aimed at people with strokes, but is applicable to residents of long term care. It is one of a series of stroke care plans.
Cor Health (2020) Bladder and Bowel Stroke Care Plans retrieved from Community Reengagement - CorHealth Ontario
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An illustration showing the muscles that control bladder emptying. Two diagrams identifying one with weak control muscles and one with strong bladder control muscles
Registered Nurses' Association of Ontario. (2006). Self-Learning Package Continence Care Education. Toronto, ON: Retrieved from: http://rnao.ca/bpg/guidelines/resources/continence-care-education-selflearning-package
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A comprehensive assessment of bladder and bowel function for LTC residents developed by the LTC BPC Project with Toronto Best Practice Steering Committee and Northwest Continence Collaborative (2005). Includes list of medications that affect continence and treatment options.
Reference: Toronto Best Practice Committee and Northwest Continence Collaborative (2006). Bladder & Bowel Continence Assessment.. Toronto.
Sources: AHCPR. 2006. Urinary Incontinence. http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat6.section.10079. ; Brigham & Women’s Hospital. 2004, Urinary incontinence http://www.brighamandwomens.org/medical/HandbookArticles/Urinaryincontinence.pdf. ; The Hartford Institute for Geriatric Nursing. 2001. Urinary incontinence. http://www.hartfordign.org/publications/trythis/issue11.pdf. ; IC-5 Continence Project, 2005, http://www.hospitalreport.ca/projects/QI_projects/IC5.html. Rehabilitation Nursing Foundation. 2002. Constipation. www.rehabnurse.org. ; RNAO. 2005, Preventing Constipation; Prompting Continence. http://www.rnao.org/bestpractices. ; Royal Women’s Hospital. 2005. Urinary incontinence, http://www.rwh.org.au/rwhcpg/womenshealth.cfm?doc_id=3661. ; Singapore Ministry of Health. 2003, http://www.moh.gov.sg/cmaweb/attachments/publication/Nursing_Management_of_Patients_with_Urinary_Incontinence_1-2003.pdf. U.S. National Library of Medicine and U.S. National Institute of Health. 2006. Drugs, supplements. < http://www.nlm.nih.gov/medlineplus/druginformation.html
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Appendix Q from the RNAO A Proactive Approach to Bladder and Bowel Management in Adults — Fourth Edition shows pictures of stools to help improve assessment of constipation.
Registered Nurses’ Association of Ontario (RNAO). A proactive approach to bladder and bowel management in adults. 4th ed. Toronto (ON): RNAO; 2020. (p. 147).
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This help sheet created by Alzheimer’s Australia provides a summary explaining incontinence and some of the reasons it may occur in people with dementia. It gives suggestions for managing incontinence.
Reference: Alzheimer’s Austrailia (2012). Caring For Someone With Dementia- Continence Retrieved April 27,2017 from https://www.fightdementia.org.au/files/helpsheets/Helpsheet-CaringForSomeone18-Continence_english.pdf
Copyright © Alzheimer’s Australia 2000-2017, all rights reserved.
You may not link to or use our content except when granted explicit permission from Alzheimer's Australia (link sends e-mail) and subject to Alzheimer's Australia being credited and subject to the content not being changed in any way. Photos on this website may not be copied or reproduced without express permission.
If permission is granted to link to an Alzheimer's Australia pdf or other format file, the link must be to the Alzheimer's Australia website address, you may not take a copy.
Requests and enquiries can be addressed in writing to Alzheimer’s Australia, attn Copyright and Permissions Enquiries, PO Box 4194 Kingston ACT 2604 Canberra or by email to copyright@alzheimers.org.au (link sends e-mail). A number of photos on this website are copyright ©Lynton Crabb and cannot be reproduced. Apart from any use as permitted under the Copyright Act 1968, all other rights are reserved.
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A powerpoint presentation that succinctly describes ways to prevent Catheter-associated Urinary Tract Infections based on the CDC guideline.
Reference: Centre for Disease Control and Prevention. (CDC). 2009. Catheter-associated Urinary Tract Infections Toolkit. http://www.cdc.gov/HAI/pdfs/toolkits/CAUTItoolkit_3_10.pdf.
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This link takes you to the comprehensive resource aimed at nurse of theoretical knowledge, evidence based and practical guidelines on indwelling catheters. The recommendations state the level of evidence of each procedure. It has clear illustrations, extensive references and annotated procedures. The resource is created by the European Association of Urology Nurses.
Reference: Vahr. S, Cobussen-Boekhorst, H, Eikenboom, J, Geng, V, Holroyd, S, Lester, M, Pearce, I. and Vandewinkel, C. 2012. Evidence-based Guidelines for Best Practices in Urological Health Care – Indwelling Catheters in Adults-Urethral and Suprapublic. European Association of Urology Nurses (EAUN). http://www.nursing.nl/PageFiles/11870/001_1391694991387.pdf
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This guideline has illustrations and procedures on how to do intermittent catheterizations in adult.
Reference: Vahr, S. Cobussen-Boekhorst, H, Eikenboom, J, Geng, V, Holroyd, S, Lester, M, Pearce, I and Vandewinke, C. 2013. Evidence-based Guidelines for Best Practice in Urological Health Care Catheterisation Dilatation, urethral intermittent in adults. European Association of Urology Nurses. http://nurses.uroweb.org/wp-content/uploads/2013_EAUN_Guideline_Milan_2013-Lr_DEF.pdf.
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Visual illustration on placement of catheter within the female bladder.
Registered Nurses' Association of Ontario. (2006). Self-Learning Package Continence Care Education. Toronto, ON: Retrieved from: http://rnao.ca/bpg/guidelines/resources/continence-care-education-selflearning-package
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Appendix O from the RNAO A Proactive Approach to Bladder and Bowel Management in Adults — Fourth Edition is a comprehensive list of physical, emotional and other factors that contribute to constipation.
Registered Nurses’ Association of Ontario (RNAO). A proactive approach to bladder and bowel management in adults. 4th ed. Toronto (ON): RNAO; 2020. (p.144-145)
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A comprehensive list of physical, emotional and other factors that contribute to urinary continence. Registered Nurses’ Association of Ontario (RNAO). A proactive approach to bladder and bowel management in adults. 4th ed. Toronto (ON): RNAO; 2020.
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A fact sheet on preventing constipation for patients and families with recommendations for action based on the RNAO Constipation BPG. Available in French.
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A one time, single resident risk assessment for dehydration based of the University of Iowa Dehydration BPG.
References:
Mentes, J. C. & The Iowa Veterans Affairs Nursing Research Consortium. (2004). Evidence-Based Practice Guideline: Hydration management. Iowa City, IA: The University of Iowa Gerontological Nursing Interventions Research Center Research Translation and Dissemination Core.
Mentes, J. C. & Iowa-Veterans Affairs Research Consortium. (2000). Hydration management. Journal of Gerontological Nursing, 6-15.
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This comprehensive factsheet provides information to assist with the prevention and management of bladder and bowel problems in people with dementia.
Reference: Australian Government (2016). Dementia and bladder and Bowel Control, retrieved Aug. 4, 2022 from https://www.health.gov.au/resources/publications/dementia-and-bladder-and-bowel-control.© Commonwealth of Australia I Department of Health and Aged Care -
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An illustration of the structure of the lower male and female urinary tracts.
Registered Nurses' Association of Ontario. (2006). Self-Learning Package Continence Care Education. Toronto, ON: Retrieved from: http://rnao.ca/bpg/guidelines/resources/continence-care-education-selflearning-package
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An illustration of the urinary system from the front and side
Registered Nurses' Association of Ontario. (2006). Self-Learning Package Continence Care Education. Toronto, ON: Retrieved from: http://rnao.ca/bpg/guidelines/resources/continence-care-education-selflearning-package
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A fact sheet with a concise overview of Urinary Tract Infections associated with catheter use. Available in poster/printable formats. Suitable for patients, families and health care providers.
Reference: Centre for Disease Control and Prevention (CDC). 2015. FAQ’s about Catheter-associated Urinary Tract Infections. http://www.cdc.gov/hai/pdfs/uti/CA-UTI_tagged-BW.pdf.
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This fact sheet from The Canadian Continence Foundation provides an overview of fecal incontinence, lifestyle changes and treatments.
Reference:
The Canadian Continence Foundation. 2010. Fecal Incontinence. Accessed June 13, 2018.
http://www.canadiancontinence.ca/pdfs/Faecal-Incontinence-2010-01-19.pdf
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A best practice guideline on preventing Catheter-associated Urinary Tract Infections. For use by infection prevention staff, administrators, nurses, and other healthcare providers across the continuum of care. Developed by the Centre for Disease Control and Prevention.
Reference: Healthcare Infection Control Practices Advisory Committee (HICPAC) and Centre for Disease Control and Prevention. (CDC). 2009. Guideline for Prevention of Catheter-associated Urinary Tract Infections. http://www.cdc.gov/hicpac/pdf/CAUTI/CAUTIguideline2009final.pdf.
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This Canadian guideline was developed by the 'Toward Optimized Practices' (TOPS) Program. It was established by Alberta physicians to help implement clinical practice improvements using evidence-based best practices and quality initiatives to improve resident care and clinical management. This Urinary Tract Infection Clinical Practice Guideline is complemented with a UTI algorithm and simplified guideline.
Reference: Toward Optimized Practice (TOP) Program. 2010. Guideline for the Diagnosis and Management of Urinary Tract Infections in Long Term Care. Edmonton, AB. Retrieved on Jan. 16, 2015 from: http://www.topalbertadoctors.org/cpgs/?sid=15&cpg_cats=66&cpg_info=41
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This IADIT tool is an excellent resource on skin care for incontinent people. It has clear pictures, definitions and short descriptions of skin changes and rashes.
Copyright © 2008 Joan Junkin. All rights reserved. Please send request for permissions to IADIT@medbiopub.com.
1. Bliss DZ, Zehrer C, Savik K, et al. Incontinence-associated skin damage in nursing home residents: a secondary analysis of a prospective, multicenter study. Ostomy Wound Manage. 2006;52:46–55.
2. Institute for Healthcare Improvement. Prevent Pressure Ulcers: How-To Guide. May 2007. Available at: http://www.ihi.org/nr/rdonlyres/5ababb51-93b3-4d88-ae19- be88b7d96858/0/pressureulcerhowtoguide.doc
3. Gray M, Bliss DB, Ermer-Seltun J, et al. Incontinence-associated dermatitis: a consensus. J Wound Ostomy Continence Nurs. 2007;34:45-54.
4. Junkin J, Selekof JL. Prevalence of incontinence and associated skin injury in the acute care inpatient. J Wound Ostomy Continence Nurs. 2007;34:260-269.
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A fact sheet on urinary continence for patients and families with recommendations for action based on the RNAO Continence BPG. Available in French.
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This definitive report on incontinence was commissioned by the Canadian Continence Foundation. It provides an overview of both urinary and fecal incontinence in Canada. There are statistics and cost estimates on the burden of incontinence, as well as advocacy recommendations. A discussion on treatments for urinary incontinence is included.
Reference: The Canadian Continence Foundation. 2014. Incontinence: The Canadian Perspective. Accessed Mar. 18, 2018. http://www.canadiancontinence.ca/pdfs/en-incontinence-a-canadian-perspective-2014.pdf
Copyright © 2018 The Canadian Continence Foundation. -
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This algorithm looks at a multidisciplinary approach to management of Urinary incontinence in community or long term care. It addresses presenting symptoms, clinical assessments, Presumed Etiology, Treatment/ Management and evaluation. This one page tool an be used for lamination and posted.
Reference:
The Canadian Continence Foundation.2001 Initial UI Management algorithm women, men and frail elderly. Incontinence Toolkit, Date Retrieved:Sept. 5, 2018 http://www.canadiancontinence.ca/images/chart-initial-management-of-ui.gif
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An illustration showing how the urinary tract nerves come from the brain and spinal cord.
Registered Nurses' Association of Ontario. (2006). Self-Learning Package Continence Care Education. Toronto, ON: Retrieved from: http://rnao.ca/bpg/guidelines/resources/continence-care-education-selflearning-package
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This powerpoint presentation for health care providers, shows how to distinguish between the types of urinary incontinence and interventions to treat urinary incontinence. A poster and patient handout are also part of this module which is also available in french.
Spencer, Martha ( 2019) Introduction to Urinary Incontinence- Clinician Learning Series.Ontario. Retrieved from https://www.rgptoronto.ca/resource/introduction-to-urinary-incontinence-clinician-learning-series/
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Fiche de renseignements pour la sensibilisation en matière de santé.
Association des infirmières et infirmiers autorisés de l’Ontario. (2003, Juilet). La constipation: La prévention est maître. Toronto, Canada: Auteur.
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Appendix P from the RNAO A Proactive Approach to Bladder and Bowel Management in Adults — Fourth Edition is a list of the major drug groups that can contribute to constipation.
Registered Nurses’ Association of Ontario (RNAO). A proactive approach to bladder and bowel management in adults. 4th ed. Toronto (ON): RNAO; 2020 (p. 146).
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A list of the major drug groups that can contribute to urinary incontinence. Registered Nurses’ Association of Ontario (RNAO). A proactive approach to bladder and bowel management in adults. 4th ed. Toronto (ON): RNAO; 2020.
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A diagram showing the bladder filling and emptying cycles and the muscles involved in this process.
Registered Nurses' Association of Ontario. (2006). Self-Learning Package Continence Care Education. Toronto, ON: Retrieved from: http://rnao.ca/bpg/guidelines/resources/continence-care-education-selflearning-package
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A diagram illustrating the pelvic floor and a descended pelvic floor.
Registered Nurses' Association of Ontario. (2006). Self-Learning Package Continence Care Education. Toronto, ON: Retrieved from: http://rnao.ca/bpg/guidelines/resources/continence-care-education-selflearning-package
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This resource explains pelvic muscle exercises, how they may help incontinence, and how to properly perform them.
Reference:
Retrieved June 22, 2018 from http://www.canadiancontinence.ca/pdfs/pelvicmuscleexercises.pdf
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A detailed policy and procedure for improving both bladder and bowel continence in LTC residents with sample policies and nursing care plans. It can also be used as a reference guide
Reference: Toronto Best Practice in LTC initiative working group , (December 2006), Policy and Procedure for Bladder and Bowel Management, date retrieved, June 8 2015,
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A detailed policy and procedure for preventing dehydration in LTC residents. It was developed by the Toronto Best Practice Implementation Steering Committee.
Reference: Toronto Best Practice in LTC initiative working group , (December 2006), Policy and Procedure: Hydration Management Toronto Best Practice in LTC Initiative, date retrieved, June 8 2015,
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Patient education pamphlet explaining how older adults can prevent dehydration in themselves
Reference: Preventing dehydration in older adults. Patient education pamphlet explaining how older adults can prevent dehydration in themselves. Source: Hamilton Health Sciences, Hamilton, Ontario
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Algorithm for supporting the process including evaluation of promoting continence using prompted voiding
Reference: Registered Nurses' Association of Ontario (2005) Promoting Continence Using Prompted Voiding Appendix B:Promoting Continence Using Prompted Voiding Algorithm p.40 Toronto, Ontario
Retrieved from: http://rnao.ca/bpg/guidelines/promoting-continence-using-prompted-voiding
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A presentation on causes, risk factors and interventions for dehydration developed by the Committee for the Enhancement of Elder Friendly Environments (CEEFE) Central South Geriatric Program (Ontario).
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Coloured poster that defines dehydration, shows the risk factors related to dehydration and strategies(mnemonic H2O) to prevent dehydration.
Reference: Developed by the Elder friendly environments Coalition http://www.rgpc.ca
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A systematic approach to encouraging incontinent people to become continent. Registered Nurses’ Association of Ontario (RNAO). A proactive approach to bladder and bowel management in adults. 4th ed. Toronto (ON): RNAO; 2020.
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A comprehensive list of physical, environmental, functional and other factors that contribute to fecal incontinence. Registered Nurses’ Association of Ontario (RNAO). A proactive approach to bladder and bowel management in adults. 4th ed. Toronto (ON): RNAO; 2020.
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La ligne directrice sur les pratiques exemplaires (LDPE) Une approche proactive de la gestion de la vessie et des intestins chez les adultes Quatrième édition, remplace les LDPE de la RNAO Favoriser la continence par le déclenchement de la miction et Prévention de la constipation chez les personnes âgées - Lignes directrices sur les pratiques, toutes deux mises à jour pour la dernière fois en 2011. Cette LDPE fournit des recommandations fondées sur des preuves pour des stratégies efficaces pour soutenir les adultes (âgés de 18 ans et plus) qui vivent avec l'incontinence urinaire, l'incontinence fécale et/ou la constipation qui amélioreront la qualité des soins et mèneront à des résultats de santé positifs.
Le LDPE comprend des énoncés de bonnes pratiques sur la réalisation d'une évaluation initiale ciblée et des domaines de recommandation qui traitent des éléments suivants : stratégies d'élimination des toilettes, activité physique, apport adéquat de fibres et/ou de liquides, approche interprofessionnelle et protocole intestinal.
Ces LDPE peuvent être utilisées par les infirmières, les membres de l'équipe interprofessionnelle et les soignants dans tout le continuum de soins et dans tous les domaines de pratique tels que l'administration, la clinique, l'éducation, les politiques et la recherche. Les recommandations fondées sur des données probantes de ce LDPE s'appliquent à tous les milieux de pratique où les personnes qui vivent avec une incontinence urinaire, une incontinence fécale et/ou une constipation accèdent à des services.
Registered Nurses' Association of Ontario (2020) Une approche proactive de la gestion de la vessie et des intestins chez les adultes retrieved from Bladder_and_Bowel_Management_FINAL_WEB_FR_LR_0.pdf (rnao.ca)
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Appendix S from the RNAO A Proactive Approach to Bladder and Bowel Management in Adults — Fourth Edition provides systematic approaches to decreasing constipation.
Registered Nurses’ Association of Ontario (RNAO). A proactive approach to bladder and bowel management in adults. 4th ed. Toronto (ON): RNAO; 2020. (p. 150-151).
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A one-time, single resident assessment for 30 signs and symptoms of dehydration.
Author and Date unknown
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This link takes you to resources with tips and information to assist long-term care homes in integrating the stroke care plans into their existing care plan libraries. There are twelve care plans:
- Activities of Daily Living
- Behaviour Change
- Bladder and Bowel Continence
- Cognition
- Communication
- Depression
- Leisure
- Mobility, Positioning & Transfers
- Nutrition, Hydration & Swallowing
- Pain
- Perception
- Skin Care & Hygiene
CoHealth Ontario. (n.d.). Stroke care plans for long-term care. Retrieved from https://www.corhealthontario.ca/resources-for-healthcare-planners-&-providers/stroke-general/qbp/clinical-tools-&-resources/community-reengagement -
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This comprehensive website from the Canadian Continence Foundation is an excellent source of resources on both urinary and fecal incontinence. They have general information, pamphlets and videos. Sections of the website include: Bladder Health; Diagnosis and Treatment; The Men’s Room; Fecal Incontinence, Pelvic Pain, Health Care Professional resources, etc.
Reference:
The Canadian Continence Foundation. 2018. The Canadian Continence Foundation Website. Accessed Mar. 18, 2018. http://www.canadiancontinence.ca
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This information sheet is intended to provide tips that can help to decide if bladder training is feasible and how to get started.
Reference: Retrieved June 22, 2018 from http://www.canadiancontinence.ca/pdfs/TrainingYourBladder.pdf
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A detailed, 5 page assessment of bowel continence issues that can be completed by a patient. Treatment options are suggested and a client record sheet is included.
Reference: Registered Nurses’ Association of Ontario (2006). Transdisciplinary Patient/Client Continence Assessment Tool. Toronto, Canada: Registered Nurses’ Association of Ontario.
Retrieved from: http://ltctoolkit.rnao.ca/sites/default/files/resources/continence/Continence_AssessmentTools/RNAO_TransdisciplinaryPatientClient_Continence.pdf
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A detailed, 8 page assessment of urinary and bowel continence issues that can be completed by a staff. Treatment options are suggested and a client record sheet is included.
Reference: Registered Nurses’ Association of Ontario (2006). Transdisciplinary Patient/Client Continence Assessment Tool. Toronto, Canada: Registered Nurses’ Association of Ontario. Retrieved from: http://ltctoolkit.rnao.ca/sites/default/files/resources/continence/Continence_AssessmentTools/RNAO_TransdisciplinaryPatientClient_Continence.pdf
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Urinary Continence Toolkit was produced by the Regional Geriatric Program of Toronto. It is aimed at older adults and caregivers. It has simple fact sheets and explanations. There is a decision aid for managing urinary incontinence aimed at health care providers.
Regional Geriatric Program of Toronto, (2018). SF7 Toolkit. Retrieved from https://www.rgptoronto.ca/resources/”
Reproduction of these materials is permitted in whole without restriction. If adapting this content, or using in part, RGP must be contacted.
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This powerpoint presentation aimed at health care providers, describes bladder physiology, classifies and identifies medications that contribute to incontinence and pharmacological treatments used for urinary incontinence. It is also available in french
Alston, Jillian ( 2020) Urinary Incontinence & Medications- Clinician Learning Series. Ontario. Retrieved from https://www.rgptoronto.ca/resource/urinary-incontinence-medications-clinician-learning-series/
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A succinct algorithm for UTI’s both catheter and non-catheter related with a built-in checklist that can be used to monitor interventions.
Reference: Alberta Health Services. 2014. Urinary Tract Infections in LTCF Checklist. http://www.dobugsneeddrugs.org/wp-content/uploads/uti-checklist.pdf
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This presentation gives a summary of the research evidence on UTI’s in Long Term Care. It discusses challenges in diagnosis, treatment and prevention of UTI’s. Developed by Barbara Grace Cowie, RN MN, Nurse Continence Advisor, Advanced Practice Nurse, West Park Healthcare Centre.
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This is a one-page algorithm that is part of Public Health Ontario’s Urinary Tract Infection (UTI) Program. It clearly describes signs and symptoms of UTI’s and promotes ‘watchful waiting’ as an acceptable alternative before treating probable UTI’s. Is suitable for posting on a bulletin board.
Reference: Public Health Ontario (PHO). 2019. Assessment algorithm for urinary tract infections (UTIs) in medically stable non-catheterized residents. Accessed Mar. 13, 2019. http://www.publichealthontario.ca/en/BrowseByTopic/IPAC/Documents/UTI_Assessment_Algorithm.pdf
© 2019 Ontario Agency for Health Protection and Promotion
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This PHO resource provides basic facts about asymptomatic bacteriuria
Reference: Public Health Ontario, 2014, Asymptomatic Bacteriuria Fact Sheet. Retrieved from http://www.publichealthontario.ca/en/Pages/default.aspx
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This PHO resource provides step-by-step instructions and detailed process information for specimen collection.
Reference: Public Health Ontario, 2014, Collecting Mid-Stream Urine Specimen Fact Sheet. Retrieved from http://www.publichealthontario.ca/en/Pages/default.aspx
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This fact sheet is part of Public Health Ontario’s Urinary Tract Infection (UTI) Program. It succinctly describes the evidence for not using dipsticks to diagnose UTI’s. Is suitable for sharing with staff, residents and families.
Reference: Public Health Ontario (PHO). Revised 2019.Urinary Tract Infection (UTI) Program Evidence to Support Discontinuing the Use of Dipsticks to Diagnose a UTI in Residents of Long-Term Care Homes (LTCHs) https://www.publichealthontario.ca/-/media/Documents/U/2016/uti-dipsticks.pdf?sc_lang=en
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This resource can be used by health care providers at the long-term care homes (LTCHs) when consulting or meeting with friends and families of residents who have questions about a LTCH’s approach to managing suspected UTIs.
Reference: Public Health Ontario (PHO). Revised 2016. Retrieved from https://www.publichealthontario.ca/-/media/Documents/U/2016/uti-faq-residents-families.pdf?sc_lang=en
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This PowerPoint presentation is part of Public Health Ontario’s Urinary Tract Infection (UTI) Program. It provides an overview of how to implement a UTI program.
Reference: Public Health Ontario (PHO). 2017. UTI Program (PHO) Management of UTIs in Non-catheterized Long-Term Care Home Residents. http://www.publichealthontario.ca/en/BrowseByTopic/IPAC/Documents/UTI_Presentation_Orientation_Education_Program.pdf
© 2017 Ontario Agency for Health Protection and Promotion
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This policy and procedure is part of Public Health Ontario’s Urinary Tract Infection (UTI) Program. It is a comprehensive policy that could be adapted by long term care homes and other health care organizations. It is complimented by a guidance document available on the PHO website.
Reference: Public Health Ontario (PHO). Revised 2019. UTI Program: Sample policy and procedure for assessment and management of urinary tract infections (UTIs) in non-catheterized residents. Retrieved from https://www.publichealthontario.ca/-/media/Documents/U/2018/uti-sample-policy-procedure.pdf?sc_lang=en
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This Public Health Ontario resource provides a list of UTI symptoms, contrasts between non-catheterized and catheterized residents and when not to send a specimen.
Reference: Public Health Ontario, 2014, When To Collect A Urine Specimen For Culture And Sensitivity Fact Sheet. Retrieved from https://www.publichealthontario.ca/-/media/Documents/U/2016/uti-urine-collection.pdf?sc_lang=en
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Public Health Ontario (PHO) has developed the Urinary Tract Infection (UTI) Program in response to concerns about the overuse of antibiotics for presumed UTI's in residents in long-term care homes (LTCHs) and the associated antibiotic-related harms. The Program contains a number of tools for assessment, planning, implementation and evaluation of a program to reduce UTI’s in LTC homes.
Reference: Public Health Ontario (PHO), 2019. Urinary Tract Infection (UTI) Program.
Retrieved Aug. 4, 2022 from https://www.publichealthontario.ca/en/Health-Topics/Antimicrobial-Stewardship/UTI-Program
© 2022 Ontario Agency for Health Protection and Promotion
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This is a comprehensive list of reasons for delirium that need to be considered before assuming that a change in mental status is due to a UTI.
Public Health Ontario (2019).UTI Program (PHO)- Causes of Delirium and Mental Status Changes retrieved from https://www.publichealthontario.ca/-/media/Documents/U/2016/uti-delirium-mental-status.pdf?sc_lang=en
© 2022 Ontario Agency for Health Protection and Promotion
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This easy-to-read, highly illustrated booklet from the Canadian Continence Foundation is for people who have continence issues. It aims to teach about the signs and symptoms, types of incontinence; diagnosis; and how to improve it.
Web Source: The Canadian Continence Foundation. 2012. The Source Your Guide to Better Bladder Control. http://www.canadiancontinence.ca/pdfs/The-Source.pdf
Reference: The Canadian Continence Foundation. 2012. The Source Your Guide to Better Bladder Control. Accessed Apr. 24, 2017. http://www.canadiancontinence.ca/pdfs/The-Source.pdf
Copyright © 2017 The Canadian Continence Foundation www.canadiancontinence.ca Acknowledge where resources come from, The Canadian Continence Foundation, and include a link to our url. www.canadiancontinence.ca
