Continence Care and Bowel Management

The Promoting Continence Using Prompted Voiding guideline can be used for implementation of a treatment program of prompted voiding for older adults with urinary incontinence. The goals of prompted voiding are to: •Reduce the frequency and severity of urinary incontinence episodes; •Prevent the complications associated with urinary incontinence; and •Improve quality of life. Revised: 2005 Revised: 2011

Registered Nurses’ Association of Ontario. Promoting Continence Using Prompted Voiding Best Practice Guideline. (2011). Toronto, ON: Author.
Retrieved from: http://rnao.ca/bpg/guidelines/promoting-continence-using-prompted-voiding  This work is funded by the Ontario Ministry of Health and Long-Term Care.

Continence Gap Analysis

Organizational assessment tool to assist with implementation and evaluation of the RNAO Promoting Continence Using Prompted Voiding by comparing current practice to evidence-based practice. Source: Registered Nurses' Association of Ontario's Long-Term Care Best Practices Program, Toronto, ON. September 2013.

A bowel movement record that captures bowel movements (BMs), incontinence, laxative use, and toileting method over a 7-day period.

Adapted from: Ontario Association of Non-Profit Homes and Services for Seniors. (2005). A Resource Guide for Long Term Care Homes: Skin and Wound Care, Continence Care, Nutrition and Hydration. Woodbridge, Canada: Ontario Association of Non-Profit Homes and Services for Seniors

This document contains sample program objectives, policy, procedures and staff training materials and tools that meet the minimum requirements of the LTCHA and regulation. 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.

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

A PowerPoint presentation in which the recommendations from the RNAO Prevention of Constipation in Older Adults Best Practice Guideline are reviewed. Resources to support implementation of best practices to address and prevent constipation are also shared.

Reference: Aranha, S, and Woodbeck, H. 2016. Best Practices for Assessment and Prevention of Constipation. Registered Nurses Association of Ontario (RNAO).

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

This 3-page educational sheet reviews the difference between bladder training and training schedule along with tips on how to deal with bladder control.

Reference:

Centre for Studies in Aging and Health, 2014. Bladder Training for Urinary Incontinence. Retrieved on Sept. 5, 2018 from: https://sagelink.ca/sites/default/files/clinical-resources/bladder_training_urinary_incontinence_2014.pdf

Newsletter that covers myths and facts about urinary continence and toileting in LTC residents.

Reference: "The Bladder Issue". (December 2006). BP Blogger, Volume 1(Issue 1). Retrieved from Regional Geriatric Program Central. All rights reserved MLvanderHorst. http://www.rgpc.ca

Newsletter that covers myths and facts about dehydration in LTC residents. BP Bloggers present credible bite-size pieces of information on clinical topics related to LTC

Reference: "The fluids Issue". (June 2007). BP Blogger, Volume 2(Issue 6). Retrieved from Regional Geriatric Program Central: http://www.rgpc.ca/resource/index.cfm. Copyrighted All rights reserved MLvanderHorst. http://www.rgpc.ca

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

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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

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
 

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

The link takes you to the required programs for continence care and bowel management section 51 of the Ontario Regulation 79/10 made under the Long-Term Care Homes Act, 2007, Government of Ontario. Retrieved from https://www.ontario.ca/laws/regulation/r10079

This presentation reviews the prevalence, impact, assessment, treatment, resources, and barriers to continence best practice implementation at West Park Health Care, Toronto.

Reference: Cowie (Cassel) Barbara, West Park Healthcare Centre, (June 16th 2012), Continence Promotion and Management

Enhance your knowledge in the area of continence and constipation. This 3-piece workshop includes: (1) facilitator's package, (2) participant's package, and (3) slide presentation.

This educational tool enables an assessment of a person’s daily bladder habits.  It reviews fluid intake, toileting habits, bladder irritants, the effects of caffeine, Etc.  

Reference:

Centre for Studies in Aging and Health, 2014. Daily Habits and Urinary Incontinence. Retrieved on Sept. 5, 2018 from: https://sagelink.ca/sites/default/files/clinical-resources/daily_habits_urinary_incontinence_2014_0.pdf

This comprehensive factsheet provides information to assist with the prevention and management of bladder and bowel problems in people with dementia.

Reference: Australian Government (2010). Dementia and bladder and Bowel Control Retrieved April 27,2017 from http://www.bladderbowel.gov.au/assets/doc/brochures/07Dementia.html

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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

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.
 

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

Patient Education handout for male who require care for urinary catheter. 

Reference: Patient Education – Going Home with a urinary catheter Male, Date Retrieved: August 12, 2015. Hamilton Health Sciences, Retrieved from: http://giic.rgps.on.ca/incontinence 

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.

This comprehensive evidence-based guideline covers non-pharmacological, pharmacological and surgical approaches to urinary incontinence.

Reference: Lucas, M.G., Bedretdinova, D., Berghmans, L.C., Bosch, J.L.H.R., Burkhard, F.C., Cruz, F., Nambiar, A.K., Nilsson, C. G., Tubaro, A. and Pickard, R.S. 2015. Guidelines on Urinary Incontinence. European Association of Urology. Retrieved from: http://uroweb.org/wp-content/uploads/EAU-Guidelines-Urinary-Incontinence-2015.pdf
 

A fact sheet on urinary continence for patients and families with recommendations for action based on the RNAO Continence BPG. Available in French.

A tool to help determine who would benefit from using prompted voiding.

Reference: Registered Nurses' Association of Ontario (2005) Promoting Continence Using Prompted Voiding Appendix C:Individuals Likely to benefit From Using Prompted Voiding p.41 Toronto, Ontario

Retrieved from: http://rnao.ca/bpg/guidelines/promoting-continence-using-prompted-voiding

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

This best practice issue covers catheterization technique, meatal care, catheter care, irrigation, drainage systems, care delivery and education. An evidence-based practice information sheet for Health Professionals on catheterization that discusses the technique, care, etc. One of the series developed by the Joanna Briggs Institute in Australia, a leader in evidence-based practice resources.

Promotional and commercial use of the material in print, digital or mobile device format is prohibited without the permission from the publisher Wolters Kluwer Health. Please contact healthpermissions@wolterskluwer.com  for further information

Management of Short Term Indwelling Urethral Catheters to Prevent Urinary Tract Infections. Retrieved from: Joanna Briggs Institute: http://joannabriggs.org/

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

This fact sheet from The Canadian Continence Foundation discusses the various medications used to treat overactive bladder

Reference:

The Canadian Continence Foundation. 2018. Overactive Bladder Medication.  Accessed June 11, 2018. http://www.canadiancontinence.ca/pdfs/OABEn-2016.pdf

Copyright © 2018 The Canadian Continence Foundation

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

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,

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

This presentation describes the key aspects and steps involved in program evaluation. It will highlight different evaluation tools and worksheets that can be used to determine outcome measure while keeping in line with the MOHLTC inspection protocol. Source: Improving Continence Care Collaborative, Phase 5 (2011-2012).

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

The Promoting Continence Using Prompted Voiding guideline can be used for implementation of a treatment program of prompted voiding for older adults with urinary incontinence. The goals of prompted voiding are to: •Reduce the frequency and severity of urinary incontinence episodes; •Prevent the complications associated with urinary incontinence; and •Improve quality of life. Revised: 2005 Revised: 2011 Registered Nurses’ Association of Ontario. Promoting Continence Using Prompted Voiding Best Practice Guideline. (2011). Toronto, ON: Author. Retrieved from: http://rnao.ca/bpg/guidelines/promoting-continence-using-prompted-voiding This work is funded by the Ontario Ministry of Health and Long-Term Care.

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

Preventing Falls and Reducing Injury from Falls (3rd ed.) replaces the RNAO (2011) BPG Prevention of Falls and Fall Injuries in the Older Adult, which was originally published in 2002 and then revised in 2005 and 2011. Whereas previous editions focused on older adults in hospital and long-term-care settings, the scope of this third edition has been expanded to include in all adults (>18 years) at risk for falls and receiving care from nurses and other health-care providers across the health-care continuum, including those living in the community.

The purpose of this guideline is to outline evidence-based approaches for preventing falls and reducing fall injuries for adults. Recommendations are provided at the following three levels:

• Practice recommendations are directed primarily toward nurses who provide direct clinical care to adults at risk for falls across the continuum of care, including (but not limited to): primary care, home care, hospital care, and long-term care settings. The secondary audience of the practice recommendations includes other members of the interprofessional team who collaborate with nurses to provide comprehensive care. All of the recommendations are applicable to the scope of practice of registered nurses and nurse practitioners (general and extended classes); however, many are also applicable to other health-care providers.
• Education recommendations are directed at individuals and organizations responsible for the education of healthcare providers, such as educators, quality improvement teams, managers, administrators, academic institutions, and professional organizations.
• Organization and policy recommendations are directed at those managers, administrators, and policy-makers responsible for developing policy or securing the supports required within health-care organizations that enable the implementation of best practices. For optimal effectiveness, recommendations in these three areas should be implemented together.

Registered Nurses’ Association of Ontario. (2017). RNAO Prevention of Falls and Reducing Injury from Falls Best Practice Guideline. (Third Ed.). Toronto, ON: Registered Nurses’ Association of Ontario. ) http://rnao.ca/bpg/guidelines/prevention-falls-and-fall-injuries 

A one-time, single resident assessment for 30 signs and symptoms of dehydration.

Author and Date unknown

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 and be used for lamination and posted. 

Reference:

The Canadian Continence Foundation.2001. Secondary Urinary Incontinence Management Algorithm Frail Elderly.Date Retrieved: Sep. 5/18. http://www.canadiancontinence.ca/images/chart-specialized-management-of-ui.gif

This presentation explore strategies for program and practice spread along with methods to prevent backsliding and sustaining practice. Previous LTCH participants have offered many practice best practice tips and examples of success to share. Source: Improving Continence Care Collaborative, Phase 5 (2011-2012).

This report from the Canadian Continence Foundation documents the costs of incontinence in Canadian funds. Canadian Continence Foundation and Cameron Institute. 2014.

Web Source: The Impact of Incontinence in Canada. http://www.canadiancontinence.ca/pdfs/en-impact-of-incontinence-in-canada-2014.pdf

Reference: Canadian Continence Foundation and Cameron Institute. 2014. The Impact of Incontinence in Canada. Accessed Mar. 29, 2017. http://www.canadiancontinence.ca/pdfs/en-impact-of-incontinence-in-canada-2014.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

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

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

Key principles of infection control, specific infection control issues related to catheterization and catheter care, aspects of catheterization and catheter care as well as catheter choice and lifestyle issues are all addressed. A best practice that covers various types of catheterization with strong emphasis on prevention of infection developed by the National Health Service in Britain.

NHS Quality Improvement Scotland 2004. Retrieved from: http://www.healthcareimprovementscotland.org/previous_resources/best_practice_statement/urinary_catheterisation__care.aspx

Public Health Ontario (PHO) has developed the Urinary Tract Infection (UTI) Program to respond to concerns about the overuse of antibiotics for presumed UTIs 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). 2017. Urinary Tract Infection (UTI) Program. Accessed Mar. 13, 2017. http://www.publichealthontario.ca/en/BrowseByTopic/IPAC/Pages/UTI.aspx

© 2017 Ontario Agency for Health Protection and Promotion

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.

This is a comprehensive list of the causes of delirium and other mental status changes, that is part of Public Health Ontario’s Urinary Tract Infection (UTI) Program. It clearly describes a variety of other conditions to consider whether a UTI is present.

Reference: Public Health Ontario. 2016. UTI Program: Causes of delirium and mental status changes. Accessed Mar. 17, 2017. http://www.publichealthontario.ca/en/BrowseByTopic/IPAC/Documents/UTI_Delirium_Mental_Status.pdf  

© 2017 Ontario Agency for Health Protection and Promotion

This PHO resource provides a form to communicate with the family about a resident's status regarding suspected cases of UTI.

Reference: Public Health Ontario, 2014, Resident And Family communication Update. Retrieved from http://www.publichealthontario.ca/en/Pages/default.aspx