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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Constipation Gap Analysis
Organizational assessment tool to assist with implementation and evaluation of the RNAO Prevention of Constipation in the Older Adult 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.
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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.
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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 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
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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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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.
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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. 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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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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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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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).
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This archived webinar and PowerPoint presentation gives 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 the Pelvic Floor Muscle! Accessed Mar. 16, 2017 at http://brainxchange.ca/Public/Events/Archived-Webinars-Events.aspx#2017
© 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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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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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
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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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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
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Newsletter that covers myths and facts about constipation, fecal incontinence and bowel programs in LTC homes.
Reference: "The bowel Issue". (February-March 2008). BP Blogger, Volume 3(Issue 2). Retrieved from Regional Geriatric Program Central http://www.rgpc.ca Copyrighted All rights reserved MLvanderHorst.
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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
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This resource contains the Bristol Stool Chart poster with written descriptions of the seven types of stools.
Reference: Retrieved July 17, 2017 from http://static1.1.sqspcdn.com/static/f/1451532/22180508/1363249562587/bristol_stool_chart.pdf
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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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A sample from a LTC home identifying and prioritizing ways to improve continence care. Developed by the IC-5 Project, Ontario
Reference: Ontario Women’s Health Council (Hospital Report Research Collaborative – HRRC), NO DATE, NO AUTHOR
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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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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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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
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Gain knowledge and better understand the voiding process as well as the neurological control of the lower urinary tract. Learn to describe the difference between treatment and management related to continence care and much more.
A self-directed learning package for health-care professionals caring for adult patients experiencing urinary incontinence developed by RNAO. The package contains diagram for:
- bladder control muscles,
- catheterization,
- male and female urinary tract,
- innervations of urinary tract,
- normal micturation, and
- pelvic floor descent
RNAO LTC Best Practice Initiative, Self-Learning Package - Continence Care Education, Retrieved from: http://rnao.ca/bpg/guidelines/resources/continence-care-education-selflearning-package
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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
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A workshop outline that can be used to enhance 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.
Reference: Registered Nurses’ Association of Ontario (2007). Continence/Constipation Education Learning Cycles: A Facilitator’s Guide. Toronto, Canada: Registered Nurses’ Association of Ontario.
Retrieved from: http://rnao.ca/sites/rnao-ca/files/Continence__Constipation_Workshop_-_Long-Term_Care_Facilitators_Guide.pdf
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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.
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A presentation on hydration, prompted voiding, constipation and hygiene based on the RNAO Continence and Constipation BPGs. Instructions on the use of this material can be found in the facilitator's package.
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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
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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 (2010). Dementia and bladder and Bowel Control Retrieved April 27,2017 from http://www.bladderbowel.gov.au/assets/doc/brochures/07Dementia.html
Copyright Commonwealth of Australia 2001-2015 This work is copyright. You may download, display, print and reproduce this material in unaltered form only (retaining this notice) for your personal, non-commercial use or use within your organisation. Apart from any use as permitted under the Copyright Act 1968, all other rights are reserved.
Requests and inquiries concerning reproduction and rights should be addressed to Commonwealth Copyright Administration, Attorney General's Department, Robert Garran Offices, National Circuit, Barton ACT 2600 or posted at http://www.ag.gov.au/cca
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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 list of commonly used medications (both trade and generic) that impact on incontinence. Source: Policy and Procedure for Bladder and Bowel Management Toronto Best Practice in LTC Initiative, (2006) page 18.
Reference: Policy and Procedure for Bladder and Bowel Management Toronto Best Practice in LTC. Initiative 2006. Retrieved from City of Toronto: http://rgp.toronto.on.ca/
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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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Le but de cette Ligne directrice est de fournir de l’information sur la mise en place d’un programme de traitement sur le déclenchement de la miction chez les personnes âgées qui souffrent d’incontinence urinaire. Les objectifs de cette Ligne directrice consistent à : ■ réduire la fréquence et la gravité des épisodes d’incontinence urinaire; ■ prévenir les complications liées à l’incontinence urinaire; ■ améliorer la qualité de vie.
Association des infirmières et infirmiers autorisés de l’Ontario (2005). Favoriser la continence par le déclenchement de la miction (Version revisée 2011). Toronto, Canada : Association des infirmières et infirmiers autorisés de l’Ontario. http://rnao.ca/bpg/guidelines/promoting-continence-using-prompted-voiding
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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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This PHO resource provides general information about UTIs for residents and their families.
Reference: Public Health Ontario, 2014, Frequently Asked Questions About Urinary Tract Infections . Retrieved from http://www.publichealthontario.ca/en/Pages/default.aspx
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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
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Patient Education Handout for females who require urinary catheter care.
Reference: Patient Education – Going Home with a urinary catheter Female , Date Retrieved: August 12, 2015. Hamilton Health Sciences, Retrieved from: http://giic.rgps.on.ca/incontinence
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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 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
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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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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
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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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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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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/
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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. Management of Urinary Tract Infections (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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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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Use of nursing process to identify and manage urinary incontinence with evidence-based practice.
The Hartford Institute, New York University College of Nursing has developed ConsultGeriRN.org as an evidence-based online resource for nurses in clinical and educational settings. Urinary Continence Nursing Standard of Practice Protocol: Urinary Incontinence (UI) in Older Adults Admitted to Acute Care.
Reference: http://consultgerirn.org/topics/urinary_incontinence/want_to_know_more
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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
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Fact sheet on bowel and bladder incontinence.
Reference: Seniors Health Knowledge Network, March 2014, Bowel and Bladder, retrieved August 6,2015. retrieved from http://www.sagelink.ca/ltc-resources-bowel-bladder
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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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Réduire la fréquence et la gravité des épisodes de constipation chez les personnes âgées par une bonne hydratation, une consommation adéquate de fibres alimentaires, une élimination régulière et l’activité physique. La prévention de la constipation, la réduction de la prise de laxatifs et l’amélioration de la qualité de vie des personnes âgées passent par l’établissement et le maintien d’habitudes d’élimination intestinale régulières. Publié : 2005 Supplément : 2005 révisé : 2011
Registered Nurses' Association of Ontario. Prévention de la Constipation chez les adultes plus âgés. (2011). Toronto, Ontario: auteur. Récupérée de : http://rnao.ca/bpg/guidelines/prevention-constipation-older-adult-population.
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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).
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This presentation shares strategies for managing bladder and bowel problems in stroke survivors. It describes normal bladder and bowel function, urinary incontinence and the effects of stroke on assessment and management of bladder and bowel incontinence. It connects nursing restorative services and incontinence.
Woodbeck, H., & Edwards, E. (2011). Promoting bladder and bowel continence with nursing restorative care. [PowerPoint slides]. Retrieved from http://ltctoolkit.rnao.ca/resources/self-learning-and-powerpoint-presentations/promoting-bladder-and-bowel-continence-nursing- -
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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 PowerPoint presentation that highlights the recommendations of the Promoting Continence Using Prompted Voiding Registered Nurses Association of Ontario Best Practice Guideline
Reference: Shaikh, S. and Woodbeck, H. 2016. Promoting Continence Using Prompted Voiding Presentation. Registered Nurses Association of Ontario Long Term Care Best Practice Program.
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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.
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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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This is Quality Improvement Roadmap to restoring and promoting continence by Residents First Initiative.
Source: Residents First (RF), Health Quality Ontario. The changes suggested in the packages, posters, and tables are not mandatory for implementation. Includes a Quality Improvement Road Map To Restoring and Promoting Continence that aims to support teams participating in the RF collaboratives and other QI projects focused on promoting urinary continence
Retrieved from http://qualitycompass.hqontario.ca/portal/long-term-care/Continence#.Vd330U1RHcs
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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: Author. Retrieved from https://rnao.ca/sites/rnao-ca/files/bpg/FALL_PREVENTION_WEB_1207-17.pdf This work is funded by the Ontario Ministry of Health and Long-Term Care
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Show description [+]
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.
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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 one pager fact sheet reviews skin care and urinary incontinence problems, solutions and suggestions
Reference: Continence Facts (skin care and urinary incontinence). The Canadian Continence Foundation, 1999, Retrieved March 2018 http://www.canadiancontinence.ca/pdfs/skincare.pdf
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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 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
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The Ontario Stroke Network has prepared numerous care plans for residents in LTC with strokes. Some of the care plans are particularly applicable to residents with stroke dementia, including those on behaviour change, cognition, communication, depression and perception.
Reference: Website: http://ontariostrokenetwork.ca/stroke-qbp-resource-centre/stroke-rehabilitation-resource-centre/clinical-tools-and-resources-for-implementation/clinical-tools-resources-implementation-community-re-engagement/
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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).
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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 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
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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
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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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This fact sheet reviews urge incontinence symptoms, causes and treatment..
Reference:
Centre for Studies in Aging and Health, 2014. Urge Incontinence: Diagnosis and Treatment. Retrieved on Sept. 5, 2018 from: https://sagelink.ca/sites/default/files/clinical-resources/urge_incontinence_diagnosis_treatment_2014.pdf
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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
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Talking with your Health Care Provider: What Can I Do about Urinary Incontinence - This booklet is aimed at middle-aged women but is applicable to any woman with stress and/or urge incontinence. Descriptions of incontinence are simple and easy to read. Alternatives to medications and surgery are provided.
Reference: Registered Nurses Association of Ontario. 2012. Talking with your Health Care Provider: What Can I Do about Urinary Incontinence. http://uida.rnao.ca/sites/uida.rnao.ca/files/documents/Uninary-Incontinence-Decision-Aid_0.pdf.
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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
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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). 2017. Assessment algorithm for urinary tract infections (UTIs) in medically stable non-catheterized residents. Accessed Mar. 13, 2017. http://www.publichealthontario.ca/en/BrowseByTopic/IPAC/Documents/UTI_Assessment_Algorithm.pdf
© 2017 Ontario Agency for Health Protection and Promotion
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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
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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. 2016. UTI Program: Evidence to support discontinuing the use of dipsticks to diagnose a urinary tract infection (UTI) in residents of long-term care homes (LTCHs). Accessed Mar. 17, 2017. http://www.publichealthontario.ca/en/BrowseByTopic/IPAC/Documents/UTI_Dipsticks.pdf
© 2017 Ontario Agency for Health Protection and Promotion
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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
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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 complemented by a guidance document available on the PHO website.
Reference: Public Health Ontario (PHO). 2016. UTI Program: Sample policy and procedure for assessment and management of urinary tract infections (UTIs) in non-catheterized residents. Accessed Mar. 17, 2017. http://www.publichealthontario.ca/en/BrowseByTopic/IPAC/Documents/UTI_Sample_Policy_Procedure.pdf
© 2017 Ontario Agency for Health Protection and Promotion
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This PHO 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 http://www.publichealthontario.ca/en/Pages/default.aspx
