Continence Care and Bowel Management

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.

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.

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

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.

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.

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.

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
 

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 

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.

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

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.

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.
 

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

A fact sheet on preventing constipation for patients and families with recommendations for action based on the RNAO Constipation BPG. Available in French.

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

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

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.

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.

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

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/
 

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

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

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
 

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

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.

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 

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

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.

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

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

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

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

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,

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.

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.

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.

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).

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

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 

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  

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/

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

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

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

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  

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.

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

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

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

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