Creating a Continence Care Plan
When an individual is not able to care for their urinary and bowel needs independently, creating a continence care plan can help ensure that not only are the person's needs attended to carefully and completely, but also that all caregivers can better coordinate care. Here are the five steps in creating a continence care plan.
Start an assessment by asking the patient, family members, and caregivers for a prior history of urinary continence. In particular, be sure to ask about:
- Known causes of incontinence and any medical diagnosis related to continence care such as multiple sclerosis, Parkinson's, obesity, congestive heart failure, tumors, or dementia.
- History of voiding, use of perineal pads, incontinence pads, or incontinence liners, use of an indwelling, intermittent, or condom catheter, catheter complications, or recurrent urinary tract infections.
- Medications which affect continence care such as diuretics, sedatives, and anticholinergics.
- The frequency of continence care needs and type of assistance required.
- What environmental or assistive devices help or hinder continence care.
- Whether continence care is temporary.
In addition, baseline assessment of the patient's frequency and pattern of continence/incontinence should be taken for at least three days by means of a bowel and bladder diary.
Using the assessment and bowel and bladder diary, health care professionals can decide which of the following incontinence diagnoses best applies:
- Functional: limitations of physical ability prevent toileting.
- Urge: overactive bladder creates a sudden need to void which leads to accidents.
- Stress: pressure on bladder from activities causes leakage.
- Transient: incontinence caused by delirium, infection, atrophy, medicines, excessive urine, restricted mobility or constipation causes incontinence.
- Overflow: inability to completely empty bladder leads to leaking.
- Mixed: two or more of the other diagnoses are causing the need for care.
- Bowel: inability to toilet independently for bowel movements.
Using the diagnosis, health care professionals can develop a personal plan for continence management which uses both the best practices of continence care and the judgment of the professional to create an individualized program. Steps in planning include:
- Listing the rationale and goals based on the diagnosis.
- Set treatment goals and planned interventions. If possible, the long-term goal is to help the individual to re-establish some or all voluntary control of urine and bowel functions. If this is not possible, the goal should be to make continence care safe and discreet.
- Explain goals and intervention plan to the individual, family members, and caregivers in a way that all can understand.
- When there are intervention choices, these should be explained clearly and the least invasive technique should be preferred.
- Plan periodic reassessment to adjust the plan as the individual's continence care needs change.
While implementing the plan of continence care, be careful to make independence, dignity, and quality care the primary goal. Methods of meeting these standards include:
- Scheduled or on-demand toileting.
- Easy and prompt access to assisted toileting.
- Training in pelvic muscle exercises with physical therapy as needed.
- Patient, family and caregiver education about continence care.
- Positive reinforcement and feedback for patient needing continence care.
- Initiate bladder and bowel retraining if appropriate.
Making sure the program and plan is working for the individual is a vital step. In fact, ongoing evaluation is one of the most important aspects. Here are good questions to ask in an evaluation:
- Has the continence care plan improved the individual's quality of life?
- Does the skin of the individual remain in good condition?
- Are the person and all caregivers comfortable with the plan?
Making any necessary adjustments to a continence care plan and regularly reassessing the program to make sure it has maintained effectiveness is an essential part of making the plan work. Although bowel and bladder incontinence can be one of the most emotionally draining and physically demanding health care issues for caregivers and their loved ones, a careful continence care plan can make this easier.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of IncontinenceSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.