Enhanced Toileting Program Decreases Incontinence in Long Term Care

Abstract

Incontinence is a common problem in long term care. In March 2003, in reviewing its performance on the Minimum Data Set (MDS 3.0) quality indicators, Sea View Hospital Rehabilitation Center and Home, a 304-bed long term care facility in Staten Island, New York, discovered it was 39% above the average of the state and national means for the incontinence indicators. In response, it initiated a facilitywide performance improvement project. Processes identified in the action plan for the project, "Residents who trigger for occasional or frequent bowel and bladder incontinence on MDS will be assessed for an individualized toileting schedule," included (1) revision of assessment documentation, which improved the initial assessment of continence, with an added reassessment process; (2) documentation of the toileting plan on the Patient Care Technician Assignment Card and the Activity of Daily Living Accountability Sheet; (3) adoption of toilet-assist devices; (4) hospitalwide in-service on incontinence and toileting; and (5) revision of the bowel and bladder incontinence policy. After implementation of the revised bowel and bladder incontinence assessment tool, the rate of incontinence without a toileting plan decreased--from 79% to 38%--and remained below the yearly mean. The new assessment processes made individualized planning possible and accurate. This initiative could be easily replicated because it requires resources that are basic to most long term care facilities.