Continence Assessment Form And Care Plan
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7Continence Assessment Form and Care Plan
RESIDENT ID
Date: ______/______/______
Refer to “Education Guide” for further information on assessment cues and care options
SECTION A: Toileting ability, Cognitive skills & Mobility
Best practice recommendations
Encourage residents to participate as much as possible in toileting activities to remain optimal mobility and independence
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Consider each residents personal preferences for continence care
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Assessment Cues
Care Options
(tick appropriate response)
(tick appropriate care option)
1. Does the resident know when
If sometimes or no:
to go to the toilet?
Identify behaviours showing that the resident may need to go to the toilet (eg restlessness)
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Yes
(List possible cues) ______________________________________________________________
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Sometimes
_____________________________________________________________________________
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No
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Supervise
Prompt
Physically assist the resident to go to the toilet at
■
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fixed times
individualised times
2. Can the resident tell you where
If sometimes or no:
the toilet is?
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Show/remind the resident where the toilet is
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Yes
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Ensure toilet is easy to identify
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Sometimes
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Leave the toilet light on
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No
3. Can the resident walk to the toilet
If sometimes or no:
independently?
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Place the resident close to the toilets
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Yes, independently
Place the following ambulation aids close to the resident
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Sometimes
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Wheely frame
Pick up frame
Gutter frame
Walking stick
Wheel chair
No, requires supervision
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No, requires physical assistance
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Other ______________________________________________________________________
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No, requires lifting equipment
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Supervise
Prompt
Physically assist the resident to walk to the toilet
N/A, unable to use toilet
If physical assistance is required, provide:
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1 staff member
2 staff members
Lifting equipment
Other ________________
4. Can the resident get on and get off
If sometimes or no:
the toilet independently?
Encourage the resident to use the following assistive devices
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Yes, independently
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Handrails
An over the toilet seat frame
A donut
Other ________________
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Sometimes
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No, requires supervision
Supervise
Prompt
Physically assist the resident to get on and off toilet
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No, requires physical assistance
If physical assistance is required, provide:
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No, requires lifting equipment
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1 staff member
2 staff members
Lifting equipment
Other __________________
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N/A, unable to use toilet
5. Can the resident undress and dress
If sometimes or no:
themselves before and after toileting?
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Ensure that the resident has clothing that is easy to manage (i.e. elastic waisted pants with no zips).
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Yes, independently
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Supervise
Prompt
Physically assist the resident to adjust their own clothing.
Sometimes
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No, requires supervision
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No, requires physical assistance
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No, requires lifting equipment
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N/A, unable to use toilet
Developed by Deakin University and funded under the National Continence Management Strategy
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