Continence Assessment Form And Care Plan (Page 2 of 7) in pdf

SECTION A: Toileting ability, Cognitive skills & Mobility (continued)

Assessment Cues

Care Options

(tick appropriate response)

(tick appropriate care option)

6. Can the resident use toilet paper

If sometimes or no:

and wipe themselves?

■

Supervise

Prompt

Physically assist the resident to get toilet paper ready

■

Yes, independently

and to use it.

■

Sometimes

■

Supervise

Prompt

Physically assist the resident to wash their hands

No, requires supervision

at toilet completion.

■

No, requires physical assistance

7. Does the resident co-operate with

If sometimes or no:

staff when they assist with toileting

ask the RN, Continence Nurse or GP about the care required and refer to resident’s

■

or changing?

behavioural management plan.

■

Yes

■

Sometimes

■

8. Does the resident experience pain

If sometimes or yes:

that restricts their toileting ability?

■

Check that the resident is getting their pain medication as ordered

■

Yes

■

Limit the resident’s movement until pain subsides

Sometimes

■

Offer bedpans, urinals and/or pads

If the resident is unable to verbally communicate, search for cues that indicate pain.

■

(List possible cues) ______________________________________________________________

_____________________________________________________________________________

SECTION B: Bladder & Bowel pattern

Refer to 3 day bladder chart and 7 day bowel chart to complete questions

Best practice recommendations

Aim for the resident to be continent and to void 4-6 times a day and no more than 2 times at night

■

Aim for the resident to have a regular (at least 3 per week) continent, soft formed stool (i.e. Bristol Stool type 3 or 4 that is easy to pass)

■

If the resident has incontinence, aim for them to feel clean and dry with changes of pads soon after each episode

■

Assess residents risk for falling if they need to go to the toilet at night

■

Assessment Cues

Care Options

(tick appropriate care option)

(tick appropriate response)

9. During the day, how many times does

If less than 3 times, ask the RN, Continence Nurse or GP about the care required.

■

the resident need to pass urine/go to

If more than 6 times, ask the RN, Continence Nurse or GP about the care required.

■

the toilet on average (from 7am-7pm)?

■

Less than 3 times

■

4 - 6 times (normal)

■

More than 6 times

10. During the night, how many times

If once or more:

does the resident need to pass urine/go

Ensure call bell is within reach.

■

to the toilet on average (from 7pm-7am)?

Turn night light on.

■

None

Ensure commode/pan/toilet is near the bed.

■

Once

Turn sensor/s on.

■

Two or more times

If resident is awake, offer toileting assistance.

■

If the resident passes urine two or more times during the night,

■

ask the RN, Continence Nurse or GP about the care required.

Developed by Deakin University and funded under the National Continence Management Strategy

Continence Assessment Form And Care Plan Page 2

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