Continence Assessment Form And Care Plan (Page 3 of 7) in pdf

SECTION B: Bladder & Bowel pattern (continued)

Assessment Cues

Care Options

(tick appropriate care option)

(tick appropriate response)

11. Does the resident experience urine

If yes to urine leakage during the day:

leakage during the day?

■

Develop and put in place an individualised toileting program

■

Yes

■

Develop and put in place a fixed time toileting program

If yes, how often?

■

Develop and put in place a pad check and change program

■

Once every few days

■

Once a day

■

Several times a day

■

Most or every time

12. Does the resident experience urine

If yes to urine leakage during the night:

leakage during the night?

■

Develop and put in place an individualised toileting program

■

Yes

■

Develop and put in place a fixed time toileting program

If yes, how often?

■

Develop and put in place a pad check and change program

■

Once every few nights

■

Once a night

■

Several times a night

■

Most or every time

13. Does the resident have a predictable

If yes:

pattern of passing urine (including urine

■

Refer to the 3 day bladder chart and use the grid below to mark the times for an individualised

leakage) ?

toileting program based on the resident’s pattern.

a) During the day?

If no:

■

Yes

■

Use the grid below to mark the times for a fixed time toileting program

(i.e. at least every 4 - 6 hours during the day)

b) During the night?

■

Use the grid below to mark the times for a pad check and change program

Yes

(i.e. at least every 4 - 6 hours during the day)

■

Toileting / pad check and change grid (please tick)

mid-

night

noon

Toileting times

Pad check

& change times

Assessment Cues

Care Options

(tick appropriate care option)

(tick appropriate response)

14. Does the need to pass urine or

If sometimes or yes:

incontinence at night make it difficult for

■

Place a commode beside the resident’s bed.

the resident to go back to sleep?

■

Offer the resident a bedpan or urinal.

■

N/A

■

Identify and put in place individualised strategies to help the resident to return to sleep

■

Sometimes

■

Yes

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

Continence Assessment Form And Care Plan Page 3

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