How to do it ... Incontinence care

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A nursing facility's stake in achieving proper incontinence care is huge. More than 60% of residents suffer from some kind of urinary incontinence, making it the activity of daily living (ADL) most often in need of attention. Correspondingly, the biggest line item in many supply budgets is incontinence care products. Any inefficiencies or waste that can be eliminated could have cost implications. Here are some top tips on how to conduct the best incontinence care program possible.

1. Educating staff on incontinence and assessment is a crucial first step, says Micki Bell, RN, BSN, National Clinical Director, West, for SCA Personal Care.
"The expectation of a surveyor around the F-315 guidance is that the facility has assessed the resident properly and is providing the appropriate care. In quizzing your staff, are they able to identify in simple terms the types of incontinence and the type of programming they would select for each type of incontinence?" Bell asks.
"If you read the guidance, it is very clear on the areas your assessment must cover," she added.
"If your assessment does not cover history, onset, duration, previous treatments, signs and symptoms, risk factors, transient causes, medical diagnoses that affect incontinence, medications that have side effects that lead to urinary retention, type of incontinence, and justification for urinary catheters, you will need to make sure that you update your assessment to match the guidance."

2. So how does one cope with everything mentioned above? Simply form a care team.
"Don't recreate the wheel," Bell says. "Determine the meeting where the majority of your interdisciplinary team is already there. Add 15 minutes on to that meeting and pull in a few key nursing assistants and your program leader. Review the assessments of new admissions, determine if any current programs need revisions, and celebrate the success you are having."

3. Even the best plans need monitoring and revision, every now and then.
"Have the nursing assistants document on a flow sheet if the resident is voiding when they are taken to the toilet. Ask them to document if there are times when they always find them wet. Try to adjust the schedule to decrease incontinent episodes," Bell advises.
In-room stocking is another way to track the number of products a resident uses, she adds.

4. Don't forget to talk to your residents about their plan of care. Tell them what's going to happen and let them give input, including about product choices, Bell says.
"If the resident refuses the plan, discuss any options and inform the resident of the consequences if they do not participate in the rehabilitation program," she says.

5. One of providers' biggest incontinence care concern stems from tape tabs coming loose on briefs and causing blisters on the resident's skin, notes Jacquie Morrison, nurse consultant with Tyco Healthcare/Kendall.
"To alleviate this issue, when applying a brief, take the top tape tabs and angle them toward the feet. Then, take the bottom tape tabs and angle them up towards the head. This causes a stronger hold, and when the resident sits or stands the tape tabs will stay," Morrison explained.

6. Do not "double brief," which is against Centers for Medicare & Medicaid Services regulations.
"When using a brief, do not stick any other kind of incontinence care product, like bladder pads, inside the brief," Morrison explained. "When using a pull-up brief, use a bladder pad if necessary but it is advised not to use any other type of incontinence care product."

7. "The absorbency of high quality briefs and liners can be compromised by thick and sticky barrier ointments and pastes. Select a durable, breathable barrier product that protects the skin but does not transfer off," says Debra Thayer, MS, RN, CWOCN, technical service specialist for the Skin and Wound Care Products segment of the 3M Medical Division. "This will maximize the performance of the absorbent product while promoting skin health."

8. Do accurate and thorough pericare with each resident, experts advise. Ammonia in a skin fold can cause skin breakdown, so be sure to clean every inch of an affected area.
"When using barrier creams, apply with a very thin coating," Tyco's Morrison says. "A thick coating of barrier cream is not only difficult to remove but can cause skin issues."