How to do it ... Incontinence care

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Providers are constantly looking for better ways to conduct incontinence care programs and assessments. It's no wonder, since the recent rollout of F-tag 315 directs surveyors to take a harder look at care plans and their execution. Also, with incontinence care products occupying such a large portion of a provider's budget, the emphasis on efficiency and good care practices remains high. Experts agree that thorough resident assessments and staff vigilance must be maintained and not taken lightly.

1.) All the good plans and intentions in the world don't count for much if you don't have frontliners skilled and ready to take charge. That's why one of the first things nursing leaders should do is designate nurses who will be trained as key facility personnel.
"Incontinence in most facilities is their number one medical supply spend," says Shawn Scott, a vice president of long-term care corporate sales for Medline Industries. "Past the budget spend, there are risk factors from liability suits, survey fines, unhappy family and residents, staff retention issues and more, that cost much more than supplies. So it would make sense that a facility would want to invest in this team."

2.) Team members should be responsible for monitoring and reinforcing staff compliance on program protocols. They also would be experts on sizing and troubleshooting issues. Their training should include instruction in documentation, skin status and product distribution, according to Scott.

3.) Make sure all nurses and staff members understand the significance and nuances of
F-tag 315. Regular review of the rules, as well as best practices, along with skill fairs arranged by the incontinence team, will help everyone.
"Not only will this help keep your incontinence spend managed, but it will highlight areas of risk with skin breakdown and resident satisfaction," Scott says.

4.) Resident assessment is vital from the beginning, adds Meghan Mielcarek, a clinical specialist with product provider Direct Supply.
"Proper assessment and treatment management can help minimize catheterization for residents," Mielcarek says. "Also, a facility spending on disposable briefs, lotion, staff time for cleaning up after an episode or escorting a resident when they didn't really have to go . . . factor in all these costs, among others, and you get a high number."

5.) Providers must emphasize individualized resident care, plans Mielcarek adds. It's a part of the new F-tag 315 stipulations but still is often not heeded.
"Oftentimes, they'll have very standard or generic treatment or management plans, such as 'take to bathroom every two hours,'" she says. "This is really getting nailed more often because of the regulations."

6.) Along those lines, pro- viders must work with residents to help retrain the bladder. It might not always halt incontinent episodes, but any improvement will help when it comes to products and labor.
"In most instances, you can have a large percentage of residents
who have their bladder trained," Mielcarek says.

7.) Tight monitoring of fluid intake and output still is not occurring enough, she adds. A "bladder diary" is critical. Because there are so many things that could contribute to incontinence, everything must be considered as part of a resident's assessment.

8.) "One thing that surprised me, even with the regulations in place, is that people are not taking post-voiding residuals," Mielcarek says. "You should check for any urine left in the bladder 10 to 20 minutes after somebody voids."
You can catheterize or use an ultrasound volume-measuring device, she explains, noting regulators' preference to avoid catheterization whenever possible.
"Just because somebody's incontinent does not mean a catheter should be put in," she says.

9.) Keep many others involved, including an interdisciplinary committee to address bladder programming, a dietitian (to ensure adequate nutrition and hydration) and activities workers (who can help with exercise programs that target pelvic muscles), advises Micki Bell, RN, BSN, national clinical director for SCA Personal Care's healthcare division.