How to do it... Incontinence management

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1 Establish a culture that promotes continence, advises Amin Setoodeh, BSN, RN, vice president of sales and clinical marketing/services for Medline Industries' Personal Care Division.

“If you truly would like to embrace a new approach for your team to promote continence rather than just checking and changing, then you must start by setting the tone,” says Setoodeh.

This includes establishing teams of incontinence clinicians, setting incident-reduction goals, raising awareness of a plan, periodically ensuring guideline compliance, benchmarking and establishing a staff competency program.

2 Develop a formal bowel and bladder program.

“One of the best ways to decrease the incidence of incontinence in long-term care residents is having a clear bowel and bladder program that is in compliance with current MDS and clinical guidelines for care,” says Melissa DeMarinis, U.S. LTC marketing director, NA Health Care Marketing Team, SCA Americas. One of the biggest untapped resources may be vendors, adds Setoodeh.

3 Promote continence with broad staff education and training. Low incontinence incidents and positive survey results may lull many providers into a false sense of security, Setoodeh says, adding “Sometimes surveyors may overlook how your home is promoting continence … and you might continue the same process that has contributed to higher incidents of falls, nosocomial infection or depression.”

Proper staff education and support on perineal care is essential to help eliminate skin breakdown or redness before it can occur, adds DeMarinis.

4 Properly assess and identify vulnerable areas.

Proper assessments include identifying the type of incontinence, and often the cause, says DeMarinis.

“The assessment should lead to the proper care plan and also the type of absorbent product and care that will best support the highest possible level of continence for each individual,” she adds.

A structured program can help identify and treat some very simple underlying causes of incontinence, such as medications, poor dexterity or mobility, anatomical defects or lack of appropriate staff.

5 Keep your eyes and ears open. It might seem simplistic, but many providers can be tricked into equating dollars spent to effectiveness.

“As far as costs are concerned, there are undoubtedly many exotic and expensive therapies available for incontinence, but the best treatment is simply to pay attention,” says Glenn Paul, vice president of marketing for Gentell.

6 Be mindful of the total cost of incontinence. Supplies represent only a fraction of care costs. Consider other metrics such as change rates, cost of laundry, nursing time, medications or ointments, falls and cost of skin injuries, says Setoodeh.

7 Understand that it's more than just a physical problem. Preserving the dignity of the resident is paramount.

Staff can help residents emotionally by making them feel confident, and by providing quality support products that reduce the incidence of embarrassing leakage, says DeMarinis.

8 Provide easily identifiable products. Make it as easy as possible for staff to identify the proper supplies, including undergarments and topical treatments. Gentell recently redesigned its packaging after learning that many caregivers had to spend time away from resident care tasks to search for products.

“During the re-design, we learned that nurses wanted tubes with product names that could be read from across the room and also that they preferred color-coded packages,” Paul stresses. “Nurses are often overworked, so[we]must make sure that different products can be quickly identified.”

Mistakes to avoid

* Using outdated continence management policies or guidelines.

* Assuming a good survey and few incontinence incidents mean you are managing the problem well.

* Skipping an initial assessment of vulnerable areas of the body.