Browsing "Incontinence"

Incontinence – Entry 3

Dear Diary:

I checked in with Hattie today. She tells me that she hasn’t had an “accident” in days and she’s feeling much better.  She said she likes it when Sherry and the other nursing assistants offer to assist her to the bathroom and she feels more comfortable asking for assistance when she needs it. She also shared new pictures of her grandchildren. What a nice lady!  I told her I’d stop by and talk with her again in a few days and that if she needed anything to please let me know.

I also checked in with Anna, the charge nurse on Hattie’s neighborhood. Anna told me that Hattie hasn’t had any incontinence episodes in the past week! Because their work reducing bladder incontinence with Hattie has gone so well, they’ve decided to work with others in the neighborhood. They identified people who are occasionally incontinent and able to ambulate. They’re in the process of completing 3 day bladder diaries to learn resident’s individual patterns. 

They’ve laid out a great plan:

  • Create individualized toileting schedules for each of these residents indicating what they need, such as cueing, standby assistance or hands-on assistance. 
  • Give information to all staff and track the resident’s bathroom times and any incontinence for a week. This will be enough data to see if they are accomplishing their goal of no incontinence episodes for each of these residents.
  • Make any changes to the individualized schedules and assistance that are needed and continue to monitor.

Staff are excited. I told Anna that the team was doing a great job testing this PDSA and to let me know if she needed anything. Once this neighborhood has tested and fine-tuned the process, we’ll spread to people who are occasionally incontinent in our other neighborhoods. Once we’ve got this done, we’ll go on to figure out what we can test for those residents who are more frequently incontinent. 

Signed, Donna

 

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Incontinence – Entry 2

Dear Diary:

Anna, the charge nurse, met with Hattie to discuss her incontinence. Hattie said she sometimes just can’t get to the bathroom in time. She said she can feel when she has to go, but sometimes she has to wait too long for staff to help her and has an “accident.” Anna assured her the team would try to figure out a solution. Anna then met with Hattie’s nursing assistant, Sherry, and the other assistant on that neighborhood. They said they wait for Hattie to call for the bathroom and they rarely offer assistance unless she asks.

Anna told me that the voiding diary was finally completed after a few false starts. Hattie’s assessment shows that to stay continent, she needs to be taken to the bathroom every 90 minutes during the day. So, the night shift checks on her beginning at 6:00 am until she wakes up and then gets her to the bathroom right away. They help her to the bathroom again right after breakfast, before 10 am activities, before lunch, before therapy, before afternoon activities and after her 3:30 pm cup of tea, before supper, before evening activities and before bedtime. Hattie doesn’t want us to wake her up at night for now. She’s agreed to try this schedule for three days and then meet with Anna and Sherry to review it. Anna’s going to give Carol, Hattie’s daughter, a call to tell her what’s going on. Hattie thought that’d be a good idea. She told Anna that Carol worries too much about her. Anna told her that everyone wants Hattie to be comfortable and dry. Hattie smiled and thanked Anna. Anna promised to check in with her and I know she will.

What systems can we use to assure bladder assessments are done? How can I get staff to individualize care versus putting people in adult briefs or taking them to the bathroom every two hours?

Signed, Donna

1 Comment

  • Did you ever follow up with Hattie and Anna to see how it was going? I am interested to know how your staff is able to individualize residents and make a certain time for everyone. Or is this something they now do will all incontinence residents take them bathroom before meals, exercise, etc.

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Incontinence – Entry 1

Dear Diary:

While making rounds, I joined a huddle at the nursing station regarding Hattie. We had a scare two weeks ago when her indwelling catheter was discontinued and she developed a urinary tract infection. She was pretty sick and everyone was worried about her. She was treated with antibiotics here at River View and is doing much better. Staff continues to encourage her to drink and is monitoring how she’s feeling.

Sherry, Hattie’s nursing assistant, shared that Hattie continues with some incontinence even though she just finished the antibiotic. Some of the staff suggested having her wear an adult brief. Sherry commented that Hattie is such a charming lady and was really independent before moving here. Although wearing a brief might bother Hattie, Sherry thought she might agree because she doesn’t like the “accidents.” Sherry is going to offer Hattie an incontinence pad to make her more comfortable. Anna, the charge nurse, said we need more information to decide on next steps. She’s going to talk with Hattie and see if she can get more history about any previous incontinence. She’s also going to see if Hattie will agree to a three-day voiding diary. What other things can we do to assist Hattie?

Signed, Donna

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