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prompted voiding

Indications: - urinary incontinence in cognitively impaired persons* * A behavioral technique for use primarily with dependent or cognitively impaired persons * Prompted voiding attempts to teach the incontinent person awareness of his/her incontinence status & to request toileting assistance, either independently or after being prompted by a caregiver. Procedure: Targeting: 1) prompted voiding is more effecting in some residents than others 2) the best candidates for continuing an effective prompted voiding protocol show the following characteristics during the assessment period (see below) a) usually correct about their wet or dry status b) void in the toilet, commode or urinal (distinguished from being incontinent in a pad or garment) more than 50% of the time c) a maximum voided volume of > 200 mL d) lower voiding frequencies e) substantial reduction in incontinence frequency as shown in the bladder records 3) patients who don NOT show any of the above characteristics should be considered for a) further evaluation to determine the specific type of incontinence b) palliative management by containment devices & a checking & changing protocol Prompted voiding protocol [2] - Goal: to reduce the frequency of wetness in selected nursing home residents from 7 am to 7 pm Assessment period: 1) duration 3-5 days 2) contact residents every 2 hours from 7 am to 7 pm 3) focus their attention on voiding by asking them whether they are wet or dry 4) check them for wetness: make a notation on the bladder record & give feed back on correctness of response 5) ask resident if they would like to use the toilet or urinal a) ask whether wet or dry b) if the answer is yes 1] assist them 2] record the results on the bladder record 3] give them positive reinforcement by talking with them for 1-2 a minutes c) if the answer is no 1] inform them that you will be back in 2 hours 2] request that they delay voiding until you return 3] if they have not attempted to void within 4 hours, request that they use the toilet 1-2 times before you leave 6) measure voiding volumes as often as possible a) place a measuring hat in the commode b) preweighing, then reweighing incontinence pads or garments Ongoing protocol: 1) contact resident every 2 hours from 7 am to 7 pm 2) use the same procedures as those for the assessment period 3) for overnight management, use either a modified prompted voiding schedule or a containment device 4) if a patient who has been responding well has an increased frequency of incontinence, evaluate for reversible factors

Related

urinary incontinence (UI)

General

behavioral technique/intervention

References

  1. nlmpubs.nlm.nih.gov/hstat/ahcpr/
  2. Ouslander JG, Schnelle JF, Uman G et al Predictors of successful prompted voiding among incontinent nursing home residents. JAMA. 1995 May 3;273(17):1366-70. PMID: 7715062
  3. Eustice S, Roe B, Paterson J. Prompted voiding for the management of urinary incontinence in adults. Cochrane Database Syst Rev. 2000;2000(2):CD002113 PMID: 10796861 PMCID: PMC7017853 Free PMC article https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD002113/full