MDS Alert

• Remember that a toileting program trial needs to be tailored specifically to each resident. “Trial toileting programs have to be individualized and resident-specific, so there is not a one-size plan that works for everyone,” says Linda Elizaitis, president of CMSCompliance Group Inc. in Melville, New York. “Staff will only be able to develop a trial toileting plan if there has been an initial assessment of the resident’s voiding pattern and a plan for ongoing assessment of the success of the program at intervals and recognition of the need to make changes as progress is made.”
• Prepare the details of your toileting program before you implement it, but pay special attention to the voiding diary. “The voiding diary is critical for the success of setting up the appropriate toileting program — the fact that CMS has stated the log is compiled over three days helps facilities gather the information correctly,” says Jane Belt, MS, Rn, RaC-Mt, QCP, curriculum development specialist at American Association of Nurse assessment Coordination (aanaC) in Denver, Colorado. “Limit the number of diaries that can be compiled over the three days; not every resident can be assessed at the same time.”
• Keeping a voiding dairy is not enough, in and of itself. Accuracy is the most important measure for you and the rest of your team to decide which toileting program is best, Belt says.
• Don’t forget about the bladder assessment. To get the most of the toileting program trial, you or a team member must perform an accurate, complete bladder assessment to determine the type of incontinence a resident is suffering, along with completing the voiding diary, Belt says. These efforts are crucial in combination for the toileting trial program to succeed.
• But maybe most important of all: All staff must be on board and providing the same level of commitment and effort. Help all of your team get on board with the level of commitment the toileting program trial requires by helping everyone understand the program goals. Training and expectations of program must be clear to the staff so that they understand and see the value of their efforts,” Belt says.
• Involve all staff, too. “Convening an interdisciplinary team meeting to discuss the prompted voiding plan before beginning a trial program can help result in success in regaining continence,” Elizaitis says. Don’t forget about nurses, CNAs, physical therapists, dieticians, and maybe even pharmacist consultants, as all of their combined knowledge and efforts can contribute to the ultimate success of the trial program, she adds.

Top tip: Remember these three qualifiers from Linda Elizaitis when you’re designing a toileting program trial or trying to decide whether a resident’s incontinence care plan qualifies as a toileting program trial per MDS item H0200 (Urinary Toileting Program).

• Prompted voiding programs require regular monitoring of the resident to report

             o continence status,
             o the implementation of a schedule that including prompting the resident to use the toilet, and
             o providing positive feedback to the resident when he or she is continent and attempts to use the toilet.

Remember: “Tracking incontinence status, or providing random assistance with toileting, hygiene or changing pads/clothing are not considered to be toileting programs,” Elizaitis says.