Section H: Toileting Program

[erin21880]

Our LTC facility MDS coordinator and RT CNA have started a toileting program which is toileting upon rising, before and after meals, at HS and PRN. They are coding this in section H as being on a bowel and bladder program. Is this ok?? The RT CNA tracks incontinent episodes and how many times they were toileted. They chart all this in the I-notes and say it is their toileting program. I just don't feel right about this...isn't this basic care for toileting, skin maintenance??

[Talino]

In order to determine that a toileting program exists, the following three requirements must have been met:

* implementation of an individualized, resident-specific toileting program that was based on an assessment of the resident's unique voiding pattern

* evidence that the individualized program was communicated to staff and the resident (as appropriate) verbally and through a care plan, flow records, and a written report

* notations of the resident's response to the toileting program and subsequent evaluations, as needed

'looks like they met the requirements.

A "basic" incontinent care to maintain skin integrity would likely be changing a pad at regular intervals.

[erin21880]

I guess maybe I'm overthinking this!! I was just concerned that our toileting program is not individualized and resident-specific enough to code on the MDS as this is how we toilet every resident. If that makes sense!!

[MarggoRita]

This is standard nursing care at our facility, not resident specific, and does not count as toileting program. To be resident specific, you must monitor output for a resident for 24/day for three days. Note when they are incontinent. Then careplan a specific routine for that specific resident based on their incontinence. Then, prove that the careplan was followed, reassess their incontinence, show if it was effective or not in reducing incontinence, continue the careplan as is if effective, or repeat the cycle until you can actually reduce incontinence. Document all assessments/monitoring tools.