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Discussion

Toileting program

I work in a certified dementia long term care facility and am on the highest functioning unit. We do have some residents that should be on another unit as we place residents based on their disease process. My question is toileting programs. At what point are residents removed from the toileting program? We automatically place all new residents on the toileting program x 1 week when first admitted and all residents on the toileting program are re evaluated every week for progress. I have one resident who is now confined to a broda chair, on hospice, Is still able to tell staff when she needs to use the BR and continues to have incontinence 1-2 day. I believe it is dribbling but the CNA's don't document that on the toileting sheets some just say wet others say small or med. ect. The resident is still able to provide some hygiene care but staff assist. Staff do not understand why she is still on the toileting program and I struggle with whether or not she needs to be. I have another resident that started with a catheter, had OT for toileting, goes to the restroom herself and Im removing her from the program despite still having 1-2 episodes a day d/t being on a diuretic. Suggestions please.

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    I've been a nurse for a long long time and honestly I've never seen anyone whose bladder was really retrained through a bladder retraining program. These are old people for goodness sakes. If they're women and have had a few kids, chances are they are going to dribble...see that ad on TV with the 40something actress saying SHE dribbles? There is no way to prevent a few drops with a cough or sneeze. CNA documentation is very limited - mostly wet or dry...the question should be: will the resident benefit from a toileting program? Certainly if being toileted several times throughout the day would help prevent skin breakdown then that resident should be toileted several times throughout the day. I've had residents who were totally continent during the day but incontinent when they were sleeping. Some were toileted with rounds overnight and some asked to be left alone since sleep was more important to them than being dry. We care planned their personal preference and made sure they had no skin issues.

    You know that some older people are fixated on going to the toilet since they are petrified of being incontinent and being embarrassed-Even residents with dementia. It takes a while but you have to come up with individual toileting plans based on the needs of the particular resident.

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