Intent:
To determine and record the person's pattern of bladder continence (control) over the last 3 days.
Definition:
This item describes the person’s bladder incontinence pattern taking into account any control plans or devices, such as scheduled toileting plans, continence training programs, or urinary appliances. It does not refer to the person's ability to toilet him - or herself - e.g., a person can receive extensive assistance in toileting and be continent. Bladder incontinence includes any level of dribbling or wetting of urine.
Process:
Review the person’s urinary elimination pattern with him or her. Make sure that your discussions are held in private. Control of bladder function is a sensitive subject, particularly for persons who are struggling to maintain control. Many people with poor control will try to hide their problems out of embarrassment or fear of retribution or institutionalization. Others will not report problems because they mistakenly believe that incontinence is a natural part of aging and that nothing can be done to reverse the problem. Despite these common reactions to incontinence, many people are relieved when a health care professional shows enough concern to ask about the nature of the problem in a sensitive, straightforward manner.
Validate continence patterns with people who know the person well (e.g., family caregivers).
Remember to consider continence patterns over the last 3-day period, 24 hours a day, including weekends.
Coding:
A six-level coding scale is used to describe continence patterns. Choose one response to code the person’s level of urinary continence over the last 3 days.
Continent — Complete control, including control achieved by cuing or supervision that involves prompted voiding, habit training, reminders, etc. The person DOES NOT USE any type of catheter or other urinary collection device.
Complete control with any catheter or ostomy — Control with use of any type of catheter or urinary collection device.
Infrequently incontinent — Not incontinent over last 3 days, but does have incontinent episodes (i.e., a recent history of incontinence).
Occasionally incontinent — Less than daily episodes of bladder incontinence (e.g., incontinent on 1-2 of the last 3 days).
Frequently incontinent — Incontinent daily, but some control present (e.g., the person is not incontinent during each episode of urination) Example: During the day, the person remains dry and is continent of urine. At night, the person wets his or her bed.
Incontinent — No control of bladder; multiple daily episodes all or almost all of time.
Did not occur — No urine output from bladder in last 3 days.
Code for the actual bladder continence pattern with urinary device if used. This pattern is the frequency with which the person is wet during the 3-day assessment period. Do not record the level of control that the person might have had under optimal circumstances (e.g., had a caregiver been available 24 hours/day to help the person with toileting).
For bladder incontinence, the difference between a code of (Frequently Incontinent) and (Incontinent) is determined by the presence (frequently incontinent) or absence (incontinent) of any bladder control.
Examples of Bladder Continence Coding
Mr. Q was taken to the
toilet after every meal, before bed, and once during the night. He
was never found wet. Code for “Continent.”
Mr. R had an indwelling
catheter in place during the entire 3-day assessment period. He
was never found wet. Code for “Complete control with Catheter.”
Although she is generally
continent of urine, every once in a while (four and six days ago over
the last week), Mrs. T doesn't make it to the bathroom to urinate
in time after receiving her daily diuretic pill. Code for “Infrequently
Incontinent.”
Mrs. A has an occasional
episode of urinary incontinence (generally less than daily), particularly
late in the day when she is tired. In the last 2 days, she was
not incontinent at all. She was incontinent 3 days ago however. Code
for “Occasionally Incontinent.”
Mrs. U has end-stage
Alzheimer's disease. She is very frail and has stiff, painful
contractures of all extremities. She is primarily bedfast on
a special water mattress, and is turned and repositioned hourly for
comfort. She was not toileted and is incontinent of urine for
all episodes. Code for “Incontinent.”