Abstract: Establishing, Implementing, and Continuing an Effective Continence Program in a Long-Term Care Facility

Agency for Health Care Policy and Research (AHCPR), American Medical Directors Association (AMDA) and American Health Care Association (AHCA). "Alert for Directors of Nursing: Establishing, Implementing, and Continuing an Effective Continence Program in a Long-Term Care Facility." AHCPR Publication No. 96-0063 (August 1996).

Objectives:
* To provide Directors of Nursing with information on how to establish effective continence care plans for the residents of long-term care facilities.

Conclusions:
* A list of literature to consult when developing a continence care program is provided. It includes Helping People with Incontinence (a booklet produced jointly by AHCPR, AMDA, and AHCA), Managing Acute and Chronic Urinary Incontinence (a quick reference guide developed by a private-sector panel), and Urinary Incontinence in Adults (the AHCPR-supported clinical practice guideline).
* To implement an effective continence care program, each resident must be assessed carefully by the nursing home team, in order to determine what type of urinary incontinence (UI) he or she might have. The assessment process should include the taking of a detailed medical history; a record of voiding frequency, timing, and volume, incontinent episodes, and fluent intake; a mental status evaluation; an assessment of manual dexterity and mobility; an environmental assessment; and a physical examination, including the measurement of post-void residual volume.
* Treatment must be tailored to each resident's needs. There are several different types of UI, including urge incontinence, stress incontinence, mixed incontinence, overflow incontinence, functional incontinence, and unconscious or reflex incontinence.
* Behavioral, pharmacological, and surgical treatments for incontinence are briefly discussed.
* "As a general rule, the first treatment choice should be the least invasive with the fewest potential adverse complications that is appropriate for the individual resident. Behavioral techniques meet these criteria for many forms of UI, and these will be the main techniques used by the CNAs. But the resident's or family's wishes must be respected."
* Motivation, teamwork and leadership are the key to an effective continence program. Continuing education of staff, ongoing evaluation of residents, and adapting the care plan to individual needs are all important aspects of maintaining a successful continence program.

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