Registered Nurses´ Association of Ontario
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Summary of Practice Recommendations
1.0 Obtain a history of the client's incontinence.
2.0 Gather information on:
- The amount, type and time of daily fluid intake, paying particular attention to the intake amount of caffeine and alcohol.
- The frequency, nature and consistency of bowel movements.
- Any relevant medical or surgical history which may be related to the incontinence problem, such as but not limited to diabetes, stroke, Parkinson's disease, heart failure, recurrent urinary tract infections or previous bladder surgery.
3.0 Review the client's medications to identify those which may have an impact on the incontinence.
4.0 Identify the client's functional and cognitive ability.
5.0 Identify attitudinal and environmental barriers to successful toileting. Barriers include:
- Proximity and availability of the nearest bathroom;
- Accessibility of commode;
- Satisfactory lighting;
- Use of restraints;
- Staff expectation that incontinence is an inevitable consequence of aging; and
- Staff belief that few interventions exist to promote continence.
6.0 Check urine to determine if infection is present
7.0 Determine how the client perceives their urinary incontinence and if they will benefit from prompted voiding. Before initiating prompted voiding, identify the client's pattern of incontinence using a 3-day voiding record.
8.0 Ensure that constipation and fecal impaction are addressed.
9.0 Ensure an adequate level of fluid intake (1500 - 2000 ml per day), and minimize the use of caffeinated and alcoholic beverages where possible.
10.0 Initiate an individualized prompted voiding schedule based on the client's toileting needs, and as determined by a 3-day voiding record.
11.0 Initiate a 3-day voiding record, a minimum of 3 weeks and a maximum of 8 weeks, after the prompted voiding schedule.
Please refer to the best practice guideline "Promoting Continence Using Prompted Voiding" for a complete list of education and organization & policy recommendations.
