prompted voiding

Indications

• urinary incontinence in cognitively impaired persons*

* A behavioral technique for use primarily with dependent or cognitively impaired persons

* Prompted voiding attempts to teach the incontinent person awareness of his/her incontinence status & to request toileting assistance, either independently or after being prompted by a caregiver.

Procedure

Targeting:

• prompted voiding is more effecting in some residents than others
• the best candidates for continuing an effective prompted voiding protocol show the following characteristics during the assessment period (see below)
  • usually correct about their wet or dry status
  • void in the toilet, commode or urinal (distinguished from being incontinent in a pad or garment) more than 50% of the time
  • a maximum voided volume of > 200 mL
  • lower voiding frequencies
  • substantial reduction in incontinence frequency as shown in the bladder records
• patients who don NOT show any of the above characteristics should be considered for
  • further evaluation to determine the specific type of incontinence
  • palliative management by containment devices & a checking & changing protocol

Prompted voiding protocol

• Goal: to reduce the frequency of wetness in selected nursing home residents from 7 am to 7 pm

Assessment period:

• duration 3-5 days
• contact residents every 2 hours from 7 am to 7 pm
• focus their attention on voiding by asking them whether they are wet or dry
• check them for wetness: make a notation on the bladder record & give feed back on correctness of response
• ask resident if they would like to use the toilet or urinal
  • ask whether wet or dry
  • if the answer is yes
    • assist them
    • record the results on the bladder record
    • give them positive reinforcement by talking with them for 1-2 a minutes
  • if the answer is no
    • inform them that you will be back in 2 hours
    • request that they delay voiding until you return
    • if they have not attempted to void within 4 hours, request that they use the toilet 1-2 times before you leave
• measure voiding volumes as often as possible
  • place a measuring hat in the commode
  • preweighing, then reweighing incontinence pads or garments

Ongoing protocol:

• contact resident every 2 hours from 7 am to 7 pm
• use the same procedures as those for the assessment period
• for overnight management, use either a modified prompted voiding schedule or a containment device
• if a patient who has been responding well has an increased frequency of incontinence, evaluate for reversible factors

More general terms

• behavioral technique/intervention

Additional terms

• urinary incontinence (UI)