prompted voiding

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Indications

* 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[2]

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

Additional terms

References

  1. nlmpubs.nlm.nih.gov/hstat/ahcpr/
  2. 2.0 2.1 Ouslander JG, Schnelle JF, Uman G et al Predictors of successful prompted voiding among incontinent nursing home residents. JAMA. 1995 May 3;273(17):1366-70. PMID: https://www.ncbi.nlm.nih.gov/pubmed/7715062
  3. Eustice S, Roe B, Paterson J. Prompted voiding for the management of urinary incontinence in adults. Cochrane Database Syst Rev. 2000;2000(2):CD002113 PMID: https://www.ncbi.nlm.nih.gov/pubmed/10796861 PMCID: PMC7017853 Free PMC article https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD002113/full