Policy Manual sample

MDT Home Health Care Agency, Inc. 19 BLADDER TRAINING PURPOSE: Patients are instructed in a bladder training program, as appropriate, to promote fluid intake to an adequate level, to alleviate patient embarrassment regarding the procedure, to improve bladder function, to prevent skin breakdown and/or irritation, and to reduce the frequency of incontinence. RESPONSIBLE PERSONNEL : RN, LPN, HHA PROCEDURE: 1. Explain the bladder training program procedure to the patient. 2. Encourage moderate fluid intake of at least 2,000 cc per day, as appropriate. Carbonated beverages, citrus juice and caffeinated drinks should be avoided. Patients should also be encouraged to establish a pattern of drinking fluid 30 minutes prior to voiding times as scheduled. 3. Encourage a limited fluid intake after the evening meal. 4. Help client to the toilet upon rising in the morning, before and after meals, at bedtime, and every 2 hours during the evening and night, until voiding schedule has been established. 5. Initiate voiding by instructing client to bear down on urethral sphincter, running water from water faucet, or offering client a drink of water. 6. Give pericare, as appropriate. 7. Assess patient for: * Time of voiding * Amount of voiding * Frequency of voiding * Force of urinary stream * Difficulty in initiating voiding. * Awareness of incontinence * Reaction to incontinence. 8. Encourage an increase in physical activity. 9. Pad bed or encourage the use of waterproof pads. Advise the patient to change these throughout the day and to wash the area where urine may come in contact with the skin thoroughly with soap and water. Teach client/family to report any skin irritations to nurse or physician promptly. 10. Teach family/caregiver to assist patient with toileting schedule to improve patient’s retraining. DOCUMENTATION: Document the frequency of urinary incontinence and associated events, any alterations in frequency or pattern of incontinence and the patient/family attitude to any exercises in the Clinical Visit Record. Document any reports to physician in clinical record. ___________________________________________________