Mar 26, 2012, 11:56 am
Last edited Mar 26, 2012, 11:56 am
update #1
Prioritizing is easy, you need to know your patient's continence management plan well.
Say you have 8 patients on incontinence pads. Firstly identify your resources specifically. Secondly identify needs specifically. That is to say you have 6 large wrap pads and 8 pull up pads. Night time is coming and usually most would be in wrap pads because they hold bigger volume. Pull ups are more for safety and accidents with low to medium capacity. you don't have sufficient wrap pads for all your patients. But some of your patients are cognitively intact and requiring minimal assist with mobilising, however are incontinent due to overactive bladder syndrome or urge incontinence. Given the scenario, you might want to put these patients in pull up pads and undertake a regular toileting regime of between 1 hourly to 2 hourly. You can also ask for medical intervention if this is possible. Doctors may start those with overactive bladder syndrome on Oxybutinin and to have a physio or a competent RN to educate and train patients with Pelvic floor exercises to strengthen their Pelvic floor (This can also be applied to those with urge incontinence) if you foresee that the shortage of resources is going to be for a while until new stocks arrive. These interventions may help you stretch your mid to long term resources but they need some time to implement.
For patients with dementia, regular toileting is probably the only option. You can also analyse bowel history and determine pts timing and regularity to plan toileting regime. So where a dementia patient is on wrap pads and has a regular bowel activity, you can put them on pull ups and toilet them accordingly to minimize "accidents". You can also include managing access to toilets. So if your facility has planned for a few big day outtings, you may want to consider deferring them. Big outing means group activity and insufficient toilets in the public area or venue to cater to mass toileting - I meant say 3 or 4 persons need to toilet, you will have to allocate with lesser resources
You may also consider using alternatives - say for men, you might want to use urodomes for those that are bed bound and unable to use the bottle. When doing this however one must take into account of increased falls risk for those who wander or can mobiilse self.
You also need to consider medications and food for their effects on the patient. Example - a patient loves coffee and have 4 cuppas a day, you can bet that this person would have diuresis because of coffee's diuretic effects. The same includes those on diuretics - spirolonactone, furosemide, thaizides and etc. They cause increased frequency and therefore toileting needs.
Hope this helps
