Section H - Bladder and Bowel:  The intent of the items in this section is to gather information on the use of bowel and bladder appliances, the use of and response to urinary toileting programs, urinary and bowel continence, bowel training programs, and bowel patterns.  Each resident who is incontinent or at risk of developing incontinence should be identified, assessed, and provided with individualized treatment and services to achieve or maintain as normal elimination function as possible.

Trial of a toileting program:  The look back period for this item is to the most recent admission/readmission assessment, the most recent prior assessment, or to when incontinence was first noted.  Research has shown that one quarter to one third of residents will have a decrease or resolution of incontinence in response to a toileting program.  Care planning should include interventions that are consistent with the resident's goals and minimize complications associated with appliance use.

Toileting (or trial toileting) programs refer to a specific approach that is organized, planned, documented, monitored, and evaluated that is consistent with the nursing home's policies and procedures and current standards of practice.  A toileting program does not refer to:

Ø  Simply tracking continence status.

Ø  Changing pads or wet garments.

Ø  Random assistance with toileting or hygiene.

Harmony stresses the importance of clear and concise documentation to support reevaluation of a toileting program whenever there is a change in cognition, physical ability, or urinary tract function.  Nursing home staff must use clinical judgment to determine when it is appropriate to reevaluate a resident's ability to participate in a toileting trial or, if the toileting trial was unsuccessful, the need for a trial of a different toileting program.